Trauma has been described as an overwhelming, life-altering event that results in pervasive physical, psychological, or emotional distress.1 Traumatic events have significant and damaging effects on many areas of a victim’s psyche, including their beliefs about the safety of the world, ability to trust others, self-value, and systems of attachment and meaning.2
Maladaptive coping behaviors, such as alcohol and drug abuse, are common in trauma survivors. Research shows that 70% of adolescents receiving treatment for substance abuse had a history of trauma.1
Various forms of trauma that might lead a person to abuse substances include:3,11
Unresolved trauma significantly increases the risk of mental health and substance abuse issues.1 Regardless of the type of trauma that a person experiences, the one thing that traumatic events tend to have in common is that they impart feelings of helplessness, extreme terror, loss of control, or threat of death.2 Trauma can profoundly alter a person’s memory, thinking, emotions, and physiological responses.2 Many victims attempt to cope with these lasting effects by abusing drugs or alcohol. Alcohol is the most widely abused substance in traumatized populations, as evidenced by the high prevalence of alcohol use disorder (AUD), or alcoholism.4
Reasons that may cause someone to abuse alcohol/drugs after a trauma may include:
Although someone may feel a temporary sense of relief from traumatic symptoms by using drugs or alcohol, chronic substance abuse increases the likelihood of addiction development and could place the user at higher risk for repeated trauma due to exposure to violence within the drug community.6
Certain substances are abused more frequently in association with specific types of trauma. Alcohol is abused the most, especially by returning combat veterans or members of the military, largely due to the easy access to the substance on military installations.5 Historically, the use of alcohol, illicit drugs, and tobacco has been common in the military. Increases in alcohol abuse in the military may be associated with the burden of war, with drinking behavior, in part, being used as a method of coping with stress or traumatic events or as self-medication for mental health problems.5
In women, sexual abuse is significantly linked with cocaine and marijuana use. Men who experience physical abuse have been found to frequently abuse heroin and cocaine, while female victims of physical abuse most commonly abuse marijuana and cocaine. Emotional abuse in men is linked to heroin use and, in women, cocaine use. As a common denominator of sorts, heavy alcohol use is a recurrent phenomenon seen in people who have experienced any type of trauma.7
Polysubstance abuse is also commonly seen in people who have experienced trauma, as abuse of one substance may facilitate or compliment the misuse of another. In other instances, polysubstance abuse may arise at some point when, for reasons of availability, someone replaces one drug with another. For example, when opioid painkillers are not available, a user may resort to using heroin, which tends to be a cheaper option.
When a person has both a substance use disorder and a mental health disorder, it is frequently referred to as dual diagnosis.8 According to the National Institute on Drug Abuse (NIDA), as many as 6 in 10 substance abusers have at least one other mental health disorder.9
Examples of co-occurring mental health issues include:
Individuals with severe mental illness are at a higher risk for developing a drug or alcohol addiction.8 Treatment is usually necessary for this population and is often tailored to address both the mental health issue and the substance abuse issue. Dual diagnosis individuals are also twice as likely to smoke cigarettes than the general population.9
An important concern with dual diagnosis patients is that, when left untreated, both chronic substance abuse and mental illness can be progressive issues, and could in fact worsen the course of the other. For this reason, a more effective implementation of treatment interventions is warranted to target and manage both issues simultaneously. Nowadays, integrated care, where clinicians combine interventions so that they can address the comorbidity, is popular.
The detox process for those with dual diagnoses will be similar to those with a substance addiction alone, but some additional considerations may need to be made.8 For example, if the user is currently taking psychotropic medications (e.g., antidepressants, antipsychotics), the combined effects of drugs and/or alcohol with these medicines may somewhat alter the presentation of certain detox symptoms. A medically monitored detox may be more strongly advised in these instances so that health professionals can better monitor the individual over the course of their withdrawal and manage any complications that arise.
Detox services for people with dual diagnoses may include:
Trauma coupled with substance addiction can be overwhelming for anyone. Despite the additional challenges associated with this predicament, help is available and recovery is possible.