The Role of Trauma and Mental Health in Addiction

Gun violence, political unrest, climate change, the affordability of healthcare, the global COVID pandemic, and its repercussions, racism, terrorism, and the cost of living—Americans are deeply concerned about many things these days. And the onslaught of problematic issues seems to have impacted the nation's mental health.

"Our country faces an unprecedented mental health crisis among people of all ages," stated a White House fact sheet in March. "Two out of five adults report symptoms of anxiety or depression… Even before the pandemic, rates of depression and anxiety were inching higher. But the grief, trauma, and physical isolation of the last two years have driven Americans to a breaking point."

The White House fact sheet notes that America's youth has been particularly impacted "as losses from COVID and disruptions in routines and relationships have led to increased social isolation, anxiety, and learning loss. More than half of parents express concern over their children's mental well-being." Surgeon General Vivek Murthy issued a similar warning in December.

Derek Thompson described it as "an extreme teenage mental-health crisis" in an April article in The Atlantic. Between 2009 and 2021, the share of high-school students who say they feel "persistent feelings of sadness or hopelessness" increased from 26 percent to 44 percent, according to a recent study by the Centers for Disease Control and Prevention (CDC)—it is the highest level of teenage sadness ever recorded in the United States.

Feelings of sadness, emptiness, or hopelessness are primary symptoms of depression, but America's youth is also anxious. From 2013 to 2019, one in 11 children aged 3–17 was affected by anxiety, according to the CDC. Although there is some variation, "the big picture is the same across all categories: Almost every measure of mental health is getting worse, for every teenage demographic, and it's happening all across the country," Thompson reported.

Pervasive feelings of sadness, hopelessness, or anxiety at any age can result from traumatic experiences—with long-lasting consequences. "The effects of unresolved trauma can be devastating," wrote psychologist Peter Levine in Healing Trauma. "It can affect our habits and outlook on life, leading to addictions and poor decision-making. It can take a toll on our family life and interpersonal relationships. It can trigger real physical pain, symptoms, and disease. It can lead to a range of self-destructive behaviors."

Trauma is an emotional response to an intense event that threatens or causes harm, such as being in an accident or witnessing a violent crime. It is often the result of overwhelming stress that exceeds one's ability to cope with or accept the emotions involved with that experience.

Some people develop post-traumatic stress disorder (PTSD) after experiencing such a shocking or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body's normal "fight-or-flight" response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most will recover from their symptoms over time. Those who continue to experience symptoms may be diagnosed with PTSD.

Trauma (and PTSD) may also result from adverse childhood experiences (ACEs), such as experiencing violence, abuse, or neglect, witnessing violence in the home or community, or having a family member attempt or die by suicide. About 61 percent of adults surveyed across 25 states reported having experienced at least one type of ACE before age 18, and nearly 1 in 6 reported having experienced four or more ACEs.

Trauma is prevalent in the United States. "The CDC statistics on abuse and violence in the United States are sobering," wrote Monique Tello, MD, MPH, on the Harvard Health Blog in 2018. "They report that one in four children experiences some sort of maltreatment (physical, sexual, or emotional abuse). One in four women has experienced domestic violence. In addition, one in five women and one in 71 men have experienced rape at some point in their lives—12 percent of these women and 30 percent of these men were younger than 10 years old when they were raped. This means a very large number of people have experienced serious trauma at some point in their lives."

"Trauma is a pernicious, silent, and progressive mental health threat that dramatically increases the risks of depression, anxiety, hypervigilance, suicidality, and further violence if not treated," explained Michael Barnes, the chief clinical officer at the Foundry Treatment Center in Steamboat Springs, Colorado.

"Unfortunately, it can take the devastating impacts of large-scale traumatic events like the Robb Elementary School shooting to bring America's mental health and traumatic experience epidemic into public view. However, for many reasons, including accidents and injury, domestic violence, loss and grief, adverse life events, intense stress, exposure to the side effects of substance use disorders, and other untreated mental health disorders, an estimated 89.7 percent of Americans are exposed to traumatic events, and 12 million adults—that's six percent of the population—suffer from post-traumatic stress disorder at any given time. For every person experiencing PTSD, there are untold numbers of family members, friends, and colleagues whose lives are directly or indirectly affected by PTSD's side effects."

The human trauma response is complicated. In addition to the familiar negative effects of the classic "fight-or-flight" stress response, the polyvagal theory introduced by Stephen Porges in the 1990s added "a second defense system with features not of mobilization as manifest in fight/flight reactions, but of immobilization, behavioral shutdown, and dissociation."  

Watch "Trauma and the Nervous System: A Polyvagal Perspective"

Trauma-informed Addiction Treatment

Trauma, depression, anxiety, and other mental health conditions are major drivers of addiction. "Trauma and addiction go hand-in-hand," wrote Tian Dayton in Trauma and Addiction. "What starts out as an attempt to manage pain evolves into a new source of it…. The cycle of trauma and addiction is endless."

Even before the highly stressful COVID-19 pandemic, Princeton economists Anne Case and Angus Deaton suggested in a 2015 paper (and a subsequent 2021 book) that working-age white men and women without four-year college degrees were dying "deaths of despair" by suicide, drug overdoses, and alcohol-related liver disease at unprecedented rates. The pandemic appears to have exacerbated that trend.

In May, the CDC reported that more than 107,000 Americans died of drug overdoses in 2021, setting another tragic record in the nation's continually escalating addiction epidemic. The provisional 2021 total translated to roughly one US overdose death every five minutes and marked a 15 percent increase from the previous year's record.

These numbers have now significantly contributed to a decline in life expectancy. A new study by the University of Colorado Boulder, Virginia Commonwealth University, and the Urban Institute found that life expectancy in the United States plunged by nearly two years between 2018 and 2020, with the COVID-19 pandemic exacerbating a troubling trend dating back more than a decade. The overall US decline was 8.5 times greater than the average decline among 16 other high-income countries during the same period.

Since trauma is frequently the driver behind a substance use disorder, any traumatic history of the patient and any resulting mental health issues need to be addressed in addiction treatment concurrent with the substance misuse.

"Giving words to trauma begins to heal it. Hiding it or pretending it isn't there creates a cauldron of pain that eventually boils over. That's where addiction comes in," wrote Tian Dayton.  

Foundry Steamboat Chief Clinical Officer, Michael Barnes, is a Licensed Addiction Counselor, Licensed Professional Counselor, and Diplomate in the American Academy of Experts in Traumatic Stress. During his forty-year career, Dr. Barnes has developed a new model for treating addictive and co-occurring mental health disorders that centers around the identification and understanding of trauma, the resolution of trauma, and learning to naturally self-regulate emotion. The Trauma-Integrated Care model practiced at Foundry Treatment Center Steamboat helps clients and family members learn about the role of trauma in individual and family system dysfunction, reduces the likelihood of re-triggering traumatic responses during treatment, and teaches skills to reduce the chances of repeating traumatizing behaviors after treatment. The program also helps clients learn how to promote recovery-supportive lifestyles.

Addiction is often described as a family disease. "The effects of a substance use disorder (SUD) are felt by the whole family," wrote Lander, Howsare, and Byrne in a 2013 study. "The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder."

The Michael Barnes Family Institute, launched in 2021, makes Trauma-Integrated approaches available to any family with members experiencing behavioral health conditions — even if no family member is receiving treatment. The ability to engage families at any stage of their recovery journey can make it easier to enter treatment and can increase a family's ability to safely and effectively communicate to reduce the causes of stress, alienation, and traumatic stimuli that can perpetuate dysfunction.

Participating in family programming improves treatment outcomes and encourages lasting positive changes in the entire family system. The Michael Barnes Family Institute offers two levels of programming to Foundry clients or any family in need of care:

● 101 provides psychoeducation, coaching, and connection to treatment resources to help families begin to establish a safe and supportive home environment for loved ones in recovery and to acknowledge the ways in which living with active addiction and traumatic experiences has affected their own lives.

● 102 provides in-depth analysis of family dysfunction root causes, in-depth coaching, counseling, and connection to treatment and support resources to help families identify and address deeper issues to improve the well-being and mental health of all participating family members and to restore family system function.  

Located in a beautiful mountain setting in Colorado, Foundry Steamboat takes a holistic approach to treating trauma and addiction. Our programs are designed to treat the entire person, meeting their physical, mental, and spiritual needs. Learn more about the program at www.forgingnewlives.com.

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