There have been great strides in the field of substance abuse treatment over the past few years in terms of recognizing that there is a definite link between substance abuse and mental health issues, and that these issues need to be treated concurrently. More and more, treatment providers are finding that substance abuse issues and mental health issues are present in people that have experienced trauma. A person that experiences a traumatic event may respond with intense fear, helplessness, or horror, and may have disturbing flashbacks and nightmares about the event, in addition to several symptoms of anxiety that may include difficulty sleeping, irritability, difficulty concentrating, and startling easily. These symptoms become so distressing that the traumatic experience impairs the person's ability to function in everyday life. Individuals that have experienced a traumatic event may also attempt to numb these responses in an effort to avoid the feelings they have resulting from the trauma; this often comes in the form of abusing substances.
In order for substance abuse and trauma to be treated concurrently, treatment must come in the form of trauma-informed care. Trauma-informed care means that service providers have knowledge of a person's trauma history, understand the role that trauma plays in different aspects of the consumer's world view, and most importantly, believes that recovery is possible. It is also important that the trauma and its impact on the person be addressed in treatment, and that healing from the trauma is a part of the individual's recovery plan. Service providers also need to make feelings of safety, choice, and control a priority in treatment; it is important that the person receiving help feels physically and emotionally safe, empowered to make their own choices in recovery, and has basic needs like shelter and food met.
When a person is abusing substances, there are several trauma-related issues that need to be taken into account. Substance abusers are vulnerable to retraumatization due to risky behavior that is associated with using substances, such as theft, prostitution, robbery, violence, and contraction/spread of deadly diseases. Substances can also play a part in physical, sexual, and/or emotional abuse, due to the perpetrator using substances, or the victim being under the influence of a substance at the time the abuse occurs. It is also important for treatment providers to understand that victims of trauma often use substances to manage emotional stress, referred to as a type of "chemical dissociation." Repeated instances of stress and abuse can cause uncomfortable physical symptoms including rapid heart beat, shortness of breath, shallow breathing, sweating, and trembling. This, in turn, prevents the substance abuser from being able to regulate intense emotional states, and a desire to get rid of the emotions and physical symptoms they are feeling.
People that are opiate dependent seem to be particularly affected by trauma. According to researchers at the University of New South Wales, 92 percent of people that meet the criteria for opiate dependence have experienced at least one traumatic event during their lifetimes, with the majority of these people experiencing multiple traumas. In addition to this alarming statistic, the researchers also discovered that 41 percent of heroin users are also dually diagnosed with post-traumatic stress disorder. While substance abusers overall suffer from issues related to past trauma, special attention must be given to the opiate dependent population in regards to treatment for trauma. Whether treatment comes in the form of an abstinence based model or a risk reduction model of recovery, treatment providers must take a whole-being approach to treatment and ensure that trauma issues are being treated concurrently.
Jessica Parks is a certified alcohol and drug counselor in the state of Illinois and has her M.A. in art therapy counseling.