From Maryland Addiction Recovery Center

By Robyn Brickel, MA, LMFT

In the struggle with substance abuse, sometimes the goal of just getting free from the frightening dependence on drugs or alcohol can hijack all our attention.  So, as a therapist, I want to thank you for your June 10, 2016 article on “The Link Between Trauma and Addiction,” and allowing me to write a follow up article from a trauma-informed care perspective.  

I cannot stress enough how important it is to consider and treat trauma when we talk about addiction treatment and recovery.  There is always a reason someone is using. When a pattern of addiction behavior has taken hold, it is not because it’s fun or feels good. People use because they are trying to maintain a sense of feeling “normal,” to feel less badly, or to feel less of anything at all.

What kind of trauma are we talking about? You said it perfectly, “trauma can be different for everyone.”  Indeed, trauma is in the eye of the perceiver.

What is Trauma?

Trauma happens when something overwhelms and threatens a person’s sense of safety or ability to cope. One person’s forgettable incident may be another person’s haunting memory. For some, it could be their parents’ divorce. It could be getting lost in the grocery store. It could be having a childhood illness, or being in the hospital. It may be witnessing violence, or the suffering of a family member. It may happen with an abusive, absent or addicted parent, or silent emotional distance from a primary caregiver.

Trauma can actually be any event!  What matters is that the person perceived trauma in their life.  We need to recognize its impact on a person’s mental health and its certain role in addiction.

Often people who develop addiction don’t see themselves as trauma survivors.  I want to encourage more people — therapists and families and people struggling with addiction — to see addiction recovery through a trauma-informed lens.

What It Means to Be Trauma-Informed

Becoming trauma-informed means learning about the impact of overwhelming, toxic stress on every part of the trauma survivor’s life.  As a therapist, providing trauma-informed care means being aware that for people that are using addiction behavior, a history of trauma is nearly always part of their experience. We need to become skilled and adept at guiding the recovery process to include treatment for trauma. This way long-term recovery is more likely to be sustainable.

Therapists study many principles and treatment methods in trauma-informed care. But here I’d like to focus on three ways a trauma-informed approach helps with addiction recovery:

• It takes a non-pathologizing view — respecting the person in recovery as a worthy human being; they are not bad people, just people in pain!
• It builds awareness of stages of recovery — a “road map” for healing, not just the using behavior, but the pain that they were trying to address by using.
• It enables the client, trauma survivors, to replace self-harming/addictive behavior with self-care, even with the same emotional triggers.

The Non-Pathologizing View in Trauma-Informed Care

Many who struggle with addiction have self-tormenting thoughts about how weak, flawed or somehow defective they are for having this problem. Being non-pathologizing means seeing the person recovering as a human being in pain facing great challenges, not a defective person.

Trauma-informed therapy creates a space to recognize and claim the innate worth of the person in recovery.  It does not mean turning a blind eye to substance abuse. Rather, we see people who tried to numb themselves to feel less badly, not because they are bad.

The non-pathologizing approach of trauma-informed care helps build the trust and safety needed for healing. But it’s also important because it offers survivors a valid self-caring way to see themselves.  They can see that they turned to self-harming addictions because there was nowhere else to turn to feel less, or to feel less badly. But now we can find a healthier path.  There is hope!

Understanding Stages of Recovery

Therapist and author Judith Herman describes three stages of recovery from trauma, including addiction:

• Stage 1: Safety and Stabilization
• Stage 2: Remembering and Mourning
• Stage 3: Reconnecting and Integration

Stage 1: Safety and Stabilization, the Longest Stage

Stage 1 is all about getting a sense of being clean and sober, and learning coping skills to deal with emotions, painful thoughts and feelings, and urges to use. When emotions are no longer numb, many in recovery feel overwhelming anxiety or depression, and they don’t know what to do.

I believe Stage 1 is the most important stage, and it’s only the beginning of the journey.

The first goal is to develop coping skills so a person in recovery knows what to do to recognize and deal with emotions in healthier ways.

It’s also about learning skills to manage painful mental states such as flashbacks or self-criticism.  Helpful skills include mindfulness, self-care and finding trusted resources and supportive people and groups that might include 12-step programs. Therapists may want to incorporate Dialectical Behavior Therapy (DBT), Community Reinforcement and Family Training (CRAFT) and many other modalities to help those in recovery develop strengths and stable relationships, and minimize unhelpful responses.  (Some therapists, myself included, use training in multiple modalities such as Sensorimotor Psychotherapy, Ego State Psychotherapy, and EMDR, which are helpful in both Stage 1 and Stage 2 of treatment and recovery.)

It is so important for family members and people in recovery to understand this process.  It’s important to realize that completing a 28-day program doesn’t mean you’re done – you’ve only just begun. It takes time to build new coping skills. It takes time to develop connections with supportive people and 12-step or other support groups.  That’s why Stage 1 is the longest stage of trauma and addiction recovery.

About Stage 2: Remembering and Mourning

In Stage 2, stabilization to gain freedom from substance use allows people to stay present and grounded while they make sense of what happened in their lives. Trauma-informed therapy helps survivors to process unresolved trauma.  Mourning the loss of the happy childhood or peace of mind that you could not enjoy is part of this process.

As a trauma survivor, you learn that this is part of your experience, but it’s not who you are.   You do not have to recall every detail to heal, but you can remember it if you wish, and retell it without reliving it. Because of Stage 1, you are able to stay in the present moment as you review the past. You know healthy ways to cope with any triggers or cravings to use that may appear.

About Stage 3: Reconnection and Integration

In Stage 3, unresolved trauma no longer defines or organizes your life. You recognize the impact of trauma – but you can heal, grow and live with it. You experienced overwhelming difficulty, but now you are growing from that. Your goal is to pursue a happy, healthy, loving life.

Replacing Self-harming Behavior with Self-Care

Therapist and author Babette Rothschild reminds us “the first goal of trauma recovery must be to improve your quality of life on a daily basis.”

It’s about living your life in the present moment, so you’re not living in the body’s unhealed response to traumatic memories.  It really is a matter of improving your quality of life.

Even if progress in trauma treatment feels slow, that does not make it poor progress.  Maintaining sobriety and recovery while processing difficult feelings and emotions is the key – stabilization is always required to make progress.  In fact, slow progress is often good progress. That is because trauma-informed recovery allows us to honor the time it takes to cultivate new skills, strengths and abilities to maintain healthy behaviors and resilient healing.

For everyone, understanding trauma’s role in addiction helps us better support people in recovery.  Being trauma-informed helps those in recovery to understand themselves and why they began using, their need for emotional safety, the universal need for healthy coping skills and connections, and their right to feel calm and good about themselves. In treatment, it helps therapists guide a positive journey to greater self-understanding, self-care and powerful coping skills.  It is the most powerful approach I know to grow from addiction into a fulfilling, self-directed life that is not trauma driven.