Addiction Isn’t “The” Problem
It shouldn’t surprise us that addiction has become one of the top health concerns in the North America:
It causes more illnesses, disabilities, and deaths than any other preventable health issue.
About 1 in 10 North Americans over the age of 15 report symptoms of alcohol or drug dependence.
Most people who struggle with addiction or substance misuse never enter a treatment program of any kind.
Of those who seek some form of treatment, the vast majority will continue to struggle with their substance use.
This information just confirms what we already know: millions of North Americans live with the painful experience of addiction – and few get the help they need to recover.
But if addiction isn’t “the” problem, what is?
The Problem is the Problem
Any effective treatment program for a problem or issue begins with a clear understanding of the nature of the problem. Why do substance misuse and addiction problems develop in the first place? Why do attempts to stop often fail? What will ultimately help our clients recover?
One important perspective that can get overlooked is that addiction is often a symptom of the problem rather than the problem itself. While addiction certainly creates additional “problems”, we need to be curious about what drives the behaviours that lead to addiction in the first place. For many people who struggle with addiction, substance misuse begins as an attempt to fix a problem.
Substance misuse is often a person’s way of managing a “problem” rather than being the only issue that needs addressing.
If we fail to take into consideration this crucial fact, we set people up for a struggle in their recovery.
But what, exactly, is that problem?
The answer to that question is a complex one. Gabor Maté, the author of “In the Realm of Hungry Ghosts”(1), encourages us to ask not about why addiction occurs but “why the pain?”
What is the pain or the problem that substance use is trying to “fix”?
To understand more about what moves people in the direction of addiction, we need to explore the recent contributions of research across diverse topics including neuroscience, genetics, addiction, and the impacts of trauma and chronic stress. Quite simply, we need to have a better understanding of the origins of addiction rather than just viewing it as “the problem”.
If we keep seeing substance misuse and addiction as “the” problem that needs fixing, we are less effective in supporting people in their desire to move out of self-destructive patterns of addiction.
When trying to understand the seemingly baffling behaviours of substance misuse and addiction, it is important to understand, firstly, how the human nervous system is wired, and secondly, how things go wrong. Although not all addiction is caused by trauma or abuse, we certainly have a growing awareness that trauma is a much more common experience, especially in the lives of those struggling with addiction. There is also a greater understanding of the profound impacts trauma has on a person’s physical, emotional, and mental well-being.
Over the last number of years, there has been a significant movement towards identifying and exploring the connection between trauma and addiction.
Many of our clients will assume (wrongly) that the term “trauma” does not fit their experience. They may see their painful life experiences as just a part of their life they wish to forget. For many, their challenging life experiences were just that – “life experiences”. Most people struggling with addiction seem quick to discount their experience – “that wasn’t trauma”, “that’s just the way it was”, or “other people have had it far worse”.
Research into the origins of addiction is clearly pointing us in the direction of considering the significant contributions of early life experiences as well as the impacts of chronic stress and trauma. Peter Levine, a leading psychologist in the field of trauma, argues that it is detrimental for someone to be unaware of the negative impacts trauma has had on their lives.
Not knowing they were traumatized doesn’t prevent someone from being negatively affected by their experiences.(2)
Trauma and its Connection to Addiction
The field of addiction research and treatment clearly identifies trauma as a significant contributing factor to patterns of substance use and dependence. This current research shows that traumatic experiences, especially when they occur early in life, create a greater vulnerability to developing substance misuse problems.
Here are some statistics from a variety of sources that show just how significant this connection is:
In North America, the percentage of people diagnosed with PTSD over their lifetime is around 7%. In the substance-dependent population, this percentage increases dramatically – various studies show that 36-50% of people receiving treatment for substance addiction also experience the symptoms of PTSD.(3)
Dr. Edward Khantzian, Harvard Medical School researcher, developed the self-medication hypothesis of substance use. His research demonstrates that people with PTSD are four times more likely to develop problems with substance dependence than those without. A history of PTSD is also a factor in beginning to use substances at an earlier age as well as greater severity of use.(4)
The National Comorbidity Study shows that as many as 46% of people with either PTSD or a substance use disorder also have the other condition. The research from this same study also suggests that trauma is more likely to occur before substance misuse rather than after it.(5)
This research encourages us to consider that traumatic events often contribute to the development of substance abuse and addiction. Even if someone doesn’t meet the criteria for an official diagnosis of PTSD, it is still important to recognize that trauma may still affect their lives and their substance abuse patterns in significant ways.
We need to be open to considering that addiction is often just one of the symptoms of “the problem”: unidentified or unresolved trauma.
Shifting our perspective in this way allows for more compassion and more support for all those who want to make lasting and positive change in their patterns of unhealthy substance use and addiction.
The second instalment in “Trauma and Addiction: The Link We Can’t Ignore” focuses on the negative impacts our client’s experience when we miss the important connection between trauma and addiction. You can also read the introduction to this series
Part 2 in “Trauma and Addiction: The Link We Can’t Ignore” focuses on the negative impact of missing the link between trauma and addiction: "7 Negative Impacts of Missing the Link".
Here are all the posts in “Trauma & Addiction: The Link We Can’t Ignore (For Clinicians):
Intro to Trauma & Addiction Link (Clinician)
Part 1: The Problem (Clinician)
Part 2: The Negative Impacts (Clinician)
Part 3: Why People Use (Clinician)
Part 4: Medicating Trauma (Clinician)
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(1) Maté, Gabor. In the Realm of Hungry Ghosts: Close Encounters with Addiction. 2008.
(2) Levine, Peter A. Waking the Tiger: Healing Trauma : The Innate Capacity to Transform Overwhelming Experiences. 1997.
(3) Weiss, N., M. Tull, M. Anestis, and K. Gratz. "The Relative and Unique Contributions of Emotion Dysregulation and Impulsivity to Posttraumatic Stress Disorder among Substance Dependent Inpatients." Drug and Alcohol Dependence 128.1-2 (2013): 45-51
(4) Khantzian, Edward J. "The Self-Medication Hypothesis Revisited: The Dually Diagnosed Patient." Primary Psychiatry Archive (2003). Primary Psychiatry. 2003.
(5) Coffey, S. F., J. P. Read, M. M. Norberg, S. H. Stewart, and P. Conrod. "Posttraumatic Stress Disorder and Substance Use Disorder: Neuroimaging, Neuroendocrine, and Psychophysiological Findings." Anxiety and Substance Use Disorders the Vicious Cycle of Comorbidity. 2008.