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Trauma Therapy

Substance addiction treatment that acknowledges the role mental health plays in one’s recovery is the best kind for people who have experienced trauma, both from life-changing events and the trauma that can accompany a drug or alcohol addiction.  Before the drinking and drug use can stop, a person’s physical, mental, emotional, and spiritual state must be addressed first.

When trauma has entered the picture, whether it’s before or after the substance use started, the already complex issue addiction becomes even more complicated.  Here, we will look at trauma therapy treatment and what that means for people who are recovering from addiction.

What Is Trauma? And How Does It Influence Addiction?

Trauma therapy in addiction treatment cannot take place without first understanding what trauma is and how it affects someone. This must happen before it can be determined what the best level of care for them will be. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape, or natural disaster.” 

A traumatic experience can be:

  • Experiencing or witnessing violence, crime (shooting, mugging, burglary, bullying, cyberbullying)
  • Being a victim of or witness to domestic violence, intimate partner violence, family violence
  • Physical, sexual abuse, sexual assault
  • Child abuse, maltreatment
  • Natural disasters such as a flood, hurricane, fire, or earthquake, or manmade disasters
  • Being in a serious accident or seeing one happen
  • Experiencing a serious illness or medical procedure
  • Experiencing war, political violence, or unrest (terrorist attacks)
  • Forced displacement
  • Neglect
  • Traumatic grief, separation
  • System-induced trauma and retraumatization (foster care, child protective services)

Negative emotions that result from a traumatic experience include but are not limited to:

  • Anger
  • Sadness
  • Pain
  • Loss
  • Betrayal
  • Guilt
  • Confusion
  • Entrapment
  • Shame
  • Helplessness

Social isolation and dissociation from reality also can occur after a traumatic experience. The APA explains that shock and denial are typical responses to such life-changing events, even if the person only witnessed what happened. However, it is the longer-term reactions, such as flashbacks, unpredictable emotions, strained relationships, and physical symptoms, such as nausea, that make it difficult for some to move on or cope with what has happened. 

The Link Between Trauma and Addiction

According to the National Council for Behavioral Health, trauma is pervasive, and its impact can be broad, diverse, deep, and life-shaping. People who feel like they cannot move on likely after a trauma has happened may have post-traumatic stress disorder (PTSD). 

Not being able to move on may mean:

  • Having unwanted memories of the traumatic event that cause distress
  • Reliving the event through recurring flashbacks
  • Having nightmares or upsetting dreams about the traumatic event
  • Avoiding reminders of the event, including places, people, and activities
  • Experiencing extreme emotional or physical reactions (e.g. chills, heart palpitations, or panic) when reminders of the events surface
  • Being on constant guard or hyper-aroused at all times. This includes feeling irritable or suddenly being angry.
  • Having trouble sleeping, concentrating, or being easily startled or surprised

One reason it may be difficult to move on is that trauma is subjective, writes David Sack, M.D., for PsychCentral. “Trauma is subjective, meaning what matters most are the individual’s internal beliefs and their innate sensitivity to stress, not whether a family member, therapist, or other outsider deems an experience traumatic.”

Under a normal stress response, people recover from a traumatic event in a month or less. But, if symptoms last for longer than month, a person’s quality of life likely changes. To cope with PTSD, people who are struggling with anxiety, depression, and other conditions may turn to drugs, both illegal and prescription, and alcohol to manage stress or numb themselves to heavy emotions so they can cope with the physical, mental, and emotional pain on their own. This is known as “self-medicating,” and this is how many addictions start.

Regular substance use changes the brain, making it hard for substance users to stop after they have come to rely on their drug(s) of choice. If they stop using, their PTSD symptoms likely will worsen as they enter withdrawal, which can be dangerous and deadly territory to be in. They also are at risk of overdosing, which is common when people return to using after a period of abstinence. This is known as a relapse.

Data Links Substance Use and Trauma

The National Center for Post-Traumatic Stress Disorder explains that experiencing trauma is not a rare event. It reports that about six of every 10 men (or 60 percent) and five of every 10 women (or 50 percent) experience at least one traumatic event in their lives.

Research has established a firm link between substance use and trauma. The relationship is complex, and it is not always easy to figure out if the trauma led to substance use or if the abuse led to traumatic events. However, data show that addictive substances often are involved as traumatic events unfold.

The National Center for Post-Traumatic Stress Disorder stated that up to 75 percent of those who have survived abusive or violent trauma report drinking problems. People with drinking problems are also more likely than others with similar backgrounds to experience psychological trauma.

According to the National Council on Alcoholism and Drug Dependence (NCAAD), alcohol is a factor in 40 percent of all violent crimes today. It also shares that, “Alcohol, more than any illegal drug, was found to be closely associated with violent crimes, including murder, rape, assault, and child and spousal abuse.”

Other statistics that illustrate the complex relationship between trauma and substance use and abuse include:

  • Nearly 4 in 10 child victimizers reported that they had been drinking at the time of the crime. Among drinkers, about half reported that they had been drinking for six hours or more preceding the offense. (NCAAD)
  • In the National Survey of Adolescents, teens who had experienced physical or sexual abuse/assault were three times more likely to report past or current substance use than those without a history of trauma
  • In surveys of adolescents receiving treatment for substance use, more than 70 percent of patients had a history of trauma exposure. (The National Child Traumatic Stress Network)

Studies also indicate that youths who are abusing substances may be less able to deal with a traumatic event as a result of functional impairments related to problematic use, writes the National Child Traumatic Stress Network.

According to its report, “In one study, investigators found that even after controlling for exposure to trauma, adolescents with substance use disorders were two times more likely to develop PTSD following trauma than were their non-abusing peers.

“The researchers suggested that the extensive psychosocial impairments found in adolescents with substance use disorders occurred in part because they lacked the skills necessary to cope with trauma exposure.”

What Is the Trauma-Informed Care?

The Substance Abuse and Mental Health Services and Administration (SAMHSA) offers guidance on the trauma-informed approach and how it should work in any program, system, or organization. This trauma therapy model can be applied to treatment programs that help people who have drug or alcohol addiction.

The agency advises that a trauma-informed approach uses the four “R’s”:

  • Realizes the widespread effects of trauma and understands the potential paths for recovery
  • Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
  • Responds by fully integrating knowledge about trauma into policies, procedures, and practices
  • Seeks to actively resist re-traumatization

These four key elements of a trauma-informed care can be implemented in any type of service setting or organization, SAMHSA advises.

In addition to these essentials, the trauma-informed approach has six principles that can be used across multiple types of settings, including addiction treatment. They are:

  • Safety.Throughout the organization, staff and clients should feel physically and psychologically safe.
  • Trustworthiness and transparency. Organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members.
  • Peer support and mutual self-help. Both are seen as integral to the organizational and service delivery approach and are understood as key vehicles for building trust, establishing safety, and empowerment.
  • Collaboration and mutuality. There is true partnering between staff and clients and among organizational staff from direct care staff to administrators.
  • Empowerment, voice, and choice. Throughout the organization, and among the clients served, people’s strengths are recognized, built on, and validated, and new skills are developed as necessary.
  • Cultural, historical, and gender issues. The organization actively moves past cultural stereotypes and biases, considers language and cultural considerations in providing support, offers gender-responsive services, leverages the healing value of traditional cultural and peer connections, and recognizes and addresses historical trauma.

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Trauma-Informed Care vs. Trauma-Specific Treatment: Is There a Difference?

Yes, there is.

While the two concepts are related, and perhaps used interchangeably among trauma therapy specialists, they are different. Trauma-informed care (TIC) is a structured framework that involves understanding, recognizing, and responding to the effects of trauma on the well-being of clients or patients and their behavior, according to the Martha K. Selig Educational Institute. Their purpose; however, is not to specifically to treat trauma-related symptoms or trauma-related syndromes.

Trauma-specific treatment are models that treat the psychological and behavioral consequences of trauma exposure, the institute says. These models are evidence-based and offers best practices for treating trauma. According to SAMHSA’s publication, “Trauma-Informed Care in Behavioral Health Services,” trauma-specific therapies vary in their approaches and objectives. Some focus on the past, while others on the present.

What Does Trauma-Informed Addiction Treatment Mean?

Substance use treatment centers that uses a trauma-informed approach take into consideration the effects and consequences of trauma on the whole person, as well as the role traumatic experiences and events play in the development of addiction. It also reviews the trauma that has resulted from drug and alcohol use.

A person’s trauma history should be reviewed during the planning of a recovery treatment program that adequately meets their unique and specific needs. It is essential in helping them heal from both the trauma and substance addiction. People who have both a mental health disorder and a substance use disorder (SUD), a condition known as dual diagnosis, are in this population. Any treatment plan that fails to address the mental health care aspect of their condition or any trauma they have experienced likely will not be effective.

SAMHSA also offers insight into what trauma-specific intervention programs recognize. Addiction treatment programs that offer trauma-focused care should offer Interventions that understand:

  • Survivors’ needs to be respected, informed, connected, and hopeful regarding their recovery
  • How trauma and symptoms of trauma, such as substance use, eating disorders, depression, and anxiety, are related
  • Why it’s important to work together with survivors, family and friends of the survivor, and other human services agencies in a way that empowers survivors and consumers

Treating PTSD and Substance Addiction

There are a variety of treatment options available to treat PTSD and other mental and emotional disorders. The kinds of approaches, therapies, and interventions offered depend on the facility. Below are a few methods that demonstrate how trauma-focused addiction treatment would look when put into practice.

Cognitive Behavioral Therapy (CBT)

Woman grabbing her head in pain because of her trauma

Cognitive behavioral therapy (CBT) is an effective approach to addressing trauma and substance use. This addiction therapy aims to help people change unhealthy thoughts and beliefs they have that are aligned with dysfunction behaviors. Therapists teach CBT clients problem-solving skills that help them recognize problematic thinking that usually leads to substance use and make better choices that keep them from using again.

The Addiction and Trauma Recovery Integrated Model (ATRIUM), one kind of trauma-specific treatment, combines CBT and treatment approaches that promote a focus on the whole person and their mental, physical, and spiritual health. As SAMHSA explains, “This 12-week model for individuals and groups blends psychoeducational, process, and expressive activities, as well as information on the body’s responses to addiction, traumatic stress, and the impact of trauma and addiction on the mind and spirit.

Trauma therapy also “helps clients explore anxiety, sexuality, self-harm, depression, anger, physical complaints and ailments, sleep difficulties, relationship challenges, and spiritual disconnection,” SAMHSA writes.

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

In the addiction center setting, trauma-informed care may include therapies, such as eye movement desensitization and reprocessing, or EMDR. This therapy was designed to help people with post-traumatic stress disorder, and those who have been dually diagnosed have found it to be effective.

During an EMDR session, therapists work with clients as they revisit painful or frightening memories and guide them through it to achieve two primary goals. One is to desensitize the person to the memory and triggers that spark negative emotions and behavior; the other is to help the person reprocess their thoughts in healthier ways.

Seeking Safety

According to its website, Seeking Safety is a counseling model started in 1992 that was designed to help people attain safely from trauma and/or substance use. This therapy, an example of a trauma-specific treatment, addresses both the trauma and the addiction in populations such as the homeless, domestic violence survivors, veterans and military, people with severe mental health disorders, and others. It does not require clients to revisit the details of their trauma experiences, which makes it easy to use, flexible, and appealing to a wide range of clients, the site says.

Seeking Safety can be used in an individual setting or within groups, and it can be adapted to any length of addiction treatment or level of care, including outpatient, inpatient, and residential. It also can be applied to any trauma or type of substance.

The Seeking Safety program’s curriculum includes 25 topics for discussion with titles such as PTSD: Taking Your Power Back, When Substances Control You, Getting Others to Support Your Recovery, among others. The topics can be done in any order and completed as time allows.


Sack, David, MD. (2017, June 22). Emotional Trauma: An Often Overlooked Root of Addiction. Retrieved from

National Center of Biotechnology Information, (January, 2017).Trauma-Specific Services. National Center of Biotechnology Information. Retrieved from

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