The cycle of trauma and substance use disorders

Trauma can leave deep emotional scars, resulting in persistent pain, fear, and anxiety. To manage these difficult and complex feelings, some people turn to substances like alcohol or drugs. While these substances might seem to offer relief in the moment, they often lead to dependency, creating a cycle that can make recovery more challenging.

Recognizing the connection between past trauma and substance use is an important first step toward healing. With the support of a therapist trained in trauma-informed care and substance use disorders, you can identify the source of the trauma, develop healthier coping strategies, and break free from the cycle of substance dependence.

Why does trauma lead to substance use?

Trauma has a profound impact on the brain, which can respond with symptoms like nightmares, depression, and anxiety. For many, substances become a way to self-medicate, offering temporary relief from physical and emotional pain. While drugs or alcohol may seem like an easy way to feel better, they don’t address the root cause of trauma and can often lead to addiction.

Traumatic events — like violence, abuse, or the death of a loved one — can increase the risk of developing a substance use disorder. This connection is especially strong for people who had adverse childhood experiences. These early traumas can shape brain development, increasing the risk of addiction and other mental health challenges later in life.

How does substance use affect trauma symptoms?

Substance use can affect trauma symptoms in many ways, often creating a vicious cycle. People may turn to substances for short-term relief, only to find their symptoms worsening.

For example, someone struggling with trauma may use alcohol to escape emotional pain, but over time, their substance use can deepen their sense of sadness and despair.

Substance use interferes with the brain’s ability to process and heal from trauma. It also enables avoidance, making it easy to suppress painful memories or dismiss symptoms. In some cases, substance use may contribute to the development of other mental health conditions, like post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), and dissociative disorders.

Several substance use disorders are closely linked to trauma, each presenting unique challenges:

• Alcohol use disorder (AUD): Alcohol may initially numb challenging feelings and distract from traumatic memories. But this is just initial relief, because intoxication can make it hard to manage traumatic memories and emotional distress. Over time, alcohol use can lead to worse trauma symptoms, creating a deeper cycle of emotional distress.
• Opioid use disorder (OUD): Opioids — often prescribed for physical pain — may initially provide a dopamine-driven sense of euphoria. However, prolonged use reduces the brain’s natural dopamine production, leading to increased risk of development of anxiety and depression.
• Stimulant use disorder: Stimulants like cocaine or methamphetamine disrupt brain function, worsening trauma symptoms and reinforcing unhealthy coping strategies.
• Sedative, hypnotic, or anxiolytic disorder: While used as prescribed in a healthy way these drugs may provide temporary relief from anxiety or panic attacks, misuse and dependency can intensify symptoms and complicate recovery.
• Tobacco use disorder: Nicotine can provide a brief calming effect, but the withdrawal symptoms like anxiety and irritability can make trauma-related stress worse.

What are the effects of co-existing trauma and substance use?

Living with unresolved trauma and a substance use disorder can result in physical and emotional challenges, including: 

• Health issues: Long-term substance use can lead to liver damage, heart problems, insomnia, headaches, and difficulties with memory and concentration.
• Increased impulsivity: Substance use is associated with heightened impulsivity, increasing the risk for behaviors like unsafe sex, reckless driving, and criminal activity. PTSD can also lead to changing behaviors based on moods and re-experiencing symptoms showing up as impulsivity. 
• Social consequences: When combined with substance use, trauma-related behaviors — like mistrust and aggression — can strain relationships, negatively impact job performance, and lead to social isolation.

If you’re experiencing coexisting substance use and trauma, know these conditions can be effectively managed and treated through a long-term commitment to recovery and consistent ongoing care.

Addressing trauma and substance use with treatment

Research shows that an integrated approach to treating substance use and trauma leads to better health outcomes. This often includes working with a therapist trained in trauma and substance use disorders. It might take some time to notice a difference based on factors like the severity of trauma, level of substance dependency, and type of therapy used. 

Common approaches to treating co-occurring substance use and trauma include: 

• Trauma-focused cognitive behavioral therapy (CBT): CBT is a common form of talk therapy that can help you learn how to navigate difficult emotions in healthier ways, overcome negative thoughts, and manage trauma-related distress.
• Eye movement desensitization and reprocessing (EMDR): Through moving your eyes in a specific way that triggers your brain reprocessing and with the support of a trained mental health professional, you can process distressing thoughts and memories related to trauma. EMDR can also help with substance use disorder, as it addresses the underlying trauma. 
• Dialectical behavior therapy (DBT): DBT teaches mindfulness, how to manage mood swings, cope with stress, and improve relationships. This form of therapy can be effective in treating both substance use and trauma.

Through therapy, you can learn how to process challenging memories and emotions in ways that don’t involve drugs or alcohol. For example, you may join an online or in-person support group to connect with others who are experiencing something similar. Or maybe you practice breathing techniques that help calm you down, or engage in hobbies that bring you joy. 

Find care with Rula

If you’re using drugs or alcohol to self-medicate and calm the symptoms of trauma like anxiety, depression, and insomnia, know that help is available. A therapist trained in substance use disorders and trauma-informed care can help you achieve long-term recovery and develop healthy ways of coping. 

With Rula, our matching tool connects you with over 10,000+ therapists dedicated to providing the care you deserve. In just seconds, you can find a therapist trained in substance use disorders and trauma-informed care who can meet with you via live video as soon as tomorrow. 

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