On Addiction: The Intersections of Trauma and Addiction

Defining Trauma and Addiction

Trauma and addiction are complex and can profoundly impact individuals' lives. Trauma can be defined as an emotional response to a distressing event, such as abuse, neglect, violence, or natural disasters (APA, 2013). It can lead to lasting emotional and psychological effects, including post-traumatic stress disorder (PTSD). However, many individuals experience traumatic events, which are not necessarily equal to PTSD.

More recently, the idea of a “T” trauma or a little “t” trauma has come about. A “T” trauma could be from an experience from combat, a sexual assault, physical assault, or other major, negative life experience. Little “t” trauma may be more around life experiences such as family dysfunction (think - parents divorcing), bullying, loss or rejection, chronic illness or disability, or witnessing interpersonal violence. These are more subtle experiences compared to big “T” traumas; many individuals experience some of them over life. However, they do have an impact. They can still have significant effects on mental health and well-being, especially when experienced repeatedly or over a long period. They can contribute to issues like anxiety, depression, low self-esteem, difficulties in relationships, and even physical health problems (Mate, 2023).

Addiction is (often) a chronic condition characterized by compulsive drug-seeking/behavior engagement and use, despite harmful consequences (NIDA, 2020, 2). According to Bessel Van Der Kolk, a renowned psychiatrist, trauma can profoundly affect brain development, leading to dysregulation of emotions and behaviors (Van der Kolk, 2014).

Addiction can be more than just substance abuse. It can be behaviors such as gambling, gaming, internet use, shopping, and compulsive overeating (Grant et al., 2010; Müller et al., 2017). These behavioral addictions share common ties with substance addictions in terms of the above-mentioned neurobiological mechanisms and behavioral patterns.

Intersection of Trauma and Addiction

The relationship between trauma and addiction is multifaceted. It is not uncommon for individuals with a history of addiction to also have a history of previous trauma(s). People often engage in compulsive behaviors with substances or behaviors as a way to cope with the distressing emotions associated with their trauma (Brady et al., 2009). In the realm of substance use, this is known as self-medication. It can provide temporary relief but often leads to further complications, including addiction. According to Daniel Siegel, a pioneer in the field of interpersonal neurobiology, traumatic experiences can disrupt the brain's regulatory systems, making individuals more vulnerable to addiction (Siegel, 2010).

There is importance in understanding addiction within the context of trauma and adverse childhood experiences (ACEs). Trauma, both big “T” and little “t”, from childhood experiences (or later in life), significantly influences the development of addiction (Smith, 2018). Adverse Childhood Experiences (ACEs), such as abuse, neglect, and household dysfunction, have been identified as highly potent predictors of addiction (Felitti et al., 1998). For example, research shows that adults with a history of higher ACEs are more likely to engage in substance abuse as a means of self-medication, often resulting in addiction (Felitti et al., 1998). To be clear, not all individuals with high ACE scores are expected to become addicts, only that there is a higher chance than those who have a low ACE score. It is important to understand, however, that environmental influences such as stress, trauma, and social factors can exacerbate susceptibility to addiction (Nestler, 2014).

Addiction goes deeper than our behaviors. The connection between trauma and addiction operates through neurobiological pathways. Traumatic experiences can lead to brain structure and function alterations, particularly in areas associated with reward processing and emotion regulation. These neurobiological changes increase vulnerability to addiction (van der Kolk, 2017).

While stigma suggests that addiction is something anyone can stop at any time, studies say otherwise. Addiction seems to involve intricate interactions between genetic, environmental, and neurobiological factors that contribute to its development and persistence (Volkow & Li, 2004). Neuroimaging studies show alterations in brain regions involved in the ability to logically and rationally engage in reward processing, impulse control, and decision-making among individuals with addiction (Volkow et al., 2016).

This information alone should make an individual pause when considering the “just stop” argument. Dopamine pathways (motor functioning, motivation, and reward-related learning), in particular, play a central role in reinforcing the cycle of addiction (Koob & Volkow, 2010). If drugs can create alterations in our brain, impacting our ability to think logically and “just stop,” and the drug or behavior gives us the dopamine hit we want, it will be hard for us to rationally stop the compulsive act.

Neuroimaging studies have demonstrated similarities in brain activation patterns between substance and behavioral addictions, which implies dysregulation in reward-related circuitry (Potenza, 2013). Like substance addictions, behavioral addictions are characterized by compulsive engagement in the behavior despite adverse consequences, loss of control, and cravings (American Psychiatric Association, 2013). Folks with behavioral addictions, like substance addictions, experience withdrawal symptoms and tolerance. This indicates changes in our neurobiology similar to those observed in substance use disorders (Grant et al., 2010; Potenza, 2013). Our brain adapts and changes how it responds and processes, through the influence of the addictive process and experiences.

Understanding the shared neurobiological aspects of substance and behavioral addictions drives home the importance of comprehensive approaches to addiction treatment. Treatment should always address both substance use and maladaptive behaviors, as well as the factors that have or do influence them (Müller et al., 2017). The more that is we learn about addiction, the clearer it becomes that it is a spectrum that encompasses substance and behavioral manifestations, both often originating from a variety of factors, many out of the individual's control. If you are a client or seeking treatment, finding a provider who uses a comprehensive and collaborative approach to your care is so important!

Cultural Norms, Values, and Disparities in Treatment:

Cultural norms and values dictate how individuals perceive and cope with trauma and addiction. Different cultures may have distinct attitudes toward seeking help, expressing emotions, and dealing with stressors. For example, in collectivistic cultures, there may be a stigma associated with seeking mental health treatment, leading individuals to suppress emotions and avoid seeking help, which can exacerbate trauma and addiction issues (Ryder et al., 2008). On the other hand, individualistic cultures, like those in Western societies, may encourage self-expression and individual autonomy, which can influence how trauma and addiction are experienced and addressed (Marsiglia & Booth, 2015).

Socioeconomic factors, including poverty, discrimination, and lack of access to resources, play a significant role in shaping trauma and addiction. Individuals from marginalized communities may face higher levels of trauma due to systemic inequalities and social injustices (Hollingsworth & Morgan, 2018).

Societal structures, such as the criminal justice system and healthcare policies, can impact how trauma and addiction are addressed. For instance, punitive approaches to drug addiction may further traumatize individuals and hinder their recovery (Alexander, 2010).

Historical traumas, such as colonization, genocide, and slavery, can have intergenerational effects on trauma and addiction within communities (Brave Heart, 2003). These traumas can shape collective memory and influence coping mechanisms and behaviors. For example, research has shown how historical trauma among Indigenous populations in North America contributes to higher rates of addiction and mental health issues (Whitbeck et al., 2004).

Cultural identity and acculturation processes can intersect with individual experiences of trauma and addiction, shaping how individuals perceive and respond to their circumstances (Gonzalez et al., 2012). Recognizing the cultural and social influences on trauma and addiction is essential for providing and receiving culturally competent care. Please always ensure you are requesting and receiving culturally tailored care, that respects your cultural backgrounds and values. Through research, it has been found that this approach is more effective in addressing trauma and addiction (Hall et al., 2016).

Despite the prevalence of trauma and addiction across diverse populations, there are significant disparities in access to trauma-informed care and addiction treatment. Minority populations, including racial and ethnic minorities, LGBTQ+ individuals, and low-income communities, often face the most barriers to accessing culturally competent and affordable treatment services (SAMHSA, 2021). I often point to disparities in access to treatment. This is to underscore the importance of providers advocating for change, as well as ensuring individuals (struggling to access care) are aware they are not alone, and that their struggle is real.

Trauma and addiction are complex issues that intersect in profound ways. Understanding the relationship between trauma and addiction, as well as the role of self-medication, cultural influences, and treatment disparities, is important. It is essential for both the treatment provider and the client to ensure comprehensive care towards their recovery, whatever that may look like. By addressing these issues holistically and advocating for equitable access to care, we can better support ourselves and others affected by trauma and addiction on their journey toward healing and recovery.

Always Be Uniquely You

I want to reiterate that I highly recommend locating providers (of any type) that respect and honor your cultural beliefs, practices, and meet you where you are at in life. This includes incorporating cultural traditions, languages, and community support systems into treatment approaches, which has been shown to enhance treatment experience and outcomes (Benish et al., 2011). It also includes ensuring they are willing to have open and transparent discussions about how to address any potential barriers to care. Self-advocacy can be hard but a rewarding and beneficial process. Asking for appropriate support, whether it be from family, friends, treatment providers, and/or your community, is a powerful step in healing.

In the following blogs, I will be addressing topics such as harm reduction; the cycle of addiction; and current evidence-based treatments for addiction. This blog series will continue to strive to address various information on addiction in hopes of educating and supporting folks struggling with addiction, their loved ones, and treatment providers.

As always, these blogs are meant to be brief and educational, based on professional experience and research references. This blog is not meant to replace professional medical or mental health advice or treatment from your primary providers. If you have questions or comments, please feel free to contact me!

References:

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