The Connection Between Trauma and Addiction

For people who struggle with substance abuse – including college students – there can be important connections between trauma and addiction. Understanding those connections can help with recovery, relapse, or even possibly prevention.

We spoke with The Haven’s Sherrie Kleinholtz, a Licensed Professional Clinical Counselor and Clinical Director at The Haven at Miami University. She has deep experience working with Miami University students in a past role as Director of a Crisis Hotline based in Oxford, OH.

Sherrie Kleinholtz Discusses the Connection Between Trauma and Addiction

Question: What's the connection between trauma and addiction?

Sherrie Kleinholtz: Trauma and addiction are connected in a couple of different ways. They can go kind of back and forth. First of all, substance abuse will increase the likelihood of trauma. In other words, if someone is intoxicated, they are more likely to experience a trauma because they're not making sound decisions at the time. They might be drinking and driving, they get into a car accident, they put themselves in risky situations for sexual assault, or getting into a fight. Just increased risk taking. And so that's one way that they're connected.

On the other side, you have people that experience trauma who are trying to mask their symptoms. They're trying to self medicate and use substances as a coping mechanism, either to feel numb or empowered or even calm. And sometimes they might depend on things like benzodiazepines to release some anxiety that they're experiencing.

On the other side of that, they might want to take stimulants so they can feel like they have energy vehicle to focus on the task at hand, be able to work, be able to go to school, be able to sit through that class. And so, it kind of goes both ways.

Substance abuse will increase the likelihood of trauma...On the other side, you have people that experience trauma who are trying to mask their symptoms.

-- Sherrie Kleinholtz

Question: Are there situations where individuals had no addiction issues before a trauma arrived. Or is it more, as you're explaining, that they may have had an addiction issue of some kind? Or is it also possible that maybe they had a latent issue and the trauma acts as a shock that triggers the addiction?

Sherrie Kleinholtz: Both of those things are correct in terms of being a trigger for the addiction, but certainly people who have experienced trauma may not have had an addiction issue before, and then it comes up. And that is because of the self-coping skills or self-coping mechanisms that they're trying to build. For instance, if you have somebody who is a combat veteran and they come back and they're diagnosed with PTSD, and they're having these constant flashbacks and constant bouts of anxiety that are too horrible for them to withstand on their own. They can't function, they can't go to work, they can't be a father, they can't be a mother, they can't be a spouse. And they have to take something in their mind, they have to take something in order to keep them calm enough just to be able to function in life.

So trauma can trigger something like that, an addiction, in that way. And then once they realize that hey, this Xanax works, I'm calm, I'm sleeping through the night now. I'm no longer truly triggered and having shakiness and horrible flashbacks, and this is working for me. And if it works, they're going to take it again. If it's the only resource that they have, that's what they're going to take because everybody has their thresholds. And once you reach that threshold, you're going to take what works.

So as many times as people say I would never have an addiction problem. Well, maybe. Or maybe you would. And maybe you haven't gotten into a threshold yet where you had to experience something in order to take a drug to calm back down. And so yes, it can be definitely triggered that way.

Question: I assume that we all – at any age – can be prone to negative impacts that result from trauma?

Sherrie Kleinholtz: Yes.

Question: Is there anything particular about college students that either makes them more susceptible? Because they're necessarily younger than people in their 30s or 40s or 60s, is coping, is managing trauma more difficult for them? Or, no, trauma is trauma, and we are all susceptible in our individual ways regardless of age or experience?

Sherrie Kleinholtz: I think in certain situations that it can be more difficult for college-aged students. That is because they are away a great deal from their support systems. Their families, the people that are typically there for them the most. Don't get me wrong, they develop very powerful relationships while they're in college. But the people that have been with them their whole life, if they've been a support system and not a trigger, then that makes it more difficult for them just feeling that sense of being alone.

However, everyone is susceptible to trauma, and everyone has a threshold. Some people are actually more susceptible to trauma than others. And some of those reasons can be levels of cortisol or dopamine, things that have brain abnormalities or norepinephrine systems, things like that can really have an effect on somebody's ability to feel trauma, or to be traumatized. And also the experience itself can be very traumatic depending on that person.

In other words, if I grew up in a neighborhood that was considered extremely rough, and people were fighting all the time and there were gunshots everywhere and crime happened all the time, more frequently than other neighborhoods. If I'm that person, and I'm with somebody else who hasn't experienced that in their life, and some guy comes up to us and pulls a knife and he shows it to both of us, I might look at him and go, really? And not be traumatized about it at all, and the person next to me, who might not have experienced any kind of trauma or that kind of experience in their lives, could be actually traumatized more.

So it depends on history, it depends on biological issues, it can depend on family and support systems and resources. So, yes, there are a lot of things that come into play when it comes to trauma.

Question: In terms of people who are dealing with addiction and trauma – for people in these situations, in order to resolve the addiction, do they first need to resolve the trauma? Where's the chicken and egg in this situation?

Sherrie Kleinholtz: That's a big conflict sometimes in the mental health field. Some people feel like you have to treat the addiction first, and the trauma second. Some people feel that you have to treat the trauma first and the addiction second. And then there is a third class of people, which I belong to, that feels that you have to treat them together. And I would say that you have to really triage, and what I mean by that is somebody is coming in and they're in severe psychosis, and they're seeing things, and they're hearing things, and they're becoming paranoid, and they're dangerous. Then you have to treat that first, obviously.

But for the most part, if people are coming in and they're struggling with both trauma and addiction, but not one is more prevalent than the other, then I encourage treating them together. And you cannot treat them separately. I'm very strong minded about that. You have to treat them together because what happens is you can heal somebody from the trauma, but you don't treat the addiction, the very moment that they go out and they get triggered, they're going to go back to the one resource that they knew of. And then if you treat somebody for the addiction but not the trauma, as soon as they get sober, all of those emotions, those feelings, those flashbacks, all of that stuff starts coming back again. And then again, they're going to go out and they're going to use because that's what works.

I'm in the school of thought that you have to treat both together, with the note that you have to triage if there's something more prevalent going on at the time.

Question: I assume that the fact that it's a double issue, trauma and addiction, makes it that much harder to manage the addiction issues, in particular?

Sherrie Kleinholtz: Yes, absolutely. You're working on skills that both treat the trauma, obviously, and triggers in the addiction. There's some really great therapy for that, like DBT therapy [dialectical behavior therapy] is really good for that. And you learn a lot of mindfulness skills and coping mechanisms to really help with both of those. And so I like to use DBT, dialectical behavioral therapy, in conjunction with trauma and addiction. And cognitive behavioral therapy, of course, which is obviously very well known in this field.

Question: What types of approaches do you use with students who are in this type of double situation, trauma and addiction?

Sherrie Kleinholtz: I go back to utilizing the cognitive behavioral therapy and the motivational interviewing is also very powerful. It's one of our core curriculums that we utilize. So with motivational interviewing, you are really meeting the person where they are. It's not trying to force them to be somewhere they're not. So if you have somebody that's coming in and their family and their professors and their bosses and everybody is saying that they have a serious problem, you need to work with them. They're not only having addiction issues but they're having trauma issues, and the client comes in and they're like, I'm fine. Everybody else is a mess, I'm actually OK. If you try to force them to be in treatment instead of working with them right where they are, you're going to fail because we are really, by nature, bred to do and to be survivors and when somebody pushes somebody in a corner, they're going to come out swinging.

So motivational interviewing is truly about meeting them where they are, trying to create some ambivalence inside of them and work with them to see that would change work for you? Would it not work for you? What if you did this versus this? And just try to get them to see kind of all paths that they take. So I'm a very big proponent of MI and then going back to the dialectical behavioral therapy, which is teaching them how to respond to triggers, and being very present in the moment.

Instead of thinking about what happened in the past, and worrying about what's going to happen in the future, you're really focused on right now. And if you're very focused right now, then tomorrow will create itself naturally. So just making good decisions now means that you'll probably have a very good tomorrow. And then cognitive behavioral therapy is just really teaching them how powerful their thoughts are and are they catastrophizing things? Are they having thinking errors and what are antidotes for their thinking errors?

So all of those three, kind of mixed together really work well for trauma and addiction.

A Message on Trauma and Addiction

Question: And you kind of touched on this, but what can the outcomes look like? Is it possible, and would you have a message for students and I guess their parents or families who may be facing this type of struggle, is there hope on the other side? What can the outcomes look like?

Sherrie Kleinholtz: That's a great question because a lot of times families have the misperception that somebody's entering treatment and within 30 days they're fine. And that is almost never the case because it takes a long time. Think about how many years it built to get to where they are now and you're trying to change all of that and undo some things, and then incorporate new skills, new thinking patterns, new behaviors, and that take a lot longer than 30 days. And natural things, such as relapses, will happen. Not to everybody, but often they happen and then soon as the relapse happens, many of their supporters get frustrated, rightfully so, but they get frustrated and then it's, I give up on them. I'm done. I've done everything I could. You guys were our last hope. You know, that kind of thinking, and that's just out of fear and anxiety and frustration, and a little bit of anger.

And so teaching them that have patience, be present with them, be positive. I can tell you over and over again clients, what they report most about enjoying being present here at this facility and with me as their counselor, is they love the positivity because so many people have been angry at them for so long. They haven't had a very warm and loving environment to be in. But when they're here they feel safe, they feel appreciated, they feel non-judged and they know that they can be themselves.

And if they mess up or they're struggling, then we say, OK. What happened? What can we do differently? What went wrong and we work on that, as opposed to being that judgmental angry, why did you do this? You're hurting our family. And that's just very difficult for families to understand. But once you educate them on that, families are usually almost always very positively responsive and say, I didn't even realize that. And often, relapses occur about between five and seven times before somebody becomes sober for more than three years.

Question: Anything else that folks should know about addiction and trauma?

Sherrie Kleinholtz: Preventative medicine I think is always the best. The moment, if you realize that addiction is genetic, running in your family. Then know that knowledge going into it. Have plans, know what your limit is, tell people, take a safe ride, and eat before you go, drink water, don't put yourself in risky situations. And look back on your family history and say, how much is this a possibility for me? And then, obviously, you have to make your own decisions, but make those decisions wisely. Because the more that you abuse substances in a negative way, the more you put yourself at risk to be traumatized.

And if you are somebody that has already experienced trauma and haven't had an addiction, before you pick up that bottle or take that pill or put that needle in your arm, go get counseling, go to a psychiatrist or a therapist or your doctor and say I am having these issues, and maybe this runs in my family, and tell them about it so that they can go OK, so let's try to prevent medication as much as possible. Or, let's make sure we're just very strict about how we prescribe it, and let's get you into counseling. And I think that that is most important, is just being aware.