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The Connection: Trauma Victims and Substance Abuse

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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

  • Domestic violence.
  • Rape or sexual assault.
  • Sexual exploitation.
  • Child abuse or neglect.
  • Exposure to gang-related or interracial violence in the community.
  • School violence or bullying.
  • Forced displacement, in which a person is forced to become a refugee or relocate.
  • Military combat.
  • Living through a natural disaster, mass shooting, chemical spill, or terrorist attack.
  • Prolonged physical torture or kidnapping.
  • An unexpected death or loss of a loved one.
  • Being attacked by a wild animal.
  • Seeing another person hurt or a dead body.

Reasons They Abuse Drugs and Alcohol

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:

  • Self-soothing/self-medicating: Trauma can cause anxiety, depression, and other mental health issues. Drugs and alcohol can provide temporary relief, but will not solve the root issue. In fact, the person’s condition often worsens.
  • Access to prescriptions: Someone who has experienced physical trauma or an injury during military warfare may be prescribed drugs to manage pain. Opioid abuse addiction has become a prevalent public health concern due to the increase in pain medication prescriptions.5
  • A traumatic brain injury (TBI): In certain cases, an acute head injury may cause the person to develop neurological dysfunction. Some research has revealed an association between TBI and binge drinking.5
  • Interpersonal problems after a traumatic event: A sudden, unexpected death in the family, divorce, and other personal tragedies may cause disruptions in relationships.3 Often, addiction and substance abuse escalate after such events.

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

Substances Most Commonly Abused

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.

Detox

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:

  • PTSD.
  • Depression.
  • Bipolar I or II.
  • Generalized anxiety disorder.
  • Schizophrenia.
  • Schizoaffective disorder.
  • Attention-deficit hyperactivity disorder (ADHD).

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:

  • State-funded detox/rehabs: These programs take state-funded insurance, such as Medicaid and Medicare, or cater to those with financial hardship.
  • Inpatient: These rehab programs provide 24-hour structured routine in a hospital or non-hospital, residential setting. The length of stay can range from 30 days to 12 months, depending on the individual treatment recommendations. Some inpatient programs offer detox, while others expect that to be completed before admission into the program.
  • Intensive outpatient: These programs vary in structure and intensity, generally cost less than inpatient treatment, and may be suitable treatment options for people with many home and work obligations and strong social support.
  • Partial hospitalization programs (PHPs): Like intensive outpatient programs, PHPs are conducted on an outpatient basis but require relatively more of a time commitment. For several days a week, those enrolled in a PHP have access to hospital services while undergoing daily detox/treatment prior to returning home for the evening.

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.

Sources

  1. Culpepper, L.D. (2016). The link: Trauma and substance abuse. Journal of Psychology and Clinical Psychiatry, 5(4): 1-3.
  2. Herman, J. (1997). Trauma and recovery.
  3. National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder.
  4. Thege, B., Horwood, L., Slater, L., Tan, M., Hodgins, D., Wild, C. (2017). Relationship between interpersonal trauma exposure and addictive behaviors; a systematic review. BMC Psychiatry, 17: 164.
  5. Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces. (2013). Substance Use Disorders in the Armed Forces.
  6. Breslau, N. (2002). Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. The Canadian Journal of Psychiatry, 47(10): 923-929.
  7. Khoury, L., Tang, Y., Bradley, B., Cubells, J., Ressler, K. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety, 27(12): 1077-1086.
  8. Drake, R., Mueser, K. (2000). Psychosocial approaches to dual diagnosis. Schizophrenia Bulletin, 26(1): 105-118.
  9. National Institute on Drug Abuse. (2007). Addiction and co-occurring mental health disorders.
  10. Greenfield, S., Azzone, V., Huskamp, H., Cuffel, B., Croghan, T., Goldman, W., & Frank, R. (2004). Treatment for substance use disorders in a privately insured population under managed care: Costs and services use. Journal of Substance Abuse Treatment, 27(1), 265-275.
  11. Substance Abuse and Mental Health Services Administration. (2016). Types of Trauma and Violence.

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