As a trauma therapist, I specialize in the intersection between addiction and trauma. Trauma is a word that not all identify with, especially early in treatment. Most of us with addiction grew up in homes with the unwritten rule “don’t talk, don’t feel, don’t trust”. So, when bad things happened, they were minimized, denied, or even blamed on us. We are all born with an internal radar system or “gut feelings” that helps us to identify unhealthy situations. But when the adults in our lives do not act on these experiences or treat them as unhealthy, we learn to not trust this gut instinct and to even turn it off (leaving us susceptible to additional painful experiences). What we experience in childhood is often our only experience of what is “normal” and we assume what we have experienced is what all kids experience. Sometimes we went to a friend’s house and noticed how differently people acted there or sometimes the concept of normal was not challenged until winding up in treatment.
Both addiction and PTSD have a biological predisposition. Environment, however, plays a huge role in this. Addiction is often called “an attachment disorder”, referring to the first three years of life in which we learn how to interact with caregivers and how-to self-sooth. If we grew up in home with addiction or severe mental illness, often our parents didn’t know how to teach us this process of self-soothing because they never learned it from their parents. A securely attached child feels that their parents knows, sees, and understands them, which gives them the confidence to go out and create healthy bonds in the world. If we did not have this secure base, it leads to anxious preoccupied attachment (fears abandonment), Avoidant-dismissive attachment (avoids uncomfortable intimacy), or disorganized attachment (a combination of both). This sets the stage for relationships later in life in which we don’t know how to self-soothe or get our needs met appropriately. Not surprisingly, we enter into relationships with people who are not emotionally available, are abusive or dismissive, or experience repeated abandonment which mirrors our childhoods experiences. We learn deep seated beliefs like “I’m not lovable”, “People can’t be trusted”, or “the world is a dangerous place”.
Besides negative beliefs, trauma also shows up as re-experiencing of trauma (flashbacks, nightmares, panic attacks). Dissociation is a tool the brain uses during trauma to protect you, but continues when trauma is untreated into adulthood and makes it difficult to remain present. This can look like amnesia, depersonalization (feeling out of body), derealization (feeling like your environment or body are not real). Dissociation can also look like absorption (i.e. watching your favorite movie and forgetting the world is going on around you) or day dreaming, but everyone experiences these types regardless of whether they have had trauma. Due to poor emotional regulation, trauma survivors often turn to self-harm (cutting, burning, etc.), thoughts of suicide to escape the internal experience, drugs/alcohol, sex, food, gambling, shopping, work, etc. Avoidance is a hallmark feature of PTSD and a well-developed coping skill of people with long standing trauma, so learning to look at the pain can be frightening or overwhelming at first. People often tell me they have done years of counseling but, either it was not trauma specific or alcohol and drugs were involved so the brain was unable to make the neurological changes to quell the nervous system.
Is it any wonder that with an inability to self-soothe and repeated painful relationships people turn to external means to feel better? These things provide powerful dopamine hits and feel good, right? Until they don’t and they further alienate us from the very thing we need most: connection. We are hard wired to need connection but trauma changes the brain to be wired for protection. This constant protection requires us to be in flight, fight, or freeze mode which essentially like living in a war zone long term. It is exhausting.
Luckily, addiction treatment has recognized the role attachment and trauma plays in our disease and has incorporated new tools to help us heal. There are many evidenced based paths to healing trauma, including: Trauma focused CBT, Brain spotting, EMDR (I will be discussing this in a later blog), Somatic Experiencing, Progressive Exposure therapy and experiential approaches. These therapies help to turn down the sympathetic nervous system (flight, fight, or freeze) and turn up the para sympathetic nervous system (relaxation and ease). Add in the 12-steps where we learn to invite our higher power into all areas of our lives, meditate/pray, learn to ask for help, learn to help others, and we can have a beautiful process of healing that makes past suffering meaningful. While I can’t say trauma therapy is easy, I can say it is worth it. It has changed the quality of my life and the life so many others into expansive, creative, joyful, and “anything is possible” lives!