Trauma and Addiction are Indisputably Linked
By David B. Bohl
Originally posted on July 16, 2018 on David B. Bohl Parallel Universes
I don’t know a lot of people with addiction whose stories don’t include the kind of experiences that would raise the hair on your neck. Broken homes, toxic relationships, abuse, neglect, poverty – there are so many factors that contribute to people self-medicating through drugs of alcohol. Drugs and alcohol allow us, people with addiction, to check out – even if for a moment. The chaos, the pain, the screaming thoughts fade away as we use – or at least that’s what happened before we go off the rails completely. Addiction is a progressive condition, so eventually, a person with substance use disorder uses just to survive, to not feel the shakes or avoid seizures.
Trust me, there is not a single person with addiction who set out to be that way – becoming a person with addiction is not exactly an aspiration like that of becoming a doctor or an engineer. There’s an indisputable link between trauma and addiction. It’s unusual to meet a person with addiction who has not had some kind of trauma – often in childhood.
In my profession, negative incidents that have occurred during one’s childhood are referred to as Adverse Childhood Experiences (ACE), and an ACE score measures different types of abuse or neglect. According to ACE studies, the more troubled your childhood, the higher your score and in turn, the higher your risk for later health problems, including addiction.
ACE is divided into three sections:
- Emotional, which includes Physical, Emotional and Sexual
- Neglect, which includes Physical and Emotional, and
- Household Dysfunction, which includes Mental Illness, Incarcerated Relative, Mother Treated Violently, Divorce, and Substance Abuse.
We’re currently experiencing an opioid crisis in America. According to CNN, “Experts say the United States is in the throes of an opioid epidemic, as more than two million Americans have become dependent on or abused prescription pain pills and street drugs (…) During 2016, there were more than 63,600 overdose deaths in the United States, including 42,249 that involved an opioid (66.4%). That’s an average of 115 opioid overdose deaths each day.”
Those are scary numbers. They are not the kinds of numbers that we, as a society, should ignore. This is why I believe that we need to raise more awareness about the link between trauma and addiction and educate professionals and paraprofessionals and those providing recovery-support services (including volunteers and persons in mutual aid support groups and families). We simply cannot talk about ACEs, and trauma in our community, and traumatic subjugation of huge populations, without concurrently discussing the intersection of trauma and addiction. We cannot talk about the opioid crisis and solutions to it without simultaneously discussing the relationships between trauma and addiction.
Labels, scores, stats, and abbreviations aside, what we also need to remember is that we’re talking about people. We are all born into this world deserving to live the best lives. For some of us it doesn’t work out right from the beginning – I was relinquished shortly after being born – but that doesn’t mean that we don’t merit love and respect and care: especially if our adversities caused us to use to be able to cope. My hope is that going forward, people in my profession will continue to improve how we offer our services, taking into account all that characterizes those with addictions, pain and heartbreak included. That’s the only way to heal.
David B. Bohl, author of the memoir Parallel Universes: The Story of Rebirth, is an independent addiction consultant who fully understands the challenges faced by so many who seek to escape from, or drown their pain through, external means. His story offers hope to those struggling with the reality of everyday life in today’s increasingly stressful world.
Through his private practice substance use disorder consulting business, Beacon Confidential LLC, David provides independent professional consultation, strategic planning, motivation and engagement, care coordination, recovery management and monitoring, and advocacy services to individuals, families, and organizations struggling with substance use issues and disorders.
Parallel Universes: The Story of Rebirth is available at HenschelHAUS Publishing Inc, and you can learn more about the book and the author here on Facebook.
It is also available at Amazon USA as a paperback or as a Kindle.
David Bohl was also the author of an article in Do Tell! Stories by Atheists and Agnostics in AA. You can read that here: A New Man.
Great article and yes, most people with addiction to substances have experienced some sort of trauma in their childhood. I also like the fact the author noted that there are many factors that contribute to addiction and that varies from person to person. Addiction is a complex illness and we all suffer varying degrees of severity which means we’re not all the same and therefore there’s no “one size fits all” treatment approach.
Steven, I could not have said it better myself. Addiction is so complex, it often times defies categorization. Is it a disease? Learned behavior? A combination? The factors that can contribute to it are endless. We do make progress, however, on understanding biological, psychological, and social/environmental factors involved. Hopefully more will continue to be revealed.
I’m a regular reader (haven’t missed a blog) of David B. One of the bonuses of editing radio (David was a recent Rebellion Dogs Radio guest) is by the nature of editing, I have to listen to tracks over and over again. More is revealed on a second or third go-around. I don’t know if the second time I get more out of it or it gets more out of me. The point is that I feel no repetitive strain. Like my favourite songs, I don’t want to listen just once and move on.
ACE is something worth spending more time on (for me). It’s worth taking inventory in terms of incidents, frequency and severity. One factor you’ll know David, I learned it from Patrick Carnes, I can have a single severe encounter, and/or suffer daily smaller impact traumas and each could have equal impact. For example, being raped once is a severe trauma and being yelled at every day is a less severe trauma but the higher exposure (every day) magnifies the impact. This is but one example of how involved mapping out my own trauma history is when it comes to understanding the effect then and how these events inform my life today.
Quite a different exercise than “just looking at our side of the street.”
As you can see, you got me thinking-again; thanks David.
Well stated Joe.
Absolutely Joe, especially the part about “understanding the effect then and how these events inform my life today.” It’s suggested to us through 12 step programs that we need to get down to “causes and conditions,” and that is certainly true for the developmental interruptions or relational obstacles we experience. Thank you for the kind words Joe.
Any time we get to talk about childhood trauma I perk up. Well, at least I wasn’t sexually abused that I know of, but so far my observation of the AA approach to such trauma, granted, I’m painting it at its most extreme, has been “oh, you were raped at 6? What was your part in it? Looks like you need some ego deflation. Oh, you’re not ready to go to any length? Well then go out and drink some more”.
And we/they do.
There IS a tiny little bit of good sense in this approach of course, and it does work to some degree in less awful circumstances:
Get on with it, focus on what you can do right now to improve your life, dwelling on the past will just leave you stuck, having resentments just kill you, not the other person, etc., but whenever it even hints at blaming the victim it is problematic, very much so, and besides, this approach only works on the milder traumas (if that’s not a contradictory term).
Which leads me to the otherwise unfounded presumption that Bill Wilson had only suffered mild traumas, though the other possibility is that he had suffered traumas so severe, that he shut down completely, and that’s why he took AA in the direction of “I can handle this if I just man up” – which only works up to a point.
There is so much that gets swept under the carpet in AA, other than my part in it, of course. How will we ever get to process it in a way that is productive?
As for the opioid crisis, I would hazard a guess that it is not only tied to childhood traumas, but also to actual adult socio-economic circumstances, such as a depressed economy, and a political climate severely poisoned by the avarice of a congress of lapdogs that are all millionaires, and it’s orange galleon figure, while they’re sailing the country to its doom.
But of course, if AA had set itself up to participate in political discourse on behalf of the downtrodden Rockefeller would have squashed it right there like a bug. And one thing that would have meant is that I would have been deprived of the opportunity to participate in the kinship of common suffering with people I under other circumstances would have been delighted to throw under the bus if I had half a chance.
And yes, I am greatly disturbed, still, whenever I run into a trump supporter in the program, it just seems so totally opposite anything we associate with recovery.
And while in some ways AA would benefit from incorporating a political analysis of the origins of addiction, I’m afraid we’re going to have to let that be, so that we can avoid getting bogged down in political squabbles and lose sight of our primary purpose. But that is certainly a problem.
And yet I’m grateful to all those would be Trump voters who sat me down in 1988 and said “you’re in the right place”. Because I was. I owe my life to this program, and I love it, and I want it to survive its own inherent problems, and I guess that’s why every day now I go up in the ring and fight those very people who once saved my life. Weird thing to have to do, isn’t it?
Wow! Incredibly thoughtful read “Mr. life”! Lol. I couldn’t agree more and it reinforces my belief that AA helps – to a degree – but sure isn’t for everyone. I think that most every addict/alcoholic could benefit from some one-on-one and/or group therapy. AA is “peer support”. Nothing more, nothing less. All too often it becomes “the blind leading the blind” and in some cases (perhaps many), a well meaning sponsor’s “suggestions” can be quite harmful. All the more reason for there to be many more and different options for chemically dependent people to have access to.
I’m grateful that the place I went to treatment in 1986 addressed childhood trauma. I had emotional abuse and neglect. So did Bill W. But we developed different defense mechanisms to deal with it – he tried to control and dominate while I tried to appease. The ego busting is great for people like him but not me. I kind of like the ecological perspective – we did what we had to do to adapt to our environment. But unfortunately we internalized those behaviors and find ourselves applying them automatically while our environment has changed, and they’re not a good fit any more. They’re not character defects; they’re survival skills. I’m still hyper-vigilant toward situations that threatened me in childhood, even though it’s unnecessary today, kind of like a soldier returning from war. I constantly feel like I have to justify my existence, otherwise I don’t deserve the space I take up or the air I breathe. When you’re told there’s no excuse for you so many times, it sinks in.
I’m presenting in Toronto on reframing the steps for shame-based people like me, if anyone is interested.
I would surely be interested. So just to see what else is going on I went to the icsaa website, and clicked on conference schedule, I would have thought that would take me to the conference schedule, but it takes me to something else. I have been lucky enough to find it before, so I guess I will just keep searching, but it seems like up here a month before the event it ought to be totally obvious, TOTALLY, where the schedule is to be found.
Anyone who can pull any strings and make the schedule findable?
Simple enough. Click on this image on the top left hand corner of AA Agnostica (or right below) and then click on the Conference Schedule:
That’s fantastic Beth, I can’t make it to the conference but I hope to hear the audio of your presentation later. I too find the ego-busting language of AA to be way out of bounds and unsafe for the trauma and shame I experienced.
Many people who do not suffer with drug (I include alcoholism) addiction have also experienced trauma at some point in their lives. Likewise, there are those too who become addicted who would report little or no significant trauma in their lives. A history of trauma is neither necessary nor sufficient for drug addiction. We know that alcoholism is a neuro-physiological disease that occurs in roughly 10 to 15 percent of those who use alcohol on a regular basis, regardless of psychological variables. The real task is to identify those who are susceptible in the early stages of their disease and to help them address their condition before they go to the depths many of us have endured.
During my professional life in the field of addiction treatment, I was most privileged to work with another recovering alcohol addict Vietnam Veteran on publishing a couple of papers and presenting at major conferences about the correlation between addiction and trauma, particularly as we experienced relative to our experience as Vietnam Veterans.
One general conclusion we derived is that though neither addiction nor trauma are necessarily causative of the other, nevertheless when they co-occur in an individual, both the addiction and the negative consequences of trauma are exacerbated in an individual if both are not sufficiently dealt with in a treatment or recovery process.
Thank you for doing that work Thomas. It is much-needed.
Here are some things research has found about the intersection between trauma and addiction:
50-66% of people who suffer from PTSD also have addiction (1)
People who suffer from PTSD are 2 – 4 X more likely to battle addiction than people without PTSD (2)
Co-occurring PTSD & SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including: (2)
o Increased chronic physical health problems
o Poorer social functioning
o Higher rates of suicide attempts
o More legal problems
o Increased risk of violence
o Worse treatment adherence
o Less improvement during treatment
Better rates of abstinence from substances and lower levels of mental health symptoms are obtained when PTSD and SUD are treated concurrently and in an integrated way. (2)
(1) Life Works Recovery Lecture – 15th September 2009 – Adoption and Addiction – understanding the impact of an early psychological wound Presented by Paul Sunderland
(2) Post-traumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment – Jenna L McCauley, Ph.D., Therese Killeen, Ph.D., A.P.R.N., Daniel F. Gros, Ph.D., Kathleen T. Brady, M.D., Ph.D., and Sudie E. Back, Ph.D.
I suffered no particular trauma in my childhood and was developing into a full-blown alcoholic well before my first taste of combat as a young U.S. Marine. Sobering up after my first war helped me weather two more wars before I retired. So, I do know a little about trauma.
Without a doubt, many alcoholics suffered trauma that contributed to their becoming alcoholics. But I’m pretty sure I never did.
It would be interesting to see solid numbers and quantitative analysis demonstrating a direct correlation between addiction and trauma. What this brief and nicely-written piece contains instead appears to be a few numbers pointing to how big a problem addiction is plus some anecdotal evidence relayed by a very smart and caring guy whose job description apparently includes working with people who have been traumatized.
When I went to treatment I told them I came from a wonderful family and if there was anything wrong with me it was my own doing. That’s because I had no frame of reference – I hadn’t experienced anyone elses’ childhood. I didn’t know I had been abused – I thought I deserved whatever they did or said. I didn’t know I had been neglected – I was completely unaware that emotional support and having adults meet my emotional needs existed. I just learned not to have or express them. My family was “normal” because it was the norm I experienced.
I can relate, Beth. I used this quote in a recent talk:
Trauma. Addiction. Gabor Maté, in is book In the Realm of Hungry Ghosts, certainly considers them strongly connected.
Eric,
Yours is a fair question. There is research. Here’s one that might answer your questions:
Substance use, childhood traumatic experience, and Post-traumatic Stress Disorder in an urban civilian population
The overview states: “Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. SUDs are also highly comorbid with Post-traumatic Stress Disorder (PTSD) and other mood-related psychopathology. Most studies examining the relationship between PTSD and SUDs have examined veteran populations or patients in substance treatment programs. The present study further examines this relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients.”
Not sure how to post. The word ” indisputably ” seems to me to be coming from a place of rigidity. To me the physical addiction to alcohol should be addressed first. What comes after depends on the individuals willingness to change.