Types of Trauma

What is traumatic for one person may not be for another, but almost everyone experiences some form of trauma in their life. For some, trauma may occur as a single event, like witnessing or experiencing a violent episode. Others may experience repetitive and long-lasting trauma, such as ongoing child abuse or living in a war zone.

Trauma is typically categorized as overt or covert:

• Overt trauma is characterized by clear, identifiable events that are generally considered harmful or frightening like physical abuse, sexual abuse, a natural disaster or war.
• Covert trauma, also known as relational trauma, is subtler and often goes unrecognized for some time. Examples include being bullied at school, experiencing emotional neglect by a parent or growing up in an environment filled with secrecy or fear.

Both overt and covert trauma can have a significant impact on your health and well-being.

The Science Behind Trauma and Substance Use

Studies like the Adverse Childhood Experiences (ACE) study show a link between people who experienced childhood trauma and who later developed certain medical conditions, including substance use disorders. Examples of adverse childhood experiences include:

• Experiencing violence, abuse or neglect
• Witnessing violence in the home or community
• Having a family member attempt or die by suicide
• Growing up in a household with someone who has substance abuse or mental health problems
• Experiencing instability due to parent separation or a household member being imprisoned

Trauma can alter brain development and make it harder to manage stress in healthy ways. This can lead to a vicious cycle:

• Trauma triggers difficult emotions.
• People seek relief through substances.
• Substance use creates new problems.
• The cycle repeats, often worsening the original trauma.

"One new problem created by substance use is breaching your own integrity, which leads to shame. People often identify as weak, broken, sick or damaged," says Mia Rusev, LCSW, a therapist at Northwestern Medicine Behavioral Health Services. "But relapse is not a moral problem. It is an automatic, impulsive, stress reaction to feeling threatened. People will continue to use whatever survival strategies that have helped them previously. The key is to understand that these behaviors are no longer helpful in the present."  

Signs of Trauma

Scars from trauma can be invisible, yet they can have a profound and lasting impact on a person's life. Symptoms that can result from a traumatic experience include:

• A persistent negative view of the world or others
• Hypervigilance
• Increased startle response
• Flashbacks
• Shame and social isolation
• Loss of self-worth and trust in self
• Intrusive or avoidant behaviors
• Eating disorders
• Problems in romantic and social relationships

According to Rusev, survivors of a traumatic experience will sometimes say nothing happened. "The body knows otherwise," she says, adding that physical symptoms, such as migraines and chronic pain, may also occur.

A Dual Diagnosis

"There's this quote that we talk about a lot in my groups," says Kimberly Cho, LPC, a therapist in the Dual Diagnosis Program at Northwestern Medicine Behavioral Health Services. "Not everyone who has trauma has addiction, but everyone who has addiction has trauma because there's generally something that's propelling you to use. If we don't treat the trauma, but we treat the addiction, the problem is still there."

Cho explains that this is why a dual diagnosis is so important. "We can't really treat one without the other," she says. "They need to be treated concurrently in order to address all the underlying concerns that are making the addiction seem like it's the biggest problem. But really, that's not the issue. It's the trauma."

Help for Breaking the Cycle

Many people who experience trauma are not equipped to process it, nor do they know where to receive the help that they need. Understanding the trauma-substance use disorder link is important. Instead of only treating the compulsion to use a substance, trauma-informed care (TIC) focuses on healing the underlying wounds fueling the compulsion. This is achieved through:

• Safety. It's important to have a physically and emotionally safe space for you and everyone involved in your care. This includes ensuring privacy, respecting boundaries and having clear procedures in place to prevent re-traumatization.
• Trustworthiness and transparency. Building trust is a key component in TIC. This includes having a care team that is transparent about processes, decisions and expectations. Honesty and open communication between you and your care team are critical.
• Collaboration and mutuality. Healing is a collaborative effort. TIC promotes teamwork between you and your care team, and potentially your family members, to ensure everyone's voice is valued and respected.
• Peer support. Connecting with others who have shared experiences is powerful. TIC often includes support group work.
• Empowerment, voice and choice. People who have experienced trauma often feel powerless. TIC focuses on empowering people to make informed decisions about their care, including the type of therapies used, and to be active participants in their healing process.
• Cultural, historical and gender awareness. Trauma can be influenced by various factors such as cultural background, historical context and gender identity. TIC acknowledges these differences and strives to provide culturally sensitive and inclusive services.

"Addiction is really an act of dissociation," says Lisa Bloom, MSW, LSW, manager of Business Development at Northwestern Medicine Behavioral Health Services. "It's a way of engaging or disengaging with yourself and the world to cope with a constant state of feeling threatened. Bringing awareness to when you're leaving the present moment is a really critical piece of treatment."

Bloom talks about the term "interoception," which she defines essentially as feeling your feelings. "It's not naming feelings, as in sad or angry, but simply feeling the sensations in your body: hot and cold, pressure, tingling, tightness or tension in your muscles," she explains. "The experience of trauma interrupts your capacity to feel in the body. To be traumatized is to feel chronically unsafe."

Therapies That Can Help

There are many types of therapies that can be employed within TIC. Bloom focuses on body-based therapy, including trauma-sensitive yoga, to help patients reconnect with their bodies. Kathleen Ryan-Fuhs, LCSW, trauma specialist at Northwestern Medicine Behavioral Health Services, specializes in memory reconsolidation therapy (MRT), which is a process of replacing a stored memory with a new version of that memory.

 "Trauma is stored in our unconscious mind, a vigilant guard scanning for threats reminiscent of past traumas," she explains. "Traditional talk therapies frequently fall short in reaching the unconscious mind because it operates beyond the realm of verbal language. MRT employs stories, metaphors and movement to reprogram mental processes, thus effectively communicating that the trauma is over."

Ryan-Fuhs says that MRT allows the therapist to clear the negative emotions from a difficult event or relationship without the patient reliving the event, and it can be done in one session. "MRT brings relief from any traumatic event, including physical, sexual and emotional abuse; frozen grief; heartbreak; and guilt and shame from events that went wrong," she says. "The mind generalizes to clear events that are structurally similar. So by clearing one or two events, the negative emotions from all similar events get cleared."  

The Takeaway

Recognizing trauma's role in substance use disorder can lead to a more comprehensive approach to healing.