Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Behind many substance use disorders is a story of pain. It might be abuse or neglect in childhood, an assault, combat, a violent relationship, a devastating accident or years of living with fear. For many people, alcohol and drugs first showed up as a way to cope with memories, feelings or body sensations that seemed unbearable. Over time, the solution became a problem of its own.
Understanding the link between trauma and addiction can replace shame with compassion and point the way toward treatment that addresses the root of the problem, not just the symptoms. If painful memories or substance use have you thinking about suicide, call or text 988 now. If there is an overdose or immediate danger, call 911.
What Counts as Trauma?
Trauma is less about the event itself and more about its impact. It generally refers to experiences that are physically or emotionally harmful or life-threatening and that have lasting effects on a person’s well-being. Examples include:
- Physical, sexual or emotional abuse
- Neglect or growing up in an unstable, frightening home
- Sexual assault or intimate partner violence
- Combat, first-responder work or witnessing violence
- Serious accidents, disasters or medical emergencies
- The sudden or violent death of a loved one
- Ongoing discrimination, bullying or community violence
Two people can go through the same event and respond very differently. There is no “right” way to react to trauma.
Childhood Adversity and Later Substance Use
The CDC uses the term adverse childhood experiences, or ACEs, to describe potentially traumatic events in childhood. These include abuse and neglect as well as growing up with household challenges such as substance use, mental illness, violence, parental separation or a family member in prison. Research has linked ACEs with a higher risk of substance use, mental health conditions and physical health problems in adulthood.
ACEs are not destiny. Supportive relationships, safe environments and effective treatment can change the path at any age.
How Trauma Changes the Brain and Body
Trauma can leave the body’s alarm system stuck in the “on” position. People may feel constantly on guard, startle easily, struggle to sleep or feel flooded by emotions that come out of nowhere. Others experience the opposite: numbness, emptiness and feeling disconnected from themselves.
Substances can seem to offer relief from both extremes. Alcohol, opioids and sedatives can quiet hyperarousal and dull painful memories. Stimulants can cut through numbness or exhaustion. Cannabis may be used to fall asleep or avoid nightmares. The relief is real in the moment, which is exactly what makes the pattern so hard to break.
The Cycle of Trauma and Substance Use
Trauma and addiction tend to reinforce each other. Intoxication can increase the risk of new traumatic experiences, such as accidents, assaults or dangerous relationships. Withdrawal symptoms like anxiety, irritability and insomnia can feel a lot like trauma symptoms, which drives more use. And when people stop using, memories and feelings that were numbed for years may come rushing back, raising the risk of relapse if support is not in place.
Signs Trauma May Be Driving Substance Use
- Using to sleep, to avoid nightmares or to stop intrusive memories
- Drinking or using when reminded of a painful experience
- Feeling unable to relax or feel safe without substances
- Past attempts to quit ending when difficult emotions resurfaced
- Strong feelings of shame, guilt or worthlessness tied to past events
What Trauma-Informed Care Means
Trauma-informed care shifts the question from “What is wrong with you?” to “What happened to you?” SAMHSA describes key principles that guide this approach, including:
- Safety, both physical and emotional
- Trustworthiness and transparency
- Peer support
- Collaboration and shared decision-making
- Empowerment, voice and choice
- Attention to cultural, historical and gender issues
At Promises Dallas-Fort Worth, trauma-informed care shapes the entire treatment environment, with the goal of making sure the care meant to help clients never repeats the harm they have already lived through.
Treating Trauma and Addiction Together
Effective care addresses both conditions in one coordinated plan. Treatment often begins with stabilization. That can include medical detox when withdrawal needs supervision, since withdrawal from alcohol and benzodiazepines can be life-threatening. Stabilization also means building coping skills and a sense of safety before diving deeply into painful memories.
From there, dual diagnosis treatment at Promises DFW can combine cognitive behavioral therapy, dialectical behavior therapy, mindfulness-based approaches, individual and group therapy, family therapy and psychiatric care. For people whose trauma has led to PTSD, PTSD treatment is part of the plan. Care is available in residential treatment, a partial hospitalization program in Lewisville and a virtual intensive outpatient program for adults anywhere in Texas, followed by aftercare planning.
When Someone You Love Is Struggling
Watching a loved one cope with trauma through alcohol or drugs can be heartbreaking and confusing. Try to respond to the pain underneath the behavior rather than only the behavior itself. Avoid pressing for details about what happened, and do not use their trauma as leverage in arguments. Set clear boundaries around substance use while making it plain that you care. Our page on supporting a loved one offers more guidance, and family therapy can help everyone heal together.
Frequently Asked Questions
Does everyone who experiences trauma develop an addiction?
No. Many people who experience trauma never develop a substance use disorder. Trauma raises the risk, but it does not determine the outcome.
Will I have to talk about my trauma right away in treatment?
No. Trauma-informed care respects your pace. Early treatment focuses on safety, stability and coping skills. You decide when and how much to share.
Can I work on trauma while I am still using?
Deep trauma work is usually safer once substance use is stabilized. A treatment team can help you build that foundation first.
Is it possible to recover from both trauma and addiction?
Yes. Recovery is a process, not a single event, but with integrated care, support and time, many people learn to live with their memories without needing substances to survive them.
Heal the Root, Not Just the Symptoms
Your substance use makes sense in light of what you have lived through, and you deserve care that sees the whole picture. Call Promises DFW 24/7 at (469) 546-9303. You can also look into coverage or send a confidential message.