Dr. Robert Weiss LCSW, CSAT

For a very long time in the world of psychology, when clients manifested symptoms of trauma and sought help to understand their feelings and behaviors, they were “diagnosed” as weak-willed and inherently emotionally unhealthy. Only rarely did therapy consider the impact of a struggling person’s potentially overwhelming life experiences. Instead, therapists looked at a person’s trauma and focused on one or more of the following:

1. Treating the client’s designated pathology, whatever that was deemed to be. Essentially, clients were told, “You’re a mess, and that’s the reason you think and behave this way.”
2. Strengthening the client’s psychological mettle. Essentially, clients were told, “Pull yourself up by your bootstraps.”
3. Coaching the client to suppress past traumas to keep them from interfering with the present. Essentially, clients were told, “Just get over it and push yourself into being well.”

Therapists of this particular era had little to no training in or understanding of trauma and its wide-ranging, long-lasting effects, so they mostly avoided the issue, providing neither resolution nor hope.

This began to change in the late 1960s with the Vietnam War. Countless combat-hardened veterans returned home manifesting profound emotional, psychological, and behavioral problems (including addiction). The impact of the war on these men was significant and undeniable. They went to Vietnam healthy and whole; they returned from the war beaten and damaged. And it wasn’t just the soldiers who identified this change; their friends and families also noticed a huge difference.

Importantly, these men could not be dismissed by psychologists as “hysterical weaklings,” as occurred with trauma survivors in the past. Because of this, we finally took a serious look at the ways in which past traumas can impact a person’s current thinking and behavior—an idea that immediately resonated with both mental health professionals and the people who’d experienced severe trauma.

With this, scholars like Christine Courtois, Bessel van der Kolk, and John Briere asked, “Can the symptoms we see with combat veterans also manifest in the general population in response to other forms of trauma?” The answer was an undeniable yes. The research that they and others conducted made it clear that trauma as seen in Vietnam veterans is no different, in terms of later-life manifestations, than trauma experienced by victims of sexual abuse, domestic violence, racial intolerance, homophobia, gender discrimination, violent crime, misogyny, bullying, neglect, chronic family dysfunction (including addiction and mental illness), and intimate betrayal.

In 1980, the American Psychiatric Association added its first trauma-focused diagnosis, Post-Traumatic Stress Disorder (PTSD). The new diagnosis identified three primary symptoms:

1. Re-experiencing trauma—in flashbacks, nightmares, and even in response to loud noises and stressful situations
2. Numbed response, including depression and abuse of addictive substances and behaviors, as a way of coping with the pain of re-experiencing
3. Hypervigilance, including anxiety, psychological arousal, jumpiness, overreactions, etc.

The arrival of PTSD as an official diagnosis meshed nicely with the rapidly evolving clinical views of humanistic psychology, where individuals were looked at holistically, with each facet of a person’s life seen as impacting other aspects of their life.

In her writings, Courtois defines trauma as “any event or experience (including witnessing) that is physically and/or psychologically overwhelming to the exposed individual.”[i] She also states that trauma has both objective and subjective dimensions, meaning trauma “can involve just about any type of adversity or harm, and a person’s response is dependent on their individualized experience, perspective, and temperament.”[ii] In other words, people can react very differently to the same situation. For instance, a new mother with her infant child in the car would likely be more profoundly traumatized by a fender bender than a professional race car driver.

My point here is that starting in the late 1960s we began to explore and understand the now well-accepted idea that trauma, no matter how it occurs, can have both immediate and long-lasting effects, such as:

• Flashbacks
• Nightmares
• Anxiety
• Depression
• Stress
• Shame
• Lowered self-esteem
• Inability to develop and maintain emotional intimacy
• Physical illness
• Rage/violence
• Addiction

In today’s world, we readily acknowledge the link between early-life trauma and numerous later-life symptoms and disorders. An immense amount of research has confirmed this link. For example, one study looking at the long-term effects of unresolved early-life trauma found that survivors are:

• 1.8 times as likely to smoke cigarettes.
• 1.9 times as likely to become obese.
• 2.4 times as likely to experience ongoing anxiety.
• 3.6 times as likely to be depressed.
• 3.6 times as likely to qualify as promiscuous.
• 7.2 times as likely to become alcoholic.
• 11.1 times as likely to become an intravenous drug user.[iii]

As therapeutic recognition of trauma grew through the 1970s and into the 80s, so did public acceptance of its impact. Laws were enacted to protect children and spouses from abuse in the home, rape and domestic violence crisis centers popped up in major cities, and suicide hotlines were created to help suicidal individuals find much needed immediate assistance. In conjunction with this, frank conversations about trauma and trauma-related issues took place in small groups and on a cultural scale, which helped take the shameful sting out of needing and asking for help. In particular, John Bradshaw’s PBS programs discussing shame and the wounded inner-child brought trauma into the light.

In time, we began to look at family-wide issues wrought by global traumas, such as how addiction affects everyone close to the addict. About the impact of trauma, secrets about trauma, and shame, Bradshaw writes:

Family secrets can go back for generations. They can be about suicides, homicides, incest, abortions, addictions, public loss of face, financial disaster, etc. All the secrets get acted out. This is the power of toxic shame. The pain and suffering of shame generate automatic and unconscious defenses. Freud called these defenses by various names: denial, idealization of parents, repression of emotions, and dissociation from emotions. What is important to note is that we can’t know what we don’t know. Denial, idealization, repression, and dissociation are unconscious survival mechanisms. Because they are unconscious, we lose touch with the shame, hurt, and pain they cover up. We cannot heal what we cannot feel. So, without recovery, our toxic shame gets carried for generations.[iv] 

This is the basic idea of trauma. It happens to us and it happens to those we love. And if we don’t find a way to recognize it, call it out, and find better ways to cope with it, it will color our thinking and behavior indefinitely.

Based on this new understanding of trauma and impacts, we also rethought addiction. Prior to this, addiction was considered by most to be a moral failing, a lack of self-will, or a deep psychological flaw (a personality disorder), rather than an emotional illness.

A trio of groups—the Research Council on Problems of Alcohol, the Yale Center of Alcohol Studies, and the National Committee for Education on Alcoholism—were leaders in switching focus in the addiction conversation onto the disease of alcoholism and addiction, rather than the inherent evils of alcohol and drugs and the moral failings of people who get hooked on them.[v]

Soon thereafter, the “Minnesota Model” of viewing and treating alcoholism as a disease rather than a moral failing took root. Pioneer House, Hazelden, and Willmar State Hospital, all located in Minnesota, implemented programs (heavily based on the experience of sober members of Alcoholics Anonymous). These treatment centers chose to view alcoholism as a primary disorder (rather than a symptom of some other psychological disorder) best treated with long-term abstinence and sobriety-focused social support.[vi]

Part and parcel with implementation of the disease model was recognition that addicts are nearly always survivors of severe or chronic trauma.[vii] And the more we know about addiction, the more sense this makes. It is clear from both research and clinical observation that addictions are not about feeling good; they’re about feeling less. Addicts turn to addictive substances and behaviors not because they want to have a good time, but to self-medicate and self-regulate their emotions. Their primary goal is to escape from life and not feel stress, anxiety, depression, fear, and other forms of discomfort.

This works, too. Addictive substances and behaviors trigger a highly distracting neurochemical response, primarily the release of dopamine (pleasure), along with adrenaline (excitement), oxytocin (love and connection), serotonin (emotional well-being), and a variety of endorphins (euphoria). This response creates sensations of pleasure, excitement, control, and, most importantly, distraction and emotional/psychological escape.

Simply stated, addicts use addictive substances and behaviors not to feel better, but to feel less. And they continue to do so even as their clearly (to an external observer) out-of-control behavior creates significant problems: relationship issues, trouble at work or in school, declining physical and/or emotional health, financial turmoil, legal concerns, mood disorders, and more. Addicts cope with stress, depression, anxiety, loneliness, boredom, attachment deficits, and unresolved trauma by getting high (via a substance or behavior) instead of turning to other people who might emotionally support them. As they do this repeatedly, this choice becomes a pattern, and then an addiction. As Gabor Maté writes his bestselling book, In the Realm of Hungry Ghosts, “It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behavior.”[viii]

By the mid-1980s, the disease model and our understanding of trauma merged into a single model of understanding and treating addiction. This model as I see it can be summarized as follows:

Addicts are almost universally traumatized as children, which affects their ability to attach in healthy ways as adolescents and adults. Thus, they learn to use fantasy and dissociation via substances and behaviors for emotional regulation, rather than relying on intimate family, friends, and community for emotional support as a healthier person might. In time, they become compulsive and obsessed with this substance or behavior, using it as their primary emotional and psychological coping mechanism.

So, once again, addictions are not about pleasure. Instead, they’re about the secondary gain of escape. Non-addicts drink, use drugs, and engage in potentially addictive behaviors because these things are, first and foremost, pleasurable. For non-addicts, pleasure is the primary gain. Not so for addicts. Addicts are more interested in the secondary gain of escape.

A normal, non-addicted person drinks a martini to get a little bit high and enjoy himself or herself. An addict drinks half a dozen martinis to escape the world and everything in it. And the addict goes back for more of the same, day after day, seeking and finding this same secondary gain, eventually getting stuck in an endless loop of feeling bad, drinking to escape that feeling, and then feeling bad again—possibly worse than before because of the regrettable things he or she did while drunk. Which leads to more drinking.

This stuckness is the “disease” of addiction.

Today, both the disease model and the role of trauma, especially unresolved early-life trauma, in the etiology of addiction are well-accepted. As Maté writes, “A hurt is at the center of all addictive behaviors. It is present in the gambler, the internet addict, the compulsive shopper, and the workaholic.”[ix] In short, addictions form because early-life traumas have poisoned the well of interpersonal attachment. Thanks to unresolved early-life trauma, addicts learn to associate fear rather than comfort to deep human intimacy and attachment. Thus, they refuse to turn to others, even loved ones, for help when they’re struggling or feeling down. Instead, they compulsively and obsessively self-soothe by numbing out with an addictive substance or behavior.

References

[i] Courtois, C.A. (2014). It’s not you, it’s what happened to you: Complex trauma and treatment. Telemachus Press.

[ii] Courtois, C.A. (2014). It’s not you, it’s what happened to you: Complex trauma and treatment. Telemachus Press.

[iii] Anda, R., Felitti, V., Bremner, J., Walker, J., Whitfield, C., Perry, B., … Giles, W. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3):174-186.

[iv] Bradshaw, J. (2005). Healing the shame that binds you: Recovery classics edition. Health Communications, Inc.

[v] Mann, M. (1944). Formation of a National Committee for Education on Alcoholism. Quarterly Journal of Studies on Alcohol, 5(2):354.

[vi] White, W. (2000). The rebirth of the disease concept of alcoholism in the 20th century. Counselor, 1(2), 62-66.

[vii] Saah, T. (2005). The evolutionary origins and significance of drug addiction. Harm reduction journal, 2(1), 8.

[viii] Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books.

[ix] Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books.