Addiction is often as mysterious an enemy as it is a ruthless one. For far too long, those experiencing dependency were stigmatized as lacking in willpower, desire, or strength of character (1, 2, 3).
Today, however, researchers, addiction recovery specialists, healthcare professionals, patients, and families alike are increasingly beginning to recognize the complex, multifaceted nature of addiction, the reality that the dependency is by no means a question of desire, of simply choosing not to get, or to remain, sober.
Rather, dependency is a tangled amalgamation of physiological, genetic, environmental, social, and personal factors that come together to create and sustain addiction. It is a witch’s brew driving the self-destructive behaviors for which those experiencing addiction have too long been blamed, condemned, and marginalized.
For many, what often lies at the dark, hidden heart of addiction is trauma, an old and deep-seated pain that has grown and festered into the disease of dependency. We are increasingly discovering that there are many connections between trauma and substance use disorder (SUD).
Inner Child
The evidence linking trauma to substance addiction is well-established. Research has also shown that the connection is particularly strong among those who have experienced trauma in childhood (4). Moreover, researchers have found that SUD risk rose exponentially with each adverse childhood event (ACE) (4, 5). The effects of childhood trauma on future dependency also significantly increased as the age of trauma exposure decreased (5). In other words, the younger the child is at the age of the trauma(s), the greater the likelihood of developing SUD in adolescence or adulthood.
Though researchers do not fully understand the mechanisms through which childhood trauma links to addiction later in life, there is significant evidence to suggest that trauma exposure (both the emotional impact of traumatic events or abuse and physical traumatic injuries) causes substantial structural and functional changes in young, developing brains. For example, in their study of SUD in those who had experienced traumatic brain injury (TBI) in childhood, Cannella et al. (2019) found that injury-related changes to blood-brain barrier permeability and synaptic and neural networks appear to compromise brain functioning, particularly in the brain’s “reward” centers (6). The researchers also found that brain inflammation induced by the TBI may also contribute to or exacerbate these deficits. The ultimate result, the researchers speculate, is a profound disruption of the maturation processes of the pediatric brain, instigating maladaptive compensatory responses. Simply put, those who have experienced both trauma and TBI, as a result of that experience, may drink or use drugs to excess in order to mitigate the physiological and psychological effects of an injured and underdeveloped brain.
However, it is not only those who have experienced TBI who are at heightened risk for developing substance dependency in the wake of childhood trauma. In a study of substance use behaviors and motives in trauma-exposed adolescents, Adams et al. (2021) found that alcohol use was strongly associated with the desire to avoid “trauma thoughts” and to cope with depression symptoms (7). The authors note that these findings support the long-standing “self-medication” theory of trauma and its relationship to substance use and dependency.
The (Dis)Comfort Zone
Although childhood trauma appears to produce changes in the developing brain that can increase the risk of addiction, social and environmental factors also seem to play a role. Evidence supports the model that dependency is a disorder that arises from and is sustained by the complex interconnections of physiology, genetics, environment, and personal attributes. For example, in the same study by Adams et al. (2021), the authors also found that trauma-exposed teens’ motives for using drugs and/or alcohol were often more complex and multifaceted than the self-medication theory suggests.
The researchers discovered, for instance, that the majority of subjects also expressed personal and social reasons for using substances, referring to environmental norms and the pleasurable effects of the substances (7). To put it simply, they drank and/or used drugs because it felt good, because it was what they were used to seeing and doing, and because it helped them fit in with their family and social group (7).
This is supported by other researchers who have shown that one’s environment plays a powerful role in triggering cravings, as well as in creating and perpetuating a drinking (or drug-user) identity (8, 9, 10, 11).
Indeed, while there is certainly robust evidence to support the role of heredity in increasing one’s vulnerability to SUD, exposure to parental substance misuse is itself considered a traumatic or adverse childhood event. For example, in their study of familial and socioeconomic factors and their relationship to educational attainment and adolescent health, Houtepen et al. (2020) found that maternal depression and parental substance use were among the greatest environmental risk factors for the development of SUD in teens and young adults (12).
It is for this reason that the quality of your familial relationships and social support networks are so important to your recovery. The ability to forge healthy connections with friends and family in the context of your sobriety is often essential to getting and staying clean. This may well mean breaking away from the environments that trigger your worst cravings as well as the people who, wittingly or unwittingly, undermine your healing.
Adult Trauma and SUD
Though the traumas experienced in childhood can have a profoundly detrimental impact for years and decades to come, this does not mean that adult trauma cannot contribute to the development of an addiction. In their comparative study of the effects of childhood trauma and combat trauma on substance abuse risk, Vest et al. (2018) found that combat trauma can, indeed, increase one’s risk of alcohol dependency, particularly in those who have also experienced childhood trauma (5). In fact, the authors found evidence of a synergistic effect when an individual experiences both forms of trauma, meaning that your risk of developing a trauma-related SUD is substantially higher if you have experienced both combat and childhood trauma, rather than one form of trauma alone.
In addition to combat-related trauma, research has shown that trauma related to physical and sexual abuse is also strongly related to substance misuse (13, 14, 15, 16). These risks are especially associated with women, racial and sexual minorities, and female members of the military, who are often at greater risk for experiencing violence, particularly sexual assault (14, 16, 17, 18, 19).
The evidence suggests that, for both adult and childhood trauma alike, one of the most important nexuses between trauma and substance misuse lies in the impact of trauma on impulsivity. Researchers have found that trauma-exposed individuals are more likely to engage in risky behaviors, including risky drug and alcohol use, than those who have not experienced trauma (13, 20, 21, 22). Indeed, the connection between trauma and impulsivity is particularly apparent in those experiencing post-traumatic stress disorder (PTSD) (21). This suggests that trauma interferes with the capacity for emotional self-regulation, decreasing one’s ability to resist drug cravings through attentional diversion or other coping techniques.
Healing and Recovery
Fortunately, research has shown that trauma-informed care in addiction recovery can not only help you heal the wounds of the past, but also increase your chances of long-term sobriety (23, 24, 25). This approach to addiction recovery not only addresses the personal, environmental, and physiological mechanisms of substance dependency, but also the deep-seated psychological impacts of trauma, impacts which, as has been shown, often instigate and fuel addiction. Trauma-informed care, in other words, helps you to address addiction at its roots and, in the process, find health and healing across all domains of your life, not only in relation to your substance dependency.
At Bayshore, we take a highly personalized approach to addiction recovery. Our multidisciplinary team of physicians, mental healthcare specialists, and family counselors can help you identify the underlying causes of your dependency. We excel in providing trauma-informed care for those who need it (23, 24, 25), prioritizing mental health as a key component of long-term sobriety. Contact us today to discuss how our team of caring professionals can help you heal the traumas of your past so that you can build the happy, dependency-free future you deserve.
