I have worked in the addiction field at some capacity since I got sober in 1996. The “12-step social model’ helped get me sober but it wasn’t until I started digging deeper and understanding the underpinnings to addiction (at about 10-12 years sober) did I really start healing. Science has clearly proven that the process of addiction is due to the brain operating from a place of survival rather than logic (read more here) . Over time the brain has come to connect intoxication as a source of survival; driving addicts to be impulsive, reckless, and insane. Much like any human would act had their source of food been taken from them for 3-4 days. In this situation we would all lie, steal, and hurt others for food. However, If it was just about the brain being addicted to intoxication, then just getting sober and quieting that hijacked brain should have a 100% success rate; but that is definitely not the case; quite the opposite. So I have taken on an endless journey to research not just what addiction is but what is driving it. While there are several factors (genes, epigenetics, temperament, and age of first intoxication) I have found the most common variable with addiction to be trauma. The more I started working in this field and unraveling addiction the more I saw trauma and I couldn’t ignore it. What I ran up against most, and still do, is the majority of people have a limited understanding of trauma, many don’t even know they have experienced it, and those that do don’t want to talk about it. Understandably, the nature of trauma makes us want to repel from it.
When most hear the word trauma they think PTSD, war, murder, etc…which is trauma but only one category of trauma. I call this “Shock” trauma. It is overt, often intentionally inflicted on us, and it literally shocks our brain and body. War, near death experiences, sexual abuse, physical, abuse, emotional abuse, neglect, and lack of basic needs like food and shelter are examples of this. In a study by the National Institute of Health they found, out of 587 adults with substance abuse or addiction, 70% had a history of shock trauma, most met criteria for PTSD. Shock trauma is the easiest to acknowledge as trauma but also the most difficult to turn towards.
The other type of trauma I see frequently is what’s referred to as Relational Trauma, or what I call Covert Trauma. Relational trauma often subtle, unintentional, and is often easily dismissed and minimized as trauma. Relational trauma comes from moments where we have a hard time fitting in, feeling like we don’t belong, difficulty relating to our parents and peers, feeling misunderstood, etc… In 12 step meetings you often hear people speak to this without even knowing it. “I grew up feeling like my skin didn’t fit.” “I grew up feeling like I missed a class everyone else got.” Different from shock trauma it is often unintentional but deeply impacts our attachment patterns with self and others. When our caregivers don’t know how to connect to us, emotionally support us, or is preoccupied with their own mental health, addiction, workaholism, sick child, or other dynamics taking away their ability to attune consistently it directly impacts our sense of self. Although different than shock trauma in many ways, our attachment to our caregivers is necessary for survival so any threat to this is perceived as a threat to our survival, and our nervous system responds similarly to Shock trauma. Ideally we want to feel validated, honored, and celebrated. We first want to feel this in relation to the attachment with our parents, then our peers, and that sets the stage for our intimate relationships. Every person I see with Shock trauma has Relational trauma and almost every addict I work with has at the minimum Relational trauma. If we can have these early healthy experiences of feeling felt and understood and that it’s okay to turn to others for help, it builds the foundations of our resiliency, ability to soothe ourselves, how we see ourselves, and how we see the world. If this is disrupted it can leave long lasting imprints. I consider Relational Trauma to be what forms the fabric of our existence and the Shock trauma is the rips and tears that happen along the way.
In one of his many speeches Gabor Mate eloquently stated “trauma is not what happens to you; but what happens inside of you as a result of what happened to you,” The psychological imprints from trauma (Shock or Relational) result in lingering negative beliefs (I’m not good enough, I’m not loveable, I’m not safe, etc…). The biological imprints are a nervous system that continues to think it’s not safe so it stays fluctuating between states of Fight, Flight, and Freeze; leaving the person perpetually dysregulated. Lastly, our ability to socially engage becomes compromised if we don’t feel safe/ okay in our skin. All this results in symptoms that look like ADHD, ODD, Anxiety, Intermittent Explosive Disorder, Panic disorders, Depression, Bipolar, Personality Disorders, and Dissociative Disorders. This Fight/ Flight/ Freeze response is supposed to be short term and temporary until we get to safety. If this trauma response persists long term over months or even years we start to then see somatic issues. Our nervous system cannot be separate from our bodies so we start to see gastrointestinal issues, autoimmune disorders, chronic pain disorders, chronic migraines, and much more (refer to the ACES study for more on this). Many of these issues become the driving forces to substance abuse. Our body inherently wants to find balance. If we are too hot we sweat, too cold and we shiver. These are responses to an imbalance. These psycho, bio, and social imbalances are often driving people to extreme lengths to find balance. Unfortunately though, if they work at all the relief is fleeting, and often only causes more damage. You throw a genetic predisposition for addiction on top if it and you’re going to have a hard time reigning that in.
Unfortunately these “symptoms” start to become the main diagnosis and focus of treatment rather than the source of the symptoms; their trauma. Further complicating this, talk therapy does not hit deep enough to address these issues. Don’t get me wrong, talk therapy is helpful and I still do a lot of it but when it comes to resolving trauma it is not the right approach for most. This in part is because of how the brain works. The brain takes in information by FIRST sending a signal to the body creating a Sensation (tightness), this sensation sends a signal up from the body to the brain triggering an Emotion (Fear), this triggers a Thought (“I’m going to die”) and this thought triggers a Behavior (Fight/ Flee/ Freeze). This is called a “bottom-up” response. If the trauma is unresolved or we can’t shake it off, then those sensations, emotions, thoughts, and behaviors stay active; and a million positive affirmations in the mirror won’t change that. To effectively resolve the trauma imprints (not just improve symptoms) treatment needs to include bottom-up body-based approaches such as The Comprehensive Resource Model, EMDR, Somatic Experiencing, Yoga, and Brainspotting to name a few. These approach treatment from the bottom up (body to the brain) where as talk therapy is trying to target a bottom-up response with a top-down approach.
This is why most of my practice is made up of people with years of previous therapy, years of recovery, active in 12 step communities, rigorously applying the steps and principles in their life, yet still not experiencing deep relief and healing, or perpetually relapsing. It is not their shortcoming; it is the nature of trauma. In her book The Trauma Heart, Judy Crane put it beautifully: “I believe that when trauma creates the impetus for such despair, there are only three choices: relapse, go crazy, or suicide. Relapse is the healthiest choice and I believe this is where chronic relapse occurs. There is a fourth choice- trauma resolution; a painful but amazing journey of healing.” Trauma and addiction are two strands of the same braid in my opinion. However it is important to keep in mind healing one will not heal the other. Treating addiction does not resolve trauma and resolving trauma will not cure addiction. However, in my opinion the two need to be treated together.
Curtis Buzanski, LMFT, LAADC