Trauma

There is a complicated relationship between trauma and substance use.

For some people, the experience of trauma can be a root cause of problem substance use. This is true especially for people who experience traumatic events in childhood (see adverse childhood experiences).

For some people who have a substance problem the risk of experiencing trauma can be greatly elevated – this can be caused by a wide range of events that can be associated with problem substance use - experiencing and witnessing overdoses; bereavement through overdose and other causes; separation due to incarceration / hospitalisation; experiencing and witnessing violence; trauma through sexual and financial exploitation; losing access to children, for example. There are also traumatic effects of social marginalisation and stigmatisation (see stigma).

The link with trauma has influenced the development of the model of problem substance use as a form of self-medication or self-soothing (see self-medicating).

The high levels of trauma experienced by people with a drug problem dictates that services should be designed and delivered in ways that take account of this, be ‘trauma-informed’. This means that services are designed and delivered in a way in which people who have experienced trauma can comfortably engage, that does not make their situation worse and acts as a sound basis and safe place from which people can address the health and other impacts of their trauma experiences including their use of substances.

The link to trauma suggests that finding ways to identify trauma and help people identify this as a driver of their substance use may be useful; it also suggest that helping people find other ways of addressing their trauma symptoms may help address their problem substance use; it may also challenge the stigmatisation of people with a substance use problem.

All of this is widely accepted and the term trauma is not contested widely. However, there is a danger that such an apparently coherent notion is universalised and that people who do not have a history of trauma or cannot recall traumatic events in their past or who do not wish to disclose events are alienated or treated as if or feel like their problem substance use cannot be ‘justified’ or explained.

The term trauma may be more useful that the term ACEs (see adverse childhood experiences) as it includes trauma in adulthood.