Understanding Addiction Through a Trauma-Informed Lens

Understanding addiction through a trauma-informed lens reveals that addictive behaviors are often coping mechanisms rooted in unresolved trauma and emotional pain, rather than simply a lack of self-control.

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Addiction is a complex and often misunderstood condition. When we hear the word ‘addiction’, many stereotypes, images, myths and misconceptions often come to mind.

By adopting a trauma-informed lens, we can better understand how trauma and chronic stress can lead to addictive behaviours. Addiction isn’t just about a person’s inability to control their behaviour, it’s often the result of deep emotional pain, unaddressed trauma, or significant life stressors.

Although it may not be the most healthy or helpful form of coping, addictions are often attempts at coping with life struggles.

Addictive behaviours can be understood as coping mechanisms which provide initial and temporary relief, but over time, often lead to harmful consequences which worsen one’s quality of life and create more problems than they solve.

What is Addiction?

Addiction can be defined as a chronic disorder characterized by repetitive, compulsive engagement in rewarding stimuli, despite negative consequences. The biopsychosocial model of addiction recognizes that addictions are complex experiences influenced by a combination of biological, psychological, social and spiritual factors (Engel, 1978). There is no singular cause of addiction, and many factors such as brain chemistry, genetics, physical health, mental health, coping mechanisms, personality traits, social environment, socioeconomic status, and culture all play a role.

Addiction typically manifests in two main forms:

1. Substance Use Disorder (Addiction to a Substance)

Substance Use Disorder refers to the compulsive use of alcohol, drugs, or other substances that can alter one's mood, thinking, or behavior. Common substances that are implicated in addiction include alcohol, cannabis, nicotine, opioids, cocaine, and prescription medications. Over time, repeated use of these substances can change brain chemistry, making it difficult to stop using without professional intervention and support.

2. Behavioral Addiction (Addiction to a Behaviour)

Behavioral addiction, also known as process addiction, involves compulsive engagement in certain activities, such as gambling, gaming, eating, internet use, sexual behaviours, or shopping. While there are no substances involved, the addictive behavior stimulates the brain’s reward system in a similar way, reinforcing the urge to repeat the behavior compulsively despite negative outcomes. Over time behavioural addictions too can rewire our brain making it challenging to stop without intervention.

Continuum of Use

Addictive behaviours occur along a spectrum, commonly called a continuum of use, ranging from no use at all to a diagnosable substance use disorder causing significant impairments. Some individuals may not engage in addictive behaviours or substances at all, some may only use medication as prescribed, some can engage in addictive substances or behaviours recreationally, some have some problematic use, and some have significantly harmful addictive behaviours. Locating yourself on the continuum of use can be a helpful way of determining the level of intervention required. For example, if you have some problematic use, you may be able to reduce use through accessing individual and community support (i.e. Therapy, AA, 12-step groups, SMART Recovery, Peer Support, formal or informal family support), however if your substance use is significant, diagnosable, or the substance or behaviour you’re engaging in is highly addictive you may require more structured intervention (i.e. Residential treatment for addiction).

Trauma and Addiction: Understanding the Link

From a trauma-informed perspective, addiction is often a response to past or ongoing trauma. Trauma can include experiences such as:

Childhood neglect or abuse (emotional, physical, or sexual)

Domestic violence or intimate partner violence

Loss of a loved one or severe grief

Discrimination, racism, or systemic oppression

Living through a natural disaster or war

Witnessing or experiencing actual or threatened serious injury or death

Witnessing or experiencing actual or threatened sexual violence

Operational Stress Injuries (persistent psychological difficulties resulting from operational duties from any service-related role such as firefighting, correctional work, paramedicine, military service, nursing, emergency dispatching or policing)

When individuals face trauma, they may use substances or engage in addictive behaviors to numb emotional pain, avoid memories, or cope with overwhelming feelings. For many people, addiction serves as a temporary escape or self-medication strategy, but over time, it can escalate into a cycle of physical and/or psychological dependence.

Trauma can also affect the brain’s ability to regulate stress and emotional responses, which can make it more difficult to break free from addiction without addressing the underlying trauma. This is why addiction treatment that is not trauma-informed may fail to address the root causes of substance or behavioral dependence.

Coping Strategies for Managing Addiction

Managing addiction requires a multi-faceted approach. Here are some trauma-informed strategies that can help people address both the addiction and the trauma that may be underlying it:

Harm Reduction

Harm reduction generally refers to intentional practices designed to reduce the adverse consequences associated with addictive behaviours without necessarily reducing or stopping the addictive behaviour itself.

Harm reduction strategies with substance use can include drug testing kits, naloxone, nicotine patches, using substances in a safe or supervised environment with trusted people, safe injection sites and needle disposal services.

With alcohol, harm reduction strategies include not drinking on an empty stomach, drinking one water for each drink, drinking slowly with small sips, measuring and counting drinks, arranging safe transportation, scheduling alcohol free days, limiting the amount of alcohol at home, and avoiding drinking while taking any medications or other substances.

Cannabis harm reduction strategies include using less harmful versions (such as edibles or oil vs. smoking or vaping), avoiding deep inhales or holding breath while smoking, choosing lower potency products, arranging safe transportation, knowing your source (regulated or unregulated market), being aware of family history (e.g. of psychosis, bipolar or schizophrenia), or limiting use to certain hours of the day or days of the week.

Engage in Trauma-Informed Therapy

Therapeutic support is often crucial to uncover and address the underlying psychological pain that may be contributing to an addiction. Trauma-informed therapy involves understanding how trauma impacts a person's mental and emotional health and creating a safe space where the individual feels supported rather than judged. Some of the most effective therapies include:

Cognitive Behavioral Therapy (CBT): Helps individuals catch, check and change unhelpful or distorted thoughts and change their actions in order to improve their symptoms and change how they feel.

Cognitive Processing Therapy (CPT): Helps individuals identify and challenge unhelpful trauma-related beliefs to improve symptoms and coping.

Dialectical Behavioral Therapy (DBT): Helps people manage strong emotions, cope with difficult life situations, and improve relationships by teaching skills in mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Acceptance & Commitment Therapy (ACT): Helps people (re)build meaningful and fulfilling lives developing psychological flexibility - the ability to be present, be more accepting of difficult inner experiences, and take action aligned with one’s core values.

EMDR (Eye Movement Desensitization and Reprocessing): A technique using bilateral stimulation (such as eye movements, tapping, or sounds) to help individuals process and heal from trauma or other distressing experiences.

Key Tip: Look for therapists who are trained in both addiction and trauma to ensure that you receive holistic support.

Build a Supportive Network

Healing from addiction and trauma is rarely a solo journey. Building a network of support can provide meaningful resources for recovery. This can include:

Support Groups: Groups such as Alcoholics Anonymous (AA), Marijuana Anonymous (MA), Narcotics Anonymous (NA), or SMART Recovery offer peer support for individuals in recovery. These groups often provide a safe space for individuals to share their experiences and receive encouragement from others who are facing similar challenges.

Peer Support: Connecting with someone who has successfully navigated addiction and recovery can be incredibly helpful. A peer mentor can provide guidance, support, and a sense of hope. Even just opening to a safe and trusted other can be incredibly helpful to lighten your emotional load, receive support, develop plans of action and strengthen relationships.

Formal Family Support: Family therapy and education can help loved ones understand addiction and how to support the person in recovery.

Key Tip: Be patient with yourself and others. Building trust and safety in relationships can take time, especially when healing from trauma and addiction.

Practice Mindfulness and Self-Compassion

Mindfulness practices, such as meditation, deep breathing exercises, yoga, and being mentally present in daily activities can be effective in managing addiction. Mindfulness helps us stay grounded in the present moment and notice what is happening with openness and curiosity. These practices teach individuals how to regulate emotions and thoughts, notice cravings, reduce stress, and tolerate discomfort without resorting to addictive behaviors.

Self-compassion is also essential in recovery. People with addiction often experience feelings of shame and guilt, which can exacerbate self-criticism and the cycle of self-destructive behavior. By practicing kindness toward yourself and acknowledging your struggles with curiosity instead of harsh judgment, you can begin to heal from both trauma and addiction.

Key Tip: Start small with mindfulness practices. Even just a few minutes of deep breathing can help reduce cravings and emotional distress.

Access Residential Treatment or Intensive Out-patient Treatment if Needed

Depending on the severity or complexity of the addiction and/or dependency on the substance or behaviour, residential (or in-patient) treatment may be recommended. The benefit of receiving residential treatment is limited or restricted access to the addictive substance or behaviour, and the intensive nature of treatment, allowing you focus on recovery and gain tools/skills more quickly. Intensive out-patient programs are another option that allow you to gain tools and skills rapidly and focus on recovery, these programs typically occur fewer days a week and do not require you reside in the treatment centre. Importantly, there are residential and outpatient programs that treat trauma and addiction concurrently, to more effectively resolve the root cause of the addictive behaviour.

Additional Points to Consider

Concurrent Disorders: Many individuals who struggle with addiction also have other mental health conditions, such as depression, anxiety, or PTSD. A trauma-informed approach recognizes the interconnection of these issues and provides integrated treatment that addresses both addiction and mental health needs simultaneously.

Medication-Assisted Treatment (MAT): In some cases, medication can be an essential part of addiction recovery. MAT, such as methadone for opioid use disorder or naltrexone for alcohol use disorder can help individuals manage cravings and withdrawal symptoms. This treatment should be accompanied by therapy and emotional support to address the underlying issues. Talk to a regulated healthcare provider such as nurse practitioner, family physician or psychiatrist regarding MAT.

Relapse as Part of Recovery: Relapse is common in addiction recovery, and it’s important to view it as part of the process rather than a failure. A trauma-informed approach helps individuals understand that relapse can occur due to unaddressed emotional pain, and it provides strategies for getting back on track without shame.

Resources for Addiction Support in Ontario

ConnexOntario
ConnexOntario is a free, confidential service that provides information and referrals for individuals seeking help with addiction, mental health, and problem gambling. They offer a 24/7 helpline and resource directory and can connect you to treatment providers across Ontario.
Phone: 1-866-531-2600
Website: ConnexOntario

Ontario Addiction Treatment Centre (OATC)
The OATC offers comprehensive addiction services, including outpatient counseling, detox, and residential treatment programs. They take a holistic, trauma-informed approach to addiction treatment.
Phone: 1-888-977-9770
Website: OATC

Canadian Centre on Substance Use and Addiction (CCSA)
CCSA provides valuable resources and research on substance use and addiction in Canada. They offer information on best practices for treatment, prevention, and harm reduction.
Website: CCSA

Addiction is a multi-layered condition, often stemming from trauma or emotional pain. By understanding addiction through a trauma-informed lens, we can provide more meaningful support to more effectively support recovery.

Recovery is possible, but it requires addressing both the symptoms of addiction and the underlying causes. Whether you are seeking help for yourself or a loved one, remember that healing is a journey, and there are many resources available to guide you along the way.

References

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from www.samhsa.gov

National Institute on Drug Abuse (NIDA). (2021). Understanding Drug Use and Addiction: A Guide for Parents. Retrieved from www.drugabuse.gov

American Psychological Association (APA). (2017). The Link Between Trauma and Addiction. Retrieved from www.apa.org

Engel GL. The biopsychosocial model and the education of health professionals. Ann N Y Acad Sci. 1978 Jun 21;310:169-87. doi: 10.1111/j.1749-6632.1978.tb22070.x. PMID: 290321.