Substance Abuse Disorders and Trauma: A Public Health Problem

A significant contributing factor to why the number of people are struggling with substance abuse disorders is having to deal with trauma. Whether that trauma was a recent experience or a past traumatic event, it increases the individual’s risk of substance abuse and mental health disorders, which many people do not realize. The importance of treating the trauma and healing from it can be the key to treating and preventing further difficulties with substance use and abuse.

Over the past few years, even a couple of decades, substance use among those who experience and have been exposed to trauma has subsequently turned into a public health problem as the number of people who develop substance abuse, acute stress disorder (ASD), and posttraumatic stress disorder (PTSD) is increasing exponentially. For many people, they are developing co-occurring substance abuse disorder and PTSD, complicating their treatment and recovery while further deteriorating their quality of life and increasing their risk of exposure to further trauma and victimization. Substance use turns into a substance abuse and dependence disorder when one’s use becomes excessive and creates tolerance with use along with symptoms of withdrawal following discontinued use of the substance (Collins & Collins, 2005). Those who experience trauma and develop signs and symptoms of distress that do not resolve after more than three full days but within 30 days develop ASD. If the signs and symptoms of distress persist after 30 days, then the diagnosis becomes that of PTSD (APA, 2013).

How Trauma is Related to Substance Abuse?

Najavits, Weiss, and Shaw (1997) discuss the idea of the traumatogenicity theory of substance abuse disorders and why people may self-medicate with substances such as alcohol and other drugs when they are suffering. Those people who have been traumatized have a more rapid rate of substance abuse than those who have not experienced traumatization. The rate is higher even if they do not have a family history of substance abuse and other family background variables. Najavits et al. (1997) studied the strong correlation between substance abuse and PTSD to find that the lifetime rate of substance abuse disorder was 43% among those diagnosed with PTSD, compared with 24.7% for those without PTSD with even higher rates of substance abuse disorder co-occurring with PTSD among women.

What is Abusive Drinking?

Stewart (1996) uses the term “posttraumatic abusive drinking” to describe the correlation between alcohol abuse that leads to alcohol abuse dependence and trauma. Stewart (1996) studied the rates of those with alcoholism and abuse histories to find that when the abuse occurred before the age of 18 with no subsequent abuse in adulthood, they are more likely to develop problem drinking. A significantly high rate of 88% of adolescents with co-occurring PTSD and alcoholism reported prior histories of sexual abuse, physical abuse, or both (Stewart,1996).

The type and increased violent nature of trauma also can predict the likelihood of the development of an alcohol or drug abuse dependence disorder. For military members and soldiers serving during war-time, current and lifetime diagnoses of alcohol abuse dependence tended to be higher in the war-zone deployed combat group who had been exposed to multiple traumatic experiences, such as the handling of human remains, than in a matched control group consisting of troops stationed stateside (Stewart, 1996). Self-reported sexual abuse histories in women with alcoholism (24–85%) are exceedingly higher than those without sexual abuse histories (Stewart, 1996). A history of sexual abuse significantly predicted the onset of drinking problems over a 5-year follow-up in those classified as nonproblem drinkers at the start of a study (i.e., 51% vs. 19% in abused and nonabused groups, respectively) (Stewart, 1996).

Risk Factors

Danielson, C.K. et al. (2009) provides risk factors which have consistently been shown to confer increased risk for the development of substance use disorders:

- age (developed prior to age 25),

- family history of a substance use disorder,

- ethnicity,

- psychiatric disorders, particularly one of PTSD,

- having experienced traumatic events, such as sexual abuse and physical abuse, or witnessed violence,

- exposure to death such as a suicide or serving in combat and seeing and handling human remains, especially when one knows the deceased.

However, of particular interest is the fact that Danielson, C.K. et al. (2009) discovers the opposite to their previously mentioned colleagues regarding gender and that young male adults report higher rates of alcohol and drug abuse than young female adults.

Regardless of whether the risk factor falls primarily on men or women, it is essential to understand that one’s risk increases when more than one and even two of the risk factors are present with trauma exposure creating a significant risk to the development of a substance abuse dependence disorder. Everyone is unique and different, and their situation must be looked upon uniquely. When the individual enters treatment, the crisis counselor must also tailor their treatment based upon the individual’s unique needs, still focusing primarily on treating the addiction while addressing those unique factors contributing to the stress that has brought them to this point in their life.

This article was written by Stephanie Schweitzer Dixon, a suicidologist, crisis intervention, and mental health educator. Ms. Schweitzer Dixon is the former Executive Director of the Front Porch Coalition in Rapid City, SD, a nonprofit, outreach organization where she coordinated its L.O.S.S. (Local Outreach to Suicide Survivors) Team which responds in partnership with law enforcement to reach suicide loss survivors immediately after a suicide death occurs, bringing hope and resources to those traumatized and grieving. She also works with schools and communities in the aftermath of suicide deaths. She provides suicide prevention, intervention, postvention, and CIT training to first responders, behavioral health professionals, service providers, school counselors, parents, and community members. For more information on these topics and developing law enforcement suicide prevention and mental wellness programs and on how to assess for risk of suicide, violence, and how to develop suicide prevention and violence prevention curriculum, and trauma-informed trainings, contact Ms. Schweitzer Dixon via email Stephanie@ssd-consulting.com or her website: http://ssd-consulting.com.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013.

Collins, B.G., & Collins, T.M. (2005). Crisis and trauma: Developmental-ecological intervention (1st Edition). Belmont, CA: Brooks/Cole, Cengage Learning.

Danielson, C. K., Amstadter, A. B., Dangelmaier, R. E., Resnick, H. S., Saunders, B. E., & Kilpatrick, D. G. (2009). Trauma-related risk factors for substance abuse among male versus female young adults. Addictive Behaviors, 34(4), 395–399. doi:10.1016/j.addbeh.2008.11.009

Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and posttraumatic stress disorder in women. The American Journal on Addictions, 6: 273–283. doi:10.1111/j.1521–0391.1997.tb00408.x

Stewart, S.H. (1996). Alcohol abuse in individuals exposed to trauma: A psychological review. Psychological Bulletin, Vol. 120, №1, 83–112.