What is Trauma
Anyone born after 1993 can remember where they were on September 11th, 2001. While the effects of this event were felt stronger by some than others, it still resonates with almost all Americans today. This is a traumatic event felt across the nation.
For those of us not directly impacted by the events of 9/11, while the memory still rings clear, we have learned to adapt and cope, clearly because over 800 flights arrive in JFK each day. While an event like 9/11 resonates with all of us, personal traumatic events can take a much greater toll on our physical, emotional, and mental health. For instance, if you’ve ever been in a car accident, chances are you’ve experienced some form of trauma. Whatever the conditions were on that day, you may be hesitant to drive during those times; for instance, if you were in an accident at night, you now might only drive during the day.
Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences.
Evolutionary, trauma was supposed to help us survive. Here’s an example: let’s pretend you are alive 15,000 years ago when humans were a part of the food chain. If for instance you walked past a bush and were suddenly attacked by a lion, your fight or flight responses would kick in - pumping your body with stress response hormones like adrenaline to help you think fast and move quicker. Chances are you’d instinctively choose the flight response and escape the dangers of the lion. Now, next time you are next to a bush, you think about that lion experience and chances are, bushes aren’t going to be a part of your daily walking trail. For this reason, this traumatic event has helped you survive and stay away from the ghost and the darkness.
Effects of Trauma Today
Now fast forward a couple of years, we still experience traumatic events, but why? We aren’t being constantly hunted by lions anymore. Unfortunately, the world is still filled with another kind of darkness, but this time, adapting to these traumatic experiences (like avoiding the bush) won’t help us but will veritably hinder our life’s experiences, sometimes indefinitely.
Take for example Jamie who was bullied through a social media platform like Facebook. Jamie might quit Facebook altogether to avoid this unwanted attack. While this seems like a fix, it is only temporary. No matter your stance on Facebook, not being a part of a large social media platform can create a sense of F.O.M.O and eventually social disconnect - especially at a young age.
The same hormonal responses you feel when you see a lion in a bush will be the same responses Jamie feels every time she turns on her computer. Every assignment she must submit online, every social gathering, every time she tries to sleep - she’s reminded of what the bully said.
Over the course of the day, the stress hormone response that was intended to help us avoid lions is now being used over and over. One of these hormones is cortisol. Cortisol is the chemical hormone used in our fight-or-flight response system. Cortisol uses inflammation to help regulate our brain to control our mood, motivation, and fear. When used normally, cortisol helps us get into the zone and overcome stressful situations. When these cylinders are firing all day, it causes in increased inflammation in the brain causing depression, anxiety, and a variety of other disorders.
What Trauma Looks Like in America
According to SAMHSA, “In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 percent of clients in public behavioral health care settings have experienced trauma.”
The effects of traumatic experiences can differ from person to person. For instance, in a car accident, the person driving might have a much greater fear of driving while the person in the passenger seat may now fear riding.
Additionally, people with minor traumatic experiences early in life may be better at coping with bigger experiences later in life. A common example of this is the death of a parent. Often times this is a very common traumatic experience - but affects different people in different ways depending on their coping skills, the strength of their relationship, and at what point in their life this occurred.
As you can see, dissecting trauma is a complicated process but crucial in understanding the root cause of the vast majority of substance use disorders. Below you will find out symptoms of trauma, the varying degrees of trauma, and how trauma correlates to substance use disorders, and lastly, the specialized trauma therapies used to treat the different kinds of trauma.
Common Responses and Symptoms of Trauma
Response to a traumatic event varies significantly among people, but there are some basic, common symptoms.
- Emotional signs include:
- sadness
- anger
- denial
- fear
- Shame
- These may lead to:
- nightmares
- insomnia
- difficulty with relationships
- emotional outbursts
- Common physical symptoms:
- nausea
- dizziness
- altered sleep patterns
- changes in appetite
- headaches
- gastrointestinal problems
- Psychological disorders may include:
- PTSD
- depression
- anxiety
- dissociative disorders
- substance abuse problems
Types of Trauma
Acute Stress Disorder vs. Post-Traumatic Stress Disorder (PTSD)
When a person develops some traumatic symptoms, but they go away after a few weeks, it is considered acute stress disorder. Acute Stress Disorders are typically associated with minor traumatic events like the break-up of a relationship or an embarrassing event at work.
A person may be suffering from Post-Traumatic Stress Disorder (PTSD) if their symptoms last more than a month and severely affect the person’s ability to function. Contributory effects of PTSD can include depression, panic attacks, suicidal thoughts, feelings of being isolated, not being able to complete daily tasks, and drug abuse.
Small ‘t’ vs. Large ‘T’ Traumas
We can place traumatic events into two categories - small ‘t’ and large ‘T’. Small ‘t’ traumas are events in which one’s bodily safety or life is not threatened, but symptoms of trauma exist nonetheless. These types of events can include things like financial troubles, legal battles, work stress, moving or a new job, divorce, infidelity, or an upsetting personal conflict.
Large ‘T’ traumas, on the other hand, are extraordinary experiences that bring about severe distress and helplessness. They can be one-time events like acts of terrorism, or prolonged stressors like war, and child abuse/neglect.
- Bullying
- Community Violence
- Complex Trauma
- Disasters
- Early Childhood Trauma
- Intimate Partner Violence
- Medical Trauma
- Physical Abuse
- Refugee Trauma
- Sexual Abuse
- Terrorism and Violence
- Traumatic Grief
Small ‘t’ events are more likely to cause acute distress disorder, whereas large ‘T’ events will commonly cause Post-Traumatic Stress Disorder. The treatments for each will vary depending on the severity of how much the event(s) affect the person and how long after the event the person is seeking therapy.
How Trauma influences Addiction
In 1995, the U.S. health maintenance organization Kaiser Permanente and the Center for Disease Control and Prevention performed a study known as the Adverse Childhood Experience Study or (ACE). They took over 17,000 participants and asked them a series of questions regarding their childhood background.
Participants were asked about different types of childhood trauma that had been identified in earlier research literature:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Exposure to domestic violence
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
The questions used can be found published as the NPR ACE quiz.
The Adverse Childhood Experience Study (ACES) found that compared to an ACE score of zero, having 4 adverse childhood experiences was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema; an ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.
When we hear the word “trauma” we almost always think of a singular event – a car crash, family death – but what the Adverse Childhood Experience study shows is that trauma is also complex, or related to multiple experiences are shared beliefs. Sometimes psychiatrists will refer to this as complex PTSD. Many of the common examples of CPTSD are found in the ACE questionnaire like childhood neglect.
Therapy Options for Trauma
We know that addiction is a supplementary effect to another underlying symptom. This can be chronic stress, severe anxiety disorder, or chronic depression among others. But generally, these mental health disorders are often side-effects from previous traumatic experiences. To fully treat all of these subsidiary symptoms (or causes) of addiction, we must address trauma.
Fortunately, there is the hope of recovering from traumatic events. Through talk therapy, individuals can slowly start to dissect these experiences and eventually come to terms with them. Over time, talk therapy can help individuals not only overcome their traumatic experiences but also reverse many of the mental and physical damages caused by trauma.
Cognitive Behavioral Therapy (CBT) teaches the person to become more aware of their thoughts and beliefs about their trauma and gives them skills to help them react to emotional triggers in a healthier way.
Clients with co-occurring disorders may benefit significantly from Cognitive Behavioral Therapy. According to a study originally published in Addictive Behaviors, 35-50 percent of people enrolled in treatment programs for addiction have a lifetime diagnosis of PTSD, and 25-42 percent have a current diagnosis. In that study, researchers found that subjects suffering from a substance use disorder and PTSD had a positive outcome when they underwent Cognitive Behavioral Therapy. Because CBT does not focus on combatting addiction directly but rather on combatting negative thought patterns that contributed to addiction, it can be an effective way to treat a variety of mental health disorders that occur alongside the disease.
Exposure Therapy (also called Vivo Exposure Therapy) is a form of cognitive-behavioral therapy that helps reduce the fear associated with the emotional triggers caused by the trauma.
Talk therapy (psychodynamic psychotherapy) is a method of verbal communication helping a person find relief from emotional pain and strengthen the adaptive ways of problem management that the individual already possesses.
Accelerated Resolution Therapy (ART) is a form of psychotherapy with roots in existing evidence-based therapies but achieves benefits much more rapidly (usually within 1-5 sessions).
At Coalition Recovery, we utilize each of these therapies to help people overcome their traumatic experiences and move on with their life. By healing these underlying disorders, we can effectively treat addiction for the long-term limiting relapse.
If you are looking into addiction treatment, ensure your facility is a dual-diagnosis facility, meaning they are able to treat both substance use disorders and mental health disorders like depression, anxiety, and trauma.
RESOURCES
If you are experiencing any of the symptoms of trauma and are looking for help and information, the following organizations may be able to help:
National Center for Post-Traumatic Stress Disorder (NCPTSD)
The NCPTSD is part of the Department of Veterans Affairs. They work to improve the clinical care and welfare of America’s veterans. Their website is an educational resource for PTSC and the consequences of traumatic stress.
