The document discusses the relationship between trauma, substance abuse, and post-traumatic stress disorder. It states that stress and trauma are key contributing factors for the initiation and relapse of substance abuse as individuals often use drugs and alcohol to cope with PTSD symptoms. Specifically, the document finds that rates of sexual abuse are high among those with subsequent substance abuse issues. It describes the three stages of treating trauma and explains that treatment for those with active substance abuse should focus on safety, stabilization, and understanding the link between trauma and substance abuse before delving into recalling the traumatic event.

1. Trauma and Substance Abuse By: Jennifer Vollman

2. Stress, Trauma, Substance Abuse According to Brady and Sonne (1999), stress is regarded as a key contributing factor to the start, continuance, and relapse of substance abuse. Research has demonstrated consistently that the possibility of drug and alcohol abuse is greater when there is a high level of stress (Khantzian, 1985; Kosten et al, 1986; Sinha et al, 2000; Dawes et al, 2000). Since stress is increased by trauma, it is a logical assumption that trauma is also associated with the start, continuance, and relapse of substance abuse. Also, prevention and treatment experts must have the awareness that post traumatic stress disorder takes place together with depression, anxiety disorder, alcohol abuse, drug abuse, and other substance abuse.

3. Sexual Abuse Trauma The need for trauma and substance abuse to be treated simultaneously has been long suggested by high rates of sexual abuse in the past and subsequent substance abuse (Evans & Schaeffer, 1980; Barnard, 1989; Glover, 1999). In 1997, a study was conducted by Janinowski, Glover, and Bordiere involving 732 respondents residing in treatment institutions and they concluded that more than one-third of the respondents have experienced incest in the past. For the traumatized individuals, consuming drugs and/or alcohol is a way of coping with the symptoms of stress such as low self-esteem, nightmares, flashbacks of the traumatic event, numbness, and avoidance. Moreover, traumatic sexual abuse usually results in over-sexualization, the individual developing sex-related phobias, being confused about his or her sexual identity, and making use of sex as a way of giving or receiving attention.

4. Sexual Abuse and Avoidance It may be difficult to recognize the sexual abuse symptoms among individuals under treatment facilities for substance abuse since the displayed symptoms are often very similar to those related with substance abuse. If the individuals who have experienced sexual abuse are left untreated, they may make use of drugs and/or alcohol to cope with feelings of numbness and hold back memories that are recurring and painful, as well as manage overwhelming emotions of betrayal, shame, and helplessness. Teenagers who have gone through traumatic events in the past turning to drugs or alcohol in order to cope with post-traumatic stress disorder symptoms are not uncommon. They may find at first that drugs and/or alcohol seem to ease their stress, either through avoiding severe emotions that may result from traumatic events, or through the increased gratifying feelings induced by the substance.

5. Post Traumatic Stress Disorder However, in the long run, substance abuse may bring about a cycle of avoidance, making recovery more difficult. The symptoms of post-traumatic stress disorder often include the following (Strand et al, 2000; National Child Traumatic Stress Network, 2011; American Psychological Association, 2000): Substance abuse Difficulty in sleeping Deterioration of performance in school Thoughts of committing suicide Physical complaints Avoiding going to school Isolation; withdrawing from other people Unruly behavior Problems with friends or changing friends Guilt, depression, and becoming uninterested in activities Feelings of worthlessness Avoiding things that would remind the teenager of the traumatic event Having nightmares and flashbacks. Fear of the traumatic event happening again Loss of trust in anyone

6. Substance Abuse Substance abuse problems usually include the following (Hawkins et al, 1992; American Psychological Association, 2000; National Institute on Drug Abuse, 2011): Poor hygiene or changes in physical appearance Having difficulty sleeping Feelings of anxiety Depression Unruly behavior Locking doors, lying, sneaking out, and other secretive behaviors Extremely moody; sudden outbursts of hostility Dropping out of activities Deterioration of performance in school Avoiding going to school Changing friends Not introducing friends to parents Frequently intoxicated and usually noticed by others

7. The Relationship The link between trauma and substance abuse is complex and important. Trauma, on the whole, involves witnessing, experiencing, or being threatened with one or more events that imply serious physical or emotional damage to oneself or to other individuals, or even the possibility of death. Horror, helplessness, and extreme fear are the usual response to such traumatic events.

8. Treating Trauma: 3 Stages The treatment of trauma has three stages, as identified by Herman (1992): establishment of safety, recollection and sorrow, and reattachment with everyday living.

9. Treating Trauma For individuals in early recovery and those with active substance abuse, particularly women, the center of trauma treatment should be on safety, security, stabilization, and understanding the relationship between trauma and substance abuse, instead of on the re-telling of the traumatic event. Using this approach, the traumatized individual is supported, strengthened, and assisted on learning new ways of coping, before he or she proceeds to the later phases of treatment.

10. Responses to Traumatic Experiences Individuals are affected by trauma in various ways and at different levels, for many different reasons. Their responses to a traumatic experience are relevant with: coping strategies and skills in place and those used in the past resiliency of the traumatized individual the protective factors and risk factors in the area of the traumatized individual and his or her family, friends, and school, the understood intensity of the traumatic experience, and the understood and the actual effect of the traumatic experience.

11. Recovery From Trauma: 3 Levels On the whole, recovery from trauma involves three levels. Traumatized individuals will eventually get better, stay the same, or become worse. While most traumatized individuals will function less for a length of time subsequent to a traumatic experience, these levels take in hand the overall life functioning of the traumatized individual beyond 18 to 24 months. The first level is referred to as the “depleted self”. In this level, the traumatized individual is not capable of returning to a level of functioning that was at least as good as the level of functioning prior to the traumatic experience. The second level is referred to as the “pre-trauma self”. In this level, meanwhile, the traumatized individual is capable of returning to a comparable level of functioning. Despite being affected by the traumatic experience, he or she has adjusted and accommodated, and is able to benefit from and contribute to daily life. Finally, the third level is referred to as the “elevated self”. In this level, the traumatized individual is capable of functioning at an improved level. He or she has gained from having gone through the traumatic experience. He or she has meditated upon or examined his or her life and made changes that brought about an increase in the level of functioning. The said changes could be in many different aspects, such as spiritual, vocational, emotional, cognitive, physical, or psychological. As a result, the traumatized individual may feel higher levels of motivation, focus, contentment, and fulfillment.

12. References American Psychological Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC. Barnard, C.P. (1989). Alcoholism and sex abuse in the family: Incest and marital rape. Journal of Chemical Dependency Treatment, 3, 131-144. Brady K. T., Sonne S. C. (1999). The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol Research Health, 23, 263-271. Brown, P. J. (2000). Outcome in female patients with both substance use and post-traumatic stress disorders. Alcoholism Treatment Quarterly, 18(3), 127-135. Brown, V. B., Huba, G. J., & Melchior, L. A. (1995). Level of burden: Women with more than one co-occurring disorder. Journal of Psychoactive Drugs, 27, 339-346. Dawes, M. A., Antelman, S. M., Vanyukov, M. M. (2000). Developmental sources of variation in liability to adolescent substance use disorders. Drug and Alcohol Dependence 61(3), 14. Evans, S. & Schaefer, S. (1980). Why Women’s sexuality is important to address in chemical dependency treatment programs. Grassroots, 37, 37-40 Glover, N. M. (1999). Play therapy and art therapy for persons who are in treatment for substance abuse and have a history of incest victimization. Journal of Substance Abuse Treatment, 16, 281-287. Hawkins, J. D., Catalano, R. E., & Miller, J. Y. (1992). Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention. Psychological Bulletin, 112(1), 64-105. Herman, J. (1992). Trauma and recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror. New York: Basic Books. Jacobsen L. K., Southwick S. M., & Kosten T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. American Journal of Psychiatry. 158(8),1184-90. Janikowski, T. P., & Glover, N. M. (1994). Incest and substance abuse: Implications for treatment professionals. Journal of Substance Abuse Treatment, 11, 177-183. Khantzian , E. J. (1985). The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry 142:1259-1264. National Child Traumatic Stress Network (NCTSN) (n.d.) Types of Traumatic Stress. Retrieved, March 23, 2011 from http://www.nctsnet.org. National Institute on Drug Abuse (NIDA) (n.d.). Understanding Drug Abuse and Addiction. Retrieved, March 23, 2011 from http://www.nida.nih.gov/Infofacts/understand.html. Sinha, R., Fuse, T., Aubin L. R., O'Malley S. S. (2000) Psychological stress, drugrelated cues, and cocaine craving. Psychopharmacology ,152,140-148. Strand, V.C., Sarmiento, T. L., & Pasquale, L. E. (2005). Assessment and Screening Tools for Trauma in Children and Adolescents. Trauma, Violence, & Abuse,6(1), 55-78.