Addressing Trauma in Addiction Treatment: A Call to Therapists

Addiction impacts us all. The word addiction often evokes negative stereotypes and labels to include junkie, bum, addict, and abuser. Person with substance use disorders or process addictions is misunderstood by members of their family and larger community. However, these descriptions fail to encapsulate the entirety of addiction.

Gabor Maté, author of, In The Realm of Hungry Ghosts: Close Encounters with Addiction drives home the message that individuals who become addicted to substances or other behavioral addictions often have a lengthy history of abuse, neglect, mistreatment, and TRAUMA! In his recounting of interactions with his patients Maté wrestles with the humanity of these individuals. Understandably, it is hard to process why someone would take a needle and inject a deadly substance into their veins. Maté himself also notes his own inner judgments and biases about patients under his care. What this book does well is sheds light on the nature of how trauma shapes the decisions his patients make.

The term Hungry Ghosts originates in Buddhist cosmology. The Realm of Hungry Ghosts includes figures who are depicted with scrawny little necks and huge bellies – riddled with powerful desires they can never really satisfy. This has been used as a metaphor for addiction. Individuals who identify with an addiction, crave a substance or behavior to satisfy a need. However, their bodies never reach satisfaction. Therefore, the use of a substance or the behavioral acting out continues in an effort to release the suffering felt.

Model of MacLean’s Triune Brain Paradigm by Lindsey Chun-Hori (2007)

Addiction treatment in my experience has not tapped into the Hungry Ghost Realm. Treatment is often guided by evidence-based practices that focus on traditional cognitive-behavioral models of intervention. The premise being “change your thoughts and you will feel and act differently”. Trauma disrupts the top down approach (executive functioning/neo-cortex) often attributed to healthy growth and development. Trauma works bottom up. Overriding fear and intense emotions guide behavior. Individuals who experience trauma and addiction often share the experience of not being able to shut off their brains and calm down intense emotions felt. That is addiction and trauma both work from the reptilian brain and limbic systems. Agencies adopting a traditional model of addiction treatment focus primarily on the cravings, urges, and triggers to the detriment of how trauma shapes behavior. Additionally, the focus on thoughts rather than the body keeps the individual stuck in a traumatized state/The Realm of the Hungry Ghosts.

Trauma treatment is addiction treatment. A colleague once told me “You need to be an addictions counselor doing addictions work. Not a mental health counselor doing addictions”. One cannot separate addiction treatment from trauma work. The historical division of labor within the addiction treatment field is harmful. In days past, mental health issues and trauma were not dealt with in addictions treatment agencies.

A story in the Big Book of Alcoholics Anonymous about a man who went to see different psychiatrists to relieve his issue with alcohol. Each attempt to seek medical treatment did not prove successful. The gentleman then sought out the great Dr. Jung who claimed he never successfully treated an individual with an alcohol use disorder so severe like the man’s unless the man had a spiritual experience. Spiritual experiences are a wonderful thing. But they are inextricably difficult to achieve for the individual who’s mind and body are frozen in the past.

In my own experience of recovery I learned that I could not keep momentum going unless trauma and the body were part of the treatment equation. The 12 steps helped me to develop a solid foundation and tools for daily recovery. However, my heart, mind, and soul continued to be stuck in the past. Eye Movement Desensitization and Reprocessing Therapy (EMDR) helped me move beyond my past and heal. EMDR taught me to listen to language my body spoke.

As a trained EMDR therapist I educate my clients about the impact of trauma and addiction on the brain. I bring the body into each treatment episode. What I have noticed is a shift in healing capacity of my clients to stay attuned to what their bodies are doing or saying to them. Reclaiming our bodies has power!

Bessel van der Kolk in The Body Keeps the Score: Brain, Mind, and the Body in the Healing of Trauma adds to the discussion of trauma treatment. His work discusses how experiences are coded deep within the body’s framework even after the event has past. Memories are stored implicitly or explicitly.

I once heard an EMDR presenter tell the story of his fear of dogs. While he had no recollection of ever being bitten by a dog (no explicit memory) his body went into hypervigalence and panic/freeze mode. During the course of inquiring where this fear came from the man went to his mother to ask about any past traumatic events occurring in his childhood. To his surprise the man’s mother confirmed in infancy neighbors dogs surrounded him and he had been crying in the backyard. This singular event was coded deep within the man’s body so much so that he had an anxiety attack some 20-30 years later when ever he saw a dog.

This story is tangible proof of the power of our bodies to remember events. When we are overwhelmed emotionally and mentally our bodies do its job to protect us. Often times dissociation and compartmentalizing is a means by which our body strives to keep us in safety mode. A trauma-based treatment model that includes the body helps the individual regain a sense of control over the past and to unfreeze. Treatments like EMDR, Brain Spotting, & Progressive Counting help the brain to heal and move stuck information into adaptive information.

Our treatment options have surpassed what was available in the early days of addiction treatment. We have access to neurobiology, neuroscience, and more effective models of treatment that help the individual to heal and live fuller lives.

If you are reading this and have noticed an aversion to include trauma work in your addictions therapy, consider what prevents you from doing this work? Perhaps it is a need for clarification of how trauma impacts life, decision making, and wellbeing. Trauma education and training within the addictions field is in its infancy stage. Consider attending trainings that focus on the intersections of trauma and addiction. Or maybe you subscribe to the philosophy that people have the will or free choices to act or not to act.

Sometimes our own wounding clouds our perceptions. It is important to consider the impact past wounding may have on the type of therapy you practice. Psychotherapy and counseling are not for clients alone. Secondary traumatization can occur when the work we do starts to affect us on a deep level. The stories we hear in our day-to-day lives as clinicians may affect you. Self-care is important for clinicians working in addictions. Burnout rates are highest in field of counseling. Our clients need us to be healthy role models. It is important that we tend to our own wounds, especially those that prevent us from going to a place of pain or vulnerability with our clients.

Whatever the case may be I ask that you allow time to consider the research available. You might start by reading Kaiser Permanente study on Adverse Childhood Experiences (ACES) Study and literature which cites an increase in addictions based on past traumatic and difficult experiences in formative years. Be part of the solution. The trauma lens is critical to helping clients create successful lives in recovery.

Let’s end the distinction between addictions treatment and trauma therapy and work to integrate the two. May the words of Ghandi be your guide:

Be the change you want to see in the world.

-Ghandi

Thank you for taking the time to read this! I look forward to hearing your experiences with integrating trauma work into your clinical practice.

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