Treating Trauma in Conjunction with Substance Use Disorders: A Comprehensive Approach

Trauma and substance use disorders (SUDs) are often intertwined in a complex and destructive cycle, where trauma serves as both a potential cause and consequence of addiction. Individuals struggling with trauma frequently turn to substances as a way to self-medicate, cope with pain, and manage overwhelming emotions.[1] However, this reliance on substances often exacerbates the effects of trauma and leads to the development of co-occurring disorders.

Successfully treating both trauma and substance use disorders requires a holistic, integrative approach that addresses both conditions simultaneously, as each can fuel the other.

Understanding Trauma and Substance Use Disorders

Trauma results from experiences that overwhelm a person’s ability to cope, often leaving lasting emotional, psychological, and physical scars.[2] Common sources of trauma include abuse (physical, emotional, sexual), neglect, loss, violence, accidents, and natural disasters. Trauma triggers intense feelings of fear, helplessness, or horror, and it may lead to the development of post-traumatic stress disorder (PTSD), anxiety, depression, and other mental health conditions.

Substance use disorders occur when an individual becomes dependent on drugs or alcohol, continuing use despite negative consequences. People with SUDs often develop a tolerance to the substance and experience withdrawal symptoms when they stop using.[3] Substances temporarily numb emotional pain, which is why many trauma survivors turn to alcohol, drugs, or other addictive behaviors to escape the memories and sensations of their traumatic experiences. Over time, however, substance use becomes maladaptive and contributes to a worsening cycle of emotional dysregulation, isolation, and poor mental health.

The relationship between trauma and SUDs is bidirectional. Trauma increases the likelihood of developing a substance use disorder, and people with a SUD are more susceptible to experiencing trauma due to the risky behaviors and environments they may find themselves in. As a result, treating only one condition without addressing the other is often insufficient and can lead to recurrence or ineffective recovery.

The Importance of Integrated Treatment

When trauma and substance use disorders co-occur, treatment approaches that focus on only one issue often fail to produce long-term recovery. If trauma is not addressed, the emotional pain may continue to drive substance use as a means of coping. On the other hand, focusing solely on trauma without treating the substance use disorder can make it difficult for individuals to fully engage in therapeutic interventions, as their addiction can cloud their judgment and undermine their ability to process difficult emotions.

Integrated treatment, which addresses both trauma and substance use disorders concurrently, is essential for achieving sustainable recovery. An integrative approach ensures that both conditions are treated holistically, recognizing their interconnection and addressing the root causes of each. This type of treatment typically involves a combination of therapies that promote emotional healing, trauma resolution, and sobriety.

Evidence-Based Therapies for Trauma and Substance Use Disorders

The focus of treatment can involve a structured and supportive approach to help individuals process and heal from their past experiences. Patients at Wellbridge can participate in trauma-focused groups where they receive education on how trauma affects the brain and body and are introduced to coping strategies for managing triggers and symptoms. These groups provide a safe space to share experiences, build resilience, and work through the emotional impact of trauma while being supported by a clinical team. In addition to group therapy, patients may also engage in individual therapy to dive deeper into personal trauma narratives and be supported by the treatment team.

Several evidence-based therapies have proven effective in treating co-occurring trauma and substance use disorders. These therapies focus on helping individuals understand and process their trauma while developing healthier coping mechanisms to manage their cravings and triggers. Some of the most commonly used therapies include:

• Trauma-Informed Care (TIC): Trauma-informed care is an overarching approach that guides all aspects of treatment. It involves creating a safe, supportive environment that acknowledges the impact of trauma on a person’s life and recovery. Providers trained in TIC avoid re-traumatization and prioritize trust, empowerment, and collaboration.
• Cognitive Behavioral Therapy (CBT): CBT is a widely used form of psychotherapy that helps individuals identify and change negative thought patterns and behaviors. In the context of trauma and SUD treatment, CBT focuses on breaking the cycle of negative thinking, self-medication, and avoidance by teaching healthier coping strategies for both trauma-related symptoms and cravings.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR is an evidence-based therapy specifically designed to help individuals process and heal from trauma. Through guided eye movements or other forms of bilateral stimulation, EMDR helps patients reprocess traumatic memories in a way that reduces their emotional impact. This allows for healing and decreases the need for substances as a coping mechanism.
• Dialectical Behavior Therapy (DBT): Originally developed for individuals with borderline personality disorder, DBT has been shown to be effective for people with co-occurring trauma and substance use disorders. DBT teaches mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills, helping individuals navigate overwhelming emotions without resorting to substance use.
• Motivational Interviewing (MI): MI is a collaborative, person-centered approach designed to increase a person’s motivation and commitment to change. It is particularly helpful for individuals struggling with ambivalence about sobriety or healing from trauma, as it fosters an empathetic therapeutic relationship and helps individuals explore their own goals and values.
• Medication-Assisted Treatment (MAT): For some individuals with substance use disorders, medication may be used to reduce cravings, manage withdrawal symptoms, and support sobriety. Medications such as buprenorphine, methadone, and naltrexone are commonly used in MAT. When combined with therapy, MAT can be an effective part of an integrated treatment plan.

Holistic and Alternative Therapies

Beyond traditional therapeutic approaches, many treatment centers incorporate holistic and alternative therapies to support healing from trauma and substance use disorders. These may include yoga, mindfulness meditation, acupuncture, art therapy, and equine therapy. Such approaches help individuals reconnect with their bodies, manage stress, and develop healthy outlets for processing emotions.

Building a Supportive Network

Social support is a crucial element in recovery from both trauma and substance use disorders. In addition to individual therapy, group therapy, peer support groups, and family therapy can provide individuals with a sense of belonging, reduce feelings of isolation, and offer encouragement throughout the recovery process.

Conclusion

Treating trauma in conjunction with substance use disorders requires a multifaceted and compassionate approach that addresses the complexities of both conditions. Combining evidence-based therapies with holistic support, integrated treatment offers individuals the best chance for healing and long-term recovery. By addressing both the emotional wounds of trauma and the destructive patterns of addiction, individuals can break free from the cycle and build a life of sobriety, resilience, and hope.