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Trauma & Alcohol and Drug Use
by Peter Goetz, MFT

First of all, a word about the title. I call it alcohol and drug use to discern it from an auto assumption of abuse, i.e., a bad thing. Maybe it is, maybe it’s not. People use drugs for one primary reason: they work. If the only resource available is drugs, people will use what is available when the need is strongest. Drug usage takes place on every level, in every class and economic strata of society. Assuming use is abuse is pejorative. Calling it substance abuse essentially calls it nothing at all; the term is vague and suggests that they’re doing it, certainly not us. Alcohol is our culture’s predominant legal drug; it functions as a drug so that’s what I call it here.

Resources are where you find them
Trauma by its nature is an ‘other force’ intruded upon from outside that overwhelms our capacities to respond. When trauma does not naturally resolve and transition through the body and mind, it continues its impact. Trauma survivors can experience cycles of activation and freezing, arousal and numbing, clear awareness then dissociation triggered by present day events, reenactments of the past, relationships, memory, or by biochemical means. Drug use is one way of controlling these cycles, bringing an individual out of numbness, down from hyper-arousal or transported to a realm where they can function in a way they want, that feels workable. Drugs are a resource, maybe the only one known or available at the time to deal with a traumatic situation. Problems usually develop over time for people when drugs are the sole resource available in their tool box to cope with trauma, now or reenacted from the past.

Drugs are used as resources to modulate, enhance, regulate or obliterate memories, dissociation, dysphoria, activation and numbing that arise from trauma. Like any resource, they’re used until a better one comes around. People struggling with unresolved trauma frequently come to psychotherapy for that reason: they want new, more adaptable resources to work with in their lives. What they have at their disposal isn’t enough; they experience ‘hitting the wall’ doingthe best that they can in coping with after-effects of trauma.

The results of using are varied; relief from distress, being provided with a temporary sense of security or protection, allowing others to be kept at a distance or creating a sense of intimacy or closeness, and most of all, the perception of controlling all these factors in what might feel like an out-of-control world with people or partners beyond their control. Drug use can be used as attempts to compensate for disruption of the biological rhytms of eating and sleeping that can come with the afteraffects of shock (sudden, one time) trauma or the wild dislocations of prolonged trauma. Drug use functions as an attempt at self soothing. The (false) sense of stability arising from this comes to feel like normal.

Drug use is adaptive at the time of most severe need or crisis. It is maladaptive when the crisis is past. While it’s an attempt at homeostasis, it prevents the full metabolization of traumatic events from occurring. It also can function as a set up for reenactment for further trauma, since psychological disunity continues.

The Way We’re Wired
Our species has effectively evolved and survived and adapted to subdue pain, either physiological or emotional. Our brains produce endogenous (inside) opiates to quell pain and to make us right. Our adrenals produce adrenaline to goad us into action, increase focus and to survive the perils - the speeding train bearing down on our cross-walk, a battlefield engagement, the grizzly bear stepping out in front of us, a child drowning - put in front of us. The hypothalamus regulates and balances the production of hormones (insulin, thyroxine, estrogen, testosterone) that make life, and stabilized emotional life in particular, possible.

The autonomic nervous system allows for us to respond to threat and danger, builds up a response, both neurologically (through immediate musculo-skeletal response) and through the endocrine system to bring the body-system back down to a de-escalated resting phase. This assumes there is a return/resting phase of afterward. When trauma is left unresolved, the resting (i.e., resolution) phase doesn’t happen; the agitation, hyper-vigilance and exhaustion coming from a traumatically activated state continues.

Treating the crisis at hand - examples
The ways in which traumatic reactivity continues are multiple and individual to the situation and response at hand.. A few examples are presented here:

  • Individuals with chronic dysphoric feelings or revolving loops of memories learn that they can turn down the volume or distract themselves from these states by drug use. Alcohol is often used to self-medicate dysphoria, though it is often exacerbated by prolonged or excessive use.
  • The intrusiveness of traumatic activation, the nightmares, flashbacks, perseverating mental images, can be controlled by sedating or pain-killing drugs (e.g., legal analgesics, opiates). Drugs are also utilized to re-regulate the autonomic nervous system by jolting or numbing, as needed.
  • Dissociative states and the numbing that comes with them, can allow people to function when overwhelming fear or the threat of intrusion looms. Marijuana and opiates give wide ranges of dissociative and pain killing experience.
  • Sex abuse survivors sometimes report dissociated responses to sexual touch -experiencing numbing, a lack of feeling, difficulty feeling pleasure. They learn to enhance or make possible feeling and function by the use of stimulants, such as amphetamines. The drugs will take someone out of a numbed, cut-off experience into realm of enhanced aliveness.

Traumatized individuals can experience their biological rhythm clocks as being thoroughly out-of-sync. A primary symptom of this will be disrupted sleep cycles, the result being over-reliance on hypnotic drugs, benzodiazapines or alcohol. The intent is to slow activation down enough to sleep or to literally knock oneself out.

  • Trauma survivors who can’t dissociate, that is, distance themselves from an activated state learn to numb themselves with alcohol.
  • Chronic avoidance, stemming from an on-going need to protect oneself from what’s perceived as a hostile and abusive world, can bring an individual out of their internal world into functioning contact by the use of stimulants (e.g., cocaine, alcohol).
  • Chronic complaints of sleep and appetite disruptions, migraine or generalized pain stemming from chronic body tension and constriction are dealt with by unregulated analgesic, hypnotic or recreational drug use.

Prolonged Impact of Abuse
Prolonged childhood abuse impacts the body-mind-spirit-system so profoundly that the regulatory, management and learning systems that are a natural part of human development are altered, the results being gaps in self-care, self soothing and the acquisition of basic socialization skills. Abuse survivors can experience these gaps subjectively as a lack of control over their own bodies, feelings states, reactivity to circumstances and relationships. This lack of control runs parallel to the lack of control abuse survivors report experiencing through the repeated chaos and unpredictability of a traumatic upbringing.

The Trauma and Drug Loop
Trauma left unresolved, or unmetabolized becomes reenacted. Repeated. The longer the duration of the trauma and the degree to which an individual’s sense of self is compromised will show directly in the reenactment patterning. Drug use, which may have been resourcing at one time, sets people up for re-victimization and re-traumatization since they never have the full opportunity to renegotiate their responses to trauma soberly, through their own embodied experience. Usage itself can be an acting out in present form of prior victimization in setting oneself up for danger by altering/diminishing awareness and less able to defend or attend to changing conditions or dangers presenting themselves. The risk taking and potential danger of the procurement and usage of drugs can parallel the normalized danger that traumatized individuals see as everyday life.

Shame associated with using can parallel or repeat the shame and self blame associated with trauma. In this way, a user’s characterological expectations of what they deserve or might optimally expect as possibilities for themselves become clear; the attitudes and expectations as seen by drug usage patterns or choice of drug. The link between traumatic shame as ingrained self-belief systems and shame played out through drug usage is a strong one.

Looking For What’s There
The leading indicator of drug use is availability, that is what’s known to an individual given their geographic location, class, cultural or social environment. Drugs can present themselves as a resource (perhaps the only one available at the time) that offer a controlled change of consciousness from what has seemed uncontrollable internal states. Out of chaos comes a sense of order.

Drug use can remain steady over a prolonged period. Users can and do partake at their own pace; they can maintain a steady state of inebriation, with an attending sense of control. When drug usage is a response/reaction to trauma, control is harder to sustain, since the motivation for use is to reestablish control or a return to homeostasis after a period of distress or activation. Control may be maintained but resolution to the systemic impact of past trauma is not.

When Resourcing becomes Addiction
Drug use becomes addiction when the chosen drug no longer works, no longer serves the same function of traumatic resource. Addiction here is defined as the maladaptive use of a drug. The steady state is gone. Drugs themselves have become the problem. Use becomes less remedial with the focus shifting to a build-up in fantasy for using; the setting, the time, the set. Trauma is the involuntary loss of freedom, an uninvited, overpowering intrusion. Addiction is the voluntary loss of freedom, though many addicts may not experience their addictive use patterns as voluntary.

Usage that functions as a coping resource for traumatic activation seldom leads to a seasoned resolution since the drug use frequently becomes traumatic in and of itself. Drug procurement, the risks involved with it, the health dangers, the compromises one is forced to make become an on-going stress or reenacted trauma.

The task at hand is to develop a full-bodied, settled resolution that’s non-pharmacutical in its coping strategies, develop new and expanded resources. Resolution responding in the present moment to conditions presenting themselves, not as reenactments. Resolution involves the ability to sequence through upsets, overwhelms, memories, the little ‘c’ and big ‘C’ crises of life where the full self-system, including body, mind, spiritual self and emotional and neurological systems can sit (and work and walk and sleep and love) through what comes each of our ways. Trauma in a resolved position is never forgotten but it can be taken out of the realm of present time reactivity and lain to rest in memory.

 

Copyright, 2001, by Peter Goetz

 

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