Trauma can contribute to addiction but is not always at the root of it
By Kevin Doyle, EdD
NOTE: This was originally published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
I recently engaged in a social media exchange about trauma and addiction, which was encouraging in that it did not degenerate into insults, name-calling, or shaming, but instead was a respectful exchange of ideas, centering around the role of trauma in the development of substance use disorders. A healthy social media experience may be worth writing about in and of itself, but in this article, I’d like to focus on the content of the exchange instead.
What got my attention initially was a statement along the lines of “all addiction is ultimately traced back to trauma.” In my experience, whenever one sees words like all or always, it is a good idea to dig a bit deeper and question the assumption.
While the powerful effects of trauma — such as physical or sexual abuse or neglect (childhood trauma, in particular) — cannot be denied or ignored, not everyone with a substance use disorder has a trauma history (nor does everyone with trauma develop a substance use disorder, for that matter). And attempts to “explain addiction” by attributing it to something else — trauma, depression, poverty, you name it — reflect a subtle stigma associated with the disease. It’s important that we continue to acknowledge addiction as a primary diagnosis or disorder with biopsychosocial elements — not something that is secondary to another condition (such as trauma, for example).
Certainly, increased substance use is one way that people with trauma histories attempt to cope with the pain of their traumatic backgrounds. With the potent substances available today, attempts to escape psychic pain through substance use are more dangerous than ever, and can have disastrous consequences, including addiction or death by overdose. However, in the search for any “holy grail” to explain why people become addicted, we run the risk of diminishing some of the realities of severe substance use disorders. For example, if one follows the slippery-slope idea that once a causal condition (such as trauma, for example) has been addressed, it’s safe to use substances again, real harm can result. In fact, this mindset can play into the idea that most every person with a substance use disorder seems to have had at one time or another: that a return to use is possible once the situation, stressor, or outside issue is resolved, be it a stressful job, an unhealthy relationship, or another factor. The reality, of course, is that we know it’s risky to return to use even when underlying psychosocial factors have been addressed.
Likewise, looking at substance use disorders as anything less than primary cheapens the work of researchers and advocates who, over the past several decades, have helped secure insurance coverage for addiction as well as recovery protections under the Americans with Disabilities Act. Viewing substance use disorders as having been universally caused by another factor would undermine the important pursuit of parity (the idea that people with addiction deserve a health care system that treats their disease as adequately as it does any other health condition).
Let’s make sure to address trauma and the important role it plays in the lives of many — not all — cases of substance use disorder, but avoid oversimplication and the risks that come with it. We know that both genetic and environmental factors contribute to addiction and that it’s an ever-evolving field of study as research continues to progress. It’s crucial to acknowledge this nuance and complexity in how substance use disorders develop so that we can prevent potential harm and help more people.
Kevin Doyle Ed.D., is the president and CEO of the Hazelden Betty Ford Graduate School of Addiction Studies in Center City, Minn.
