When people enter treatment for a substance use disorder, they usually carry with them a notion that they have a problem with whatever substance, or process, they have been engaging in. And that all the difficulties that have built up in their lives will be resolved simply by stopping the behaviour or gaining some control. Solve the problem and everything is going to be okay.
It seems simple enough. It even feels logical. For many people, it is enough. Maybe they do have, for example, an alcohol problem. If they can stop drinking or learn how to better manage their relationship with alcohol, then many aspects of their lives will improve - health, relationships and so on.
For some people, however, things run a little deeper. The substance is not the problem, it is a symptom of the real problem. They can make the behavioural changes, and things may improve in the short term, but somewhere along the line problems once again develop. And the symptom may return, or indeed manifest in a slightly different manner. In these cases, unless we can get to the root cause, or causes, breaking the cycle may feel like a game of snakes and ladders.
NB: In this article (and in general!) I do not differentiate alcohol from drugs. Alcohol is a drug. If I mention substance use, addiction, or dependency I am discussing all substances.
People seeking help for a substance use disorder are always assessed before any treatment starts. Such an assessment will include explorations of topics such as how things are now, and how things were, significant life events, childhood, relationships, and family history. Practitioners will, even at this early stage, often see patterns emerging way before a substance was taken.
Some of these will be easy to spot - abuse, bullying, parental substance use, and mental health issues. Some may be more subtle – low self-esteem, sensitivity, shyness, not fitting in, or a general sense of unease.
A good example of the function of a substance is social anxiety and alcohol. Alcohol will put people at ease in social situations. Alcohol has a calming effect and will help to reduce anxiety in social settings. People feel less inhibited and may have increased confidence. However, it is not a cure for social anxiety, and the line between it being effective and making things worse is a very thin one. The problem is only solved in the short term and if alcohol becomes the go-to solution then there is a risk of drinking excessively. This can lead to impaired judgement, risky behaviours, and regrettable incidents – it can exacerbate anxiety. The use of alcohol can quickly edge into dependency, and suddenly it is required to get through the day not just social situations.
If we can begin to understand the function of the substance, it will give us some real clues as to the root causes that sit underneath the behaviour. Then we can really begin to develop a treatment approach that is truly holistic. Below are some other recognised underlying issues often identified as going hand in hand with a substance use disorder.
Research has indicated that around 15% of young people experience a clinically diagnosable depressive illness before turning 18 – and only 25% receive any treatment. A person experiencing depressive symptoms, and other mental health symptoms, can feel a sense of relief when they try substances for the first time. The mood is changed, perhaps they feel a sense of liberation and freedom. It is easy to see how a connection is made between taking a substance and feeling better. The seeds of dependency can grow well in such circumstances. The substance becomes a crutch to lean on, a coping strategy.
Addiction is a slow, progressive disorder. Initially, there are likely very few negative consequences, but if the substance use progresses, then issues associated with addiction may begin to arise in daily life. The substance, that initially helped with the depression, can quickly end up causing more problems than it solves – including bringing its own depressive symptoms and risk factors to the table.
The links between trauma and addiction are now well-known and well-documented. Most healthcare providers and people that work in the field of substance use disorders will have seen the strong link between them during their work.
Many different life events can be described as trauma. They can include physical, emotional, or sexual abuse, natural disasters, car accidents, bereavement, domestic violence and illness. If I were to make a full list, we would have a very long article. Witnessing a traumatic event can be as impactful as experiencing one. Domestic violence is a good example of this – violence in the family home or even threats of violence and high-octane arguments can trigger a trauma response in children.
How individuals respond to traumatic events in life vary from person to person. We all experience things differently and have different levels of resilience or sensitivity to different events. The divorce of parents may be straightforward for one person to cope with emotionally, and devastating for another.
Post-Traumatic Stress Disorder (PTSD) is a diagnosable condition that can develop after experiencing or witnessing a traumatic event. There are identifiable symptoms of PTSD and they include nightmares, avoidance behaviours, hyperarousal, anxiety, depression and a sense of isolation from others. There is no better avoidance strategy than getting loaded - to self-medicate. It will bring a holiday from the pain of trauma. This is often a pain that sits below the surface. It reminds me of a movie scene, where the hero has just saved the day with a big fight, and in the aftermath, someone notices blood on the hero’s shirt, they have been hurt, but did not even realise it until it’s pointed out.
Where children experience chronic trauma or PTSD, they are at an increased risk of developing other psychiatric conditions such as affective bipolar disorder or borderline personality disorder. As adults, they are also around 3 times more likely to become addicted to drugs and develop a substance use disorder. The connection is real. Substance use helps deal with the symptoms. And as already discussed, if the drug use continues it will likely progress and symptoms will in fact increase – maybe further trauma might be experienced. And if the person comes into treatment, and stops the drug use, the trauma and the symptoms are still there – the substance hasn’t solved the issue.
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in a child’s life from birth up to the age of seventeen. They have a well-documented effect on many different areas of a person's life. Examples of ACEs are exposure to violence, physical, emotional or sexual abuse, household dysfunction, neglect, parental abandonment (including divorce), and substance use in the home. ACEs can destabilise a child’s sense of security, safety and stability. They can affect emotional development and bonding and the consequences are felt on many levels into adulthood.
ACEs have been shown to impact a person’s mental and physical well-being. Research has shown that individuals with a history of ACEs have a reduced life expectancy and are at a higher risk of developing PTSD later in life. ACEs can lead to changes in the brain's structure and function, making individuals more susceptible to stress and trauma. Additionally, ACEs can lead to maladaptive coping strategies and behavioural changes, such as substance abuse and addiction issues, that can further exacerbate the symptoms of co-occurring disorders such as PTSD. They can result in difficulties in education, in relationships, and in many areas of life.
The key to finding solutions is first identifying the problems. As the title of the article suggests, if we just focus on one aspect – the substance – then we do not get to the heart of the issue. If we can accept that drug use is just the tip of the iceberg – the bit we can see - and that looking below the surface hold the key, then we can begin to treat effectively and understand the right pathway for recovery.
This requires a multidisciplinary approach, with a strong assessment of a person’s history, including a trauma inventory and lifeline. Psychiatric assessment is key to help understand and diagnose any potential underlying mental health issues. Family history can be important. It will help us to understand the impact of the environment on development. A program of family support and counselling will certainly help to improve outcomes.
Developing trust and creating a safe environment is fundamental. Trauma and PTSD can feel almost paralysing so the process of working on the past needs the right setting and the right people. Once a person feels safe and protected, then they can begin to work through the past and understand how it may have led to dysfunctional coping strategies.
Support from friends and family can be crucial in the recovery process. It is important to have a strong support system in place to help individuals cope with the challenges of recovery. Many individuals find support groups such as Alcoholics Anonymous or Narcotics Anonymous can provide a sense of community and help to reduce feelings of shame and isolation.
Other interventions, including mindfulness, meditation, journaling, healthy self-care routines and exercise will all help an individual. These are strategies that support resilience and nurture a sense of calmness in the face of trauma and stress.
The more we can understand how addiction is a symptom of underlying issues, the more we can connect with a sense of hope, and a process of healing is possible. We start to make tailored interventions to improve the opportunity for change. We are no longer stuck in a cycle that sees the addict as the problem, or the substance as the problem.
Trauma-informed care is now recognised across the world. There’s a wealth of excellent literature and research and more and more therapists and treatment centres who understand the need to work on the underlying causes of addiction and drug use to improve long-term outcomes for the individual and their families.
Our experienced team of experts and professionals will work with you every step of the way to create a treatment plan that meets your unique needs and goals. From our dedicated Medical and Psychiatric Teams to our innovative BIO-R® programme, we provide a safe and supportive environment for you to achieve lasting recovery. With our luxurious surroundings and unparalleled attention to detail, The Kusnacht Practice offers a holistic, 360-degree approach to mind, body and soul rebalancing and restoration. If you or a loved one is struggling with addiction, we are here to help. Contact us today to learn more about our personalised addiction treatment programmes.
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