Addiction often stems from trauma. Enduring stressful or distressing experiences can overwhelm a person’s adaptive capacity, predisposing them to self-medicate and numb the painful emotions and physical sensations resulting from trauma. Consequently, therapists frequently employ trauma-informed care approaches in treating substance use disorders.
Trauma-informed care addresses the root traumatic etiology, rather than surface-level addiction only. Guided by an understanding of trauma’s disruption to the brain’s threat detection system and stress response, trauma-informed care recognizes how distressing experiences become deeply embedded in one’s psychology and physiology. Therapists employ strategies to avoid exacerbating trauma survivors’ hyper-aroused alarm states by carefully managing triggers that could induce feelings of endangerment, lack of safety, or loss of control throughout the healing process.
Central to this care model are the foundational three Rs. The first element is realizing how past trauma profoundly shapes clients’ lives and contributes to substance use; the second is recognizing trauma’s manifestations through behaviors and symptoms; and the third is responding with care and treatment plans tailored to the client’s unique trauma background and current situation.
Trauma-focused therapies use different techniques to help people recover from addiction. Cognitive behavioral therapy looks at the irrational thoughts that trauma caused and allows people to question and challenge those thoughts. Cognitive processing therapy reformulates the trauma narrative to facilitate understanding and lessen its ongoing impact and associated substance use cravings. Eye movement desensitization and reprocessing (EMDR) harnesses dual attention stimuli, such as bilateral eye movements and auditory tones, to enhance information processing and reduce emotional intensity, leading to desensitization and healing.
In addition, exposure-based interventions constitute a complementary treatment modality, providing controlled, graded exposure to trauma-associated stimuli or anxiety-provoking situations to facilitate desensitization and extinction of fear responses. Additionally, therapists may prescribe medication to target specific symptoms or imbalances in the brain chemistry. Medications such as selective serotonin reuptake inhibitors (SSRIs) - a type of antidepressant - can help relieve patients’ panic states by allowing them to relax and improving their mood. However, medication alone cannot wholly resolve trauma. A combined approach using different therapies is often necessary.
The various principles of trauma-informed care help practitioners deliver sensitive and effective services. Foremost is the imperative of promoting safety by cultivating secure, welcoming environments that foster physical and psychological security. Equally vital is developing authentic, empathetic therapeutic relationships that recognize patients’ diverse traumatic histories. Clearly defining organizational policies, financial obligations, and treatment protocols further bolsters trust and therapeutic rapport.
Another seminal principle is promoting collaboration and mutuality built on openness, transparency, and cooperation between service providers and those they serve. Rather than just prescribing treatment, providers work with clients as partners. Together, they shape choices and set goals, keeping the client’s needs and preferences front and center. This mutual effort empowers the client and gives them a sense of shared responsibility in their treatment path.
Trauma-informed care also incorporates the principle of empowerment to help those with substance addictions recover. Recognizing their increased vulnerability that can further cause harm, providers implement a comprehensive, multidisciplinary approach that extends beyond clinical interventions. Psychoeducation fosters self-awareness and equips clients with adaptive coping mechanisms to identify and manage triggering circumstances. Patients develop critical skills such as impulse control, affect regulation, and self-efficacy.
Addressing trauma within addiction treatment can be challenging for clients and providers.
Exploring negative experiences can evoke intense emotional responses during recollection and discussion, causing significant distress. Additionally, therapists and staff are at risk of secondary traumatization through empathetic engagement with their clients’ pain. Consequently, to balance therapeutic needs with self-care, providers receive regular clinical supervision and healthy outlets to process their experiences, preventing burnout while supporting clients through their healing journey.
