This post was inspired by an experience that our Director, Dr Lisa Cherry had when delivering training to staff working with people using alcohol. She explains, “quite openly, two people were having a conversation about someone who they had seen outside the building who was unhoused. They described him as a ‘hobo’ and went on to say that it was his choice that he was drinking and therefore, his fault that he was in that situation. This was not a conversation on the bus. I was there delivering trauma informed training and they were there in the capacity of serving people living with the impact of self medicating on drugs and alcohol. I was shocked.”
When we talk about addiction, one of the most important factors often overlooked is the profound connection between trauma and self-medication (Dixon et al., 2024). Now, before you read any further, at TICS, we recognise that many people struggling with addiction are frequently judged due to the persuasive ideology that alcohol and drug misuse is simply about making a choice. We hold the view that ‘addiction’ is actually self medicating; it is about survival. So, this blog comes from a place of understanding and compassion and we hope that this will support increasing the level of understanding about the psychological underpinnings of self-medicating through the lens of trauma. Without this, taking an authentic, compassionate perspective is impossible.
The Link Between Trauma and Self-Medication
Self-medication is often a response to overwhelming emotional pain from unresolved trauma. Individuals who have experienced trauma may turn to substances—whether drugs, alcohol, or even food—to numb the persistent feelings of fear, shame, anxiety, or depression. The substances become a way to escape or soothe the nervous system’s heightened state of alertness, a hallmark of trauma (Ayres, 2021).
Many of us who have experienced trauma may face hyper-vigilance, intrusive memories, or dissociation. These symptoms can make everyday life feel unbearable (Stubley & Young, 2021). In the absence of healthy coping mechanisms or emotional support, turning to substances can feel like the only way to manage these symptoms. This is particularly the case given that sometimes the situations which surround the trauma may leave the individual lost for words so seeking other forms of support may feel impossible. This can be an isolating time and leave a person feeling that the only thing they can do is to try to help themselves reduce the deep distress that hyper-vigilance or intrusive memories (Downey & Crummy, 2022). Therefore, self-medication is often subconscious - a desperate attempt to reclaim a sense of safety or control over emotions that feel unmanageable (Costanzo & Schimmenti, 2023).
The Psychology Behind Addiction and Trauma
From a trauma-informed perspective, addiction is not simply about seeking pleasure or avoiding discomfort. It isn’t a choice. It isn’t an easy option. The brain, especially one impacted by trauma, seeks balance and safety. Traumatic experiences can alter brain function, particularly the areas responsible for regulating stress and pleasure. Chronic trauma leads to long-term changes in how the brain processes stress, emotions, and rewards due to neuroplasticity, or essentially, the brain’s structure adapting (Thomason & Marusak, 2017).
When someone with a history of trauma turns to substances, those substances can temporarily ease the burden on the brain's overwhelmed stress response systems (Ebrahimi, et al.,2024). For instance, one particular substance might dull anxiety, while opioids can provide a numbing effect against emotional pain. Over time, however, the brain begins to rely on these substances to maintain equilibrium, gradually leading to dependency (Maria-Rios & Morrow, 2020).
In many cases, addiction arises not because of a lack of willpower, but as a result of the brain's attempt to regulate itself in the wake of trauma at a time of inner turmoil. This understanding challenges the traditional narrative of addiction as a moral failing and instead reframes it as a survival strategy that, over time, becomes harmful.
What can be done to help?
If you find yourself supporting those who self-medicate or struggle with addiction, your first port of call must be to view it through a trauma-informed lens. This ensures that we see beyond “curing” the addiction itself but that we consider what needs might be being met (Ogilvie & Carson, 2022). How might this person be using their self-medication to help them to survive and what can we do about it? It demands understanding the underlying trauma that may be driving the behaviour. Here are some of the things that we know work:
There will likely be feelings of shame and guilt surrounding their addiction. These feelings are compounded by societal stigma. As a professional, one of the most crucial steps is establishing a space where individuals feel safe from judgment and criticism. Listening empathetically and validating their experiences fosters trust, which is essential for healing (Comiskey, 2024).
2. Understand the Role of Trauma
It’s vital to assess for trauma in any patient struggling with addiction. Trauma history should be considered from point of treatment outset and onwards. We need to ask questions about trauma gently, acknowledging that for many people, the roots of their addiction lie in past painful experiences.
3. Focus on Coping Skills, Not Just Abstinence
While reducing or eliminating substance use is an important goal, recovery efforts should focus on what healthy coping mechanisms might look like for them, holding in mind this will be different for everyone. Essentially, we want to gently work towards a place where they have alternative ways of managing their emotions and trauma triggers. This reduces the reliance on substances to cope.
4. Address Co-Occurring Disorders
Trauma survivors often experience co-occurring mental health disorders such as PTSD, anxiety, or depression. Treating these alongside addiction is critical to long-term recovery (Robinson & Deane, 2022). A trauma-informed approach integrates both mental health treatment and addiction recovery, ensuring that the individual’s emotional well-being is fully supported.
5. Empowerment Through Choice
Trauma often deprives individuals of their sense of agency. They may feel powerless in the face of both their past and their addiction. Be sure to actively work to keep them at the centre of all decision-making processes regarding their treatment. Offering choices about their recovery plan can help them to be more in control which is a critical part of healing from trauma.
6. Incorporate Trauma-Specific Therapies
Trauma specific therapeutic modalities including EMDR (Eye Movement Desensitisation and Reprocessing), somatic therapy, or trauma-focused cognitive-behavioural therapy (CBT) can be integrated into addiction treatment to directly address the underlying trauma by trained and skilled practitioners. These therapies focus on reprocessing traumatic memories in a way that allows the brain to heal and reduces the emotional triggers that often lead to substance use. Alternatively, you can play an invaluable role in signposting if you are not a clinician.
Conclusion
When it comes to addiction, we must move beyond the surface-level understanding of substance use and look at the deeper causes. For many, addiction is rooted in a desperate attempt to cope with overwhelming trauma. By adopting a trauma-informed perspective, professionals can provide more compassionate, effective care, helping individuals not just manage their addiction but also heal from the trauma that drives it.
Healing from addiction is possible, but it requires that we shift from focusing solely on symptoms to addressing the core of the pain. Trauma-informed care is the key to creating long-lasting change, empowering individuals to reclaim their lives and find healthier paths to recovery.
References
Ayres, T. C. (2021). Childhood trauma, problematic drug use and coping. Deviant Behavior, 42(5), 578-599.
Comiskey, C. (2024). Strengths-Based Approaches Addressing Stigma and Trauma: How Do We Address Stigma and Develop Trauma-Informed Approaches?. In Addiction Research and Evaluation: Addressing Key Challenges for Policy and Practice (pp. 121-142). Cham: Springer Nature Switzerland.
Costanzo, A., Santoro, G., & Schimmenti, A. (2023). Self-medication, traumatic reenactments, and dissociation: A psychoanalytic perspective on the relationship between childhood trauma and substance abuse. Psychoanalytic Psychotherapy, 37(4), 443-466.
Dixon, K. E., Owens, A., Lac, A., Samuelson, K. W., & Mahoney, C. T. (2024). Do Coping Self-Efficacy, Coping Flexibility, and Substance Use Coping Mediate the Connection from PTSD Symptoms to Problematic Alcohol Use Behaviors? Journal of Psychopathology and Behavioral Assessment, 1-13.
Downey, C., & Crummy, A. (2022). The impact of childhood trauma on children's wellbeing and adult behavior. European Journal of Trauma & Dissociation, 6(1), 100237.
Ebrahimi, C. T., Gette, J. A., Saraiya, T. C., & Hien, D. A. (2024). Treating Comorbid Posttraumatic Stress Disorder and Substance Use Disorder. In Treating Comorbid Substance Use and Emotional Disorders (pp. 93-121). Cham: Springer Nature Switzerland.
María-Ríos, C.E., & Morrow, J.D. (2020). Mechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders. Frontiers in Behavioural Neuroscience, 14, 6.
Ogilvie, L., & Carson, J. (2022). Trauma, stages of change and post-traumatic growth in addiction: A new synthesis. Journal of substance use, 27(2), 122-127.
Stubley, J., & Young, L. (Eds.). (2021). Complex Trauma: The Tavistock Model. Routledge.
Thomason, M. E., & Marusak, H. A. (2017). Toward understanding the impact of trauma on the early developing human brain. Neuroscience, 342, 55-67.