Addiction and substance abuse are widespread problems in our culture, and often we become so invested in the discussion about the use of substances, we can overlook underlying factors, most commonly, trauma.  Studies have shown that 70 percent of those in treatment for substance abuse have had exposure to trauma. The relationship between addiction and trauma is significant, and as we explore the recovery process, trauma work is a necessity.

Dr. Gabor Mate, an expert on trauma, shares his perspective that we need to broaden our view of trauma, since every person has an individual interpretation of what is traumatic. He suggests we look at the Greek meaning of the word trauma, which is “wound.” We tend to think about trauma as a severe set of circumstances that are life-threatening or involve a risk of imminent harm. Dr. Mate suggests that, depending on the unique factors of an individual, including sensitivity levels, genetic makeup, and nurturing, trauma can mean many different things. When we think about trauma in this broader sense, it is easy to envision the many ways in which an individual may be inadvertently traumatized, even when their circumstances do not necessarily seem “that bad” from an outsider’s perspective.

Exploring addiction as a response to trauma makes so much sense. People turn to substances as an “attempt to solve a problem”. The aspects of substance use that make it appealing for trauma survivors are:

These compelling results of substance use become the perceived solution to the problems caused by trauma. Rather than “why is the person addicted,” we should ask ourselves, “why is this person in pain?”

When substance use disorder and trauma are treated simultaneously, the outcomes far exceed siloed treatment. No one knows this better than Patrick Devlin, psychotherapist, substance abuse counselor, and co-founder of Skyline Recovery in Bend, Oregon. Devlin and his team treat young adult men with addiction, and co-occurring trauma.

In his work with young adults, Patrick has seen how trauma affects the young adult mind. He states, “we know that trauma has a significant impact on the way a person sees themselves, their sense of safety, their relationship to their body, the comfort or lack thereof in their own skin, and their ability to tolerate or feel their own feelings. When you couple these impacts with the primary developmental task of adolescence as identity development (as opposed to adults that have a fully developed sense of self), this creates the conditions for deeply entrenched negative behavioral patterns, view of the world and low self-esteem.”

Though Patrick and his team at Skyline Recovery treat each teen as unique individuals and work on the specific needs of each person in the program, he notes that there are certain types of treatment that have been particularly helpful for those in recovery with trauma histories. One important aspect of treatment is family work, as Patrick explains that “addiction and substance use is a family issue and never exists in a vacuum.”

Devlin notes that increasing awareness and educating all family members about the systemic patterns is an important first step.  He also emphasizes the importance of family members getting needed supports such as therapy, siblings getting support at school, medication, and other resources. Because it is a family issue, Patrick says that each member of the family must be aware of their own needs and boundaries, take care of themselves and ask for help with it as needed. Decreasing patterns of co-dependency is an important step in families growing and becoming healthier, even if some family members continue to struggle.

Patrick recommends tried and true resources such as 12-step programs, mindfulness-based recovery programs and Al-Anon for families. He also suggests that parents and mentors educate themselves and help young people get connected to trauma-informed care. Devlin reminds us that, “you can lead a horse to water, but you can’t make them drink (although you can help make them thirsty by not enabling self-destructive patterns). There is a point in which you have to let go and give them the space to have their own journey. Also, to try to maintain a balance between support and detachment. Healthy detachment is an art that takes a lifetime to explore, but it is THE way to best support a person struggling with trauma and addiction.”

In terms of treatment for trauma, Patrick points to the growing body of evidence that talk-therapy is not as impactful as we would like. He also states, “addiction is not a rational problem but is largely emotional in nature and about dissociation.” Devlin advises that all types of therapy should be trauma-informed and support young people to be “in their bodies, and process feelings in a healthy way.” He suggests treatments such as somatic experiencing, attachment-informed psychotherapy, EMDR and Brainspotting. Patrick also shares that ego-states or “parts” work is helpful in working through trauma and addiction.

Patrick Devlin’s path toward helping others began with his own journey of trauma healing and recovery. He openly shares part of his story in the interview, stating, “I grew up in an environment where I was struggling with things that I didn’t have words for and the only solace I found was in substances. The groundwork was laid for me to fall into addiction and eventually lead me to the proverbial rock and a hard place that so many addicts encounter.” He further shared that he had a great deal of support and after several relapses was ready to get sober. “This led me toward being of service to other people suffering as part of my recovery and I quickly found that I loved the work and the power of people making profound changes in their lives. Now I am inspired by all my clients and feel so honored to be a part of peoples healing journey. I can’t imagine doing anything else.”

Patrick refers to the role of self-sabotage in mental health and recovery. He notes that Peter Levine, trauma expert, talks about the trauma repetition cycle and the ways people get stuck. The powerless feelings and sense of victimization people experience as a result of trauma can lead to an effort to exert control and regain personal power. Though the desire for self-actualization and autonomy is a healthy one, it can sometimes be misdirected into self-sabotage. Patrick has seen this pattern play out repeatedly over his years in the field of recovery. He suggests that families make an effort not to add shame to the person going through this type of regression, as this can reinforce the pattern. “The more shame an addict feels the more avoidant, dissociated, and unconscious they become. There is a difference between having boundaries as a loved one of an addict, detaching with love as they say in al-anon, and punishing them with your boundaries because you are angry that they regressed again.”

Trauma and addiction can be treated effectively with the right interventions. Understanding one’s pain and trauma, and the underlying thoughts, feelings and beliefs that have stemmed from it can help people in recovery heal. Trauma-informed care for substance use can help individuals and their families recover, reconnect, and heal.

The way we connect with each other as humans influences every aspect of life, from our daily interactions with people around us to the health of our intimate relationships and view of ourselves.  Each of us has an attachment style that typically falls within four general categories: secure, avoidant, resistant, and disorganized.

The ways we attach to primary caregivers in early life is a predicting factor of our attachment style. As a “tabula rasa”, or blank slate with no conscious awareness or expectations, infants respond to the reactions of caregivers. Infants who learn that others are not likely to meet their needs consistently sometimes develop attachment problems during their lifespan. This can mean the difference between an infant who knows their needs will be met and one who learns that their needs are a burden or illicit hostility or unpredictable responses. Data from the Early Childhood Longitudinal Study indicates that out of 14,000 kids that participated, 40% had insecure attachment. If the challenges are profound enough and negatively impact a child’s life, it could indicate the presence of an Attachment Disorder, and may warrant mental health intervention. 

​Attachment Disorder is a diagnostic term used by mental health professionals that explains a range of emotional and behavioral symptoms related to an individual’s inability to establish trusting, loving relationships. In children, this may look like behavioral outbursts and attention seeking behaviors, resistance to connection with parents and others, or conversely, indiscriminate attachment and limited boundaries with others. 

​Often when we think of Attachment Disorder, we envision scenarios that may contribute to difficulty trusting others, such as negative early childhood experiences. While it is true that disordered attachment usually stems from early interactions, it is important to consider that some issues related to attachment are not as easily explained, and in some cases, it may feel like a complete mystery.

Parents who adopt are often provided with information about attachment issues prior to adopting, to help identify potential signs for early intervention. People who have adopted from infancy, however, may feel as though their child is protected from disordered attachment, since they have been the primary caregivers since day one. Even with adoption from infancy, attachment disorder can sometimes manifest, leaving adopted parents feeling confused, riddled with guilt, and deeply saddened about their child’s emotional suffering. 

​The ongoing study of the attachment process has shown that the way we connect with others and establish trust in human relationships is complex and deeply rooted. Attachment is influenced by a variety of factors, including but not limited to the way caregivers respond to infant needs. Babies who are adopted from birth can still have attachment problems unrelated to any experiences out of the womb. This phenomenon shows us that attachment is more than just having one’s needs met at crucial times in our lives. It also happens at the microscopic level, in utero, and is impacted by neurological and genetic factors that are beyond what we can control in an infant’s world. 

We have known that trauma changes our brains for decades, but the in-utero impact of trauma on the attachment of unborn babies is relatively new information. A 2017 study of maternal lifetimes stress, cortisol levels during pregnancy and infant reactivity showed significant findings. Mothers who have experienced a greater amount of traumatic experience during their lifespan are more likely to have infants with negative affective reactions. 

The maternal Hypothalamic-pituitary-adrenal-axis (HPAA) impacts infant and toddler affect, increasing the likelihood of distress, fear, and behavioral issues. The results of this study show that the impact of maternal stress over the lifespan influences maternal neurobiology and even impact the way unborn babies develop. These changes also compromise attachment wiring in the brain.  In short, attachment problems can become intergenerational and hard-wired, even when the infant is raised in a safe, loving home.  It is no one’s fault. Fortunately, there is help for addressing attachment issues.

Attachment disorder that is hard-wired may feel futile and hopeless to manage, but it can be addressed with the right tools and support. Professional therapists offer attachment therapy to parents and children as a means of helping to mend some of the barriers that can influence attachment. Early intervention is best, but older children can also benefit from attachment work. 

​Helping children and parents connect is the focus of attachment therapy, and it is done with careful planning and in consideration of the unique needs of specific families’ circumstances. Parents who have children struggling with attachment issues can experience growth, connection, and greater attachment with a little help. 

Often when people hear the term EMDR as a mental health treatment method, they wonder three things: what do the letters stand for, will it hurt, and does it work? The answers to that three-part question are: Eye Movement Desensitization and Reprocessing, no it does not hurt, and yes, it does work remarkably well for many people suffering trauma, and other painful experiences contributing to emotional pain. EMDR can begin to have an impact from the first few sessions of treatment, or can be integrated into existing therapy sessions.

EMDR is a non-invasive treatment method developed to help a breadth of needs from attachment wounds to physical trauma. The mechanism of EMDR is fascinating, as it is neurologically based and works through six phases of cognitive, emotional, and physiological interventions. Therapists who are trained in EMDR take people through the process carefully and explain each element of treatment prior to starting.

EMDR essentially helps transfer deeply entrenched trauma and other ingrained experiences away from the automatic physiological responses of PTSD to minimize impact on daily life. When trauma reactions (such as increased heart rate, intrusive thoughts, flashbacks, and heightened cortisol levels) are reduced, our bodies have an opportunity to function properly, resulting in better quality of life and lower stress levels.