Clarifying the Relationship Between Addiction and Trauma

In recent years, there’s been a rising trend to view addiction as a symptom of trauma, and while there is an undeniable connection between the two, this view requires clarification. As stated by the American Society of Addiction Medicine (ASAM), addiction is a "primary, chronic disease of brain reward." The word "primary" here is crucial; it emphasizes that addiction isn’t merely a symptom of something else. Rather, it’s a condition in itself, one that develops due to repeated substance use and the lasting changes it causes in the brain.

Trauma, Addiction, and Self-Medication: Untangling the Connections

It’s natural for people who have experienced trauma to turn to substances as a form of relief. Substances can dull pain, offer temporary comfort, and ease stress. For someone who’s been through trauma, this kind of relief might seem like a lifeline. However, while substance use may start as a coping mechanism, addiction isn’t a direct outcome of trauma itself:

Addiction occurs as a result of repeated use and the effects of those substances on the brain’s reward pathways.

This distinction matters because it impacts how we approach treatment. Addressing trauma is crucial to helping someone heal, but it doesn't automatically resolve a substance use disorder. Trauma work might reduce the initial urge to use substances, yet the changes in the brain's reward system remain. The ASAM definition highlights this by describing addiction as a chronic, progressive condition—one that continues and worsens without intervention, even if the underlying trauma is addressed.

Misinterpretations and the Risks They Pose

One problem with conflating trauma resolution and addiction treatment is that some people may mistakenly believe that healing their trauma will automatically resolve their substance use issues. This mindset, unfortunately, can enable avoidance. I’ve encountered individuals deeply invested in focusing on their trauma, even to the detriment of addressing clear and pressing substance use issues.

CASE STUDY

I worked with a woman on the brink of losing custody of her child. She had been arrested on a drug charge that resulted in a probation violation, and her parents urged her to see me to address her ongoing substance use. Despite the severe consequences of her continued substance use, she was sitting at home watching Gabor Mate’ videos on YouTube, hearing the message that her addiction is merely a symptom of her underlying trauma. She understood that to mean that addressing her trauma was all she needed to do.

Now, I’m guessing that Gabor Matè and the other trauma professionals putting out this type of message would say that is not what they are saying. (Or maybe they are?) But the sad truth from out here in trenches is that I’ve worked with numerous clients over the past several years who are using this message as a way to avoid addressing their substance use.

No matter how valid the need to address trauma is, if a substance use disorder has developed, it needs to be treated as well. (If Dr. Matè wants to help me understand that resolving my trauma will allow me to return to controlled use of alcohol and drugs, I'm all ears. Unfortunately, I'm not sure that I'm willing to take the chance to find out. As much as I feel that I've healed from my own trauma through years of treatment and therapy, I also know the possibility exists that if I start using again I could find myself right back in the insidious trap of addiction. I'm not aware of any litmus test that proves to me my substance use disorder is gone and I can safely use again.)

The Brain’s Role in Addiction: Rewiring and Consequences

Addiction isn’t simply about wanting to use substances; it’s about the changes in brain function that arise after repeated use. Substances impact the reward circuitry, creating a compulsion to continue using, even when the consequences become dire. The brain essentially "learns" to crave the substance, reinforcing this behavior over time. This rewiring makes addiction a chronic condition that must be managed over time, not a condition that can be simply reversed by dealing with past pain or trauma.

It’s essential to recognize that the progressive nature of addiction means that without stopping the use of substances, the condition tends to become worse over time. And because addiction results in loss of control, it often leads individuals to continue using even when they’re aware of the harm it’s causing.

Moving Forward: Trauma and Addiction as Separate Yet Intertwined Challenges

I fully support the valuable work done by trauma specialists, and I defer to their expertise. I’m “just” a drug and alcohol counselor. But what I do I understand is the importance of responsible substance use intervention and treatment. Addressing trauma is critical for holistic healing, but when addiction is present, it requires dedicated attention. Conflating trauma and addiction can unintentionally minimize the gravity of addiction, delaying crucial interventions. Addiction must be managed as a primary condition alongside any trauma work. The goal is not to disregard trauma but to treat addiction as a distinct, chronic condition that needs its own specific care and management.

In summary, while trauma can lead to substance use, Substance Use Disorder (the appropriate diagnostic term) is a separate condition—one that results from repeated use and the subsequent brain changes. Recognizing this distinction can help guide individuals toward comprehensive treatment, supporting both their recovery from trauma and their management of addiction. For anyone dealing with a substance use disorder, it’s crucial to understand the impact this has on the brain and to approach recovery with a clear-eyed view of what each condition requires.

If you found this perspective helpful, let’s keep the conversation going. Whether you agree or disagree, open dialogue on these topics is essential to supporting those affected by addiction.

(For a slightly less "refined" discussion on this topic, watch the YouTube video I did that led to writing this article: Addiction Is Not A Symptom! )