Trauma and Substance Use

This article was also published in “We Are Warriors” a free magazine for First Responders

At the first session of counselling therapy, the therapist goes through a list of questions and one of them is about the use of alcohol and drugs and another is about past trauma. Clients often report very honestly that they use alcohol and other drugs. It is less easy to obtain an impression on how much and how often people drink and whether they use drugs (prescriptions as well as recreational drugs) in addition to alcohol.

Not all clients feel safe and comfortable enough to disclose symptoms resulting from the experience of traumatic events, at the start of therapy.

The reason that people underreport alcohol and drug use can be related to some level of shame and not being ready to admit all. Clients know that if they would admit that they are drinking too much, it means that they will hear about the risks they are taking. Therapists and medical doctors understand clients tend to underreport alcohol use and therefore they tend to check-in with clients on a regular basis.

That not all clients report past trauma is complicated. Some feel more confident and at ease than others based on many factors and past experiences and here too, clients might not be ready to “go there” yet.

The current Canadian guidelines for low-risk alcohol drinking is no more than 10 standards drinks for women and 15 for men in one week. The Center for Disease Control and prevention (CDC) has a stricter guideline with one drink a day for women and two for men.

Most of us are familiar with the effects of alcohol. Initially there is this positive buzz and an elevation of pleasant feelings, but this may vary depending on the mood before drinking and on who is present and the occasion. The positive effects do not last and although this is known, the brakes are loose, and many find it hard to stop right there and then. Some of my clients say that they combine alcohol with eating, and the day after do feel frustrated with themselves that they went overboard with both food and drinks. This effect is caused by the suppressant effect of alcohol on the part of the brain responsible for rational thought.

Researchers in Canada reported in 2017 that 20% of adults in Canada met the criteria for Substance Use Disorder (SUD) at one point in their lifetime (This percentage includes the use of alcohol and drugs). Researchers in the United States stated in 2018 that 29% of adults met the criteria for alcohol use disorder at one point in their lifetime. These are shockingly high numbers.

The same researchers in the US and Canada report a strong relationship between trauma and SUD. Between 25% and 50% of people with SUD have a history of trauma, with those with a more severe SUD reporting more severe trauma during their lifetime and a diagnosis of post-traumatic stress disorder (PTSD). Researchers in the US found that 40% of people with PTSD have developed an Alcohol Use Disorder (AUD).

From the above, it is clear that there is a correlation between trauma and alcohol use. Alcohol is the most common substance used to self-medicate. People with high anxiety and intrusive trauma symptoms suffer from chronic insomnia and use alcohol as an aid to falling asleep. Unfortunately, alcohol does not result in a better night sleep as it negatively effects the natural sleep rhythm and the quality of sleep leaving people groggy and tired the next day.

Many drink to reduce their level of anxiety and intrusive thoughts and memories. However, after the initially positive effects, people who use alcohol to self-medicate often feel more isolated and hopeless.

Recent reports by the Canadian Centre on Substance Use and addiction reported in November 2020, that two out of ten people increased alcohol use during lockdown and restrictions related to the COVID-19 pandemic, mentioning boredom and anxiety as reasons.

Past research investigating the relationship between PTSD and addiction focused on veterans and first responders as the incidence of PTSD is well established and well-known among these groups of people. More recent research has also included survivors of childhood trauma and those who have trauma symptoms due to natural disasters, death of loved ones and accidents that were experienced as traumatic.

There is no shame in admitting using alcohol to escape (temporarily) the intrusive thoughts and upsetting memories and triggers. It is perfectly understandable that self-medicating is tempting. Everyone who has experienced traumatic events and the debilitating symptoms resulting from the trauma, can relate to the desire to numbing and distracting oneself from the pain and agony.

Avoiding however, does not help a client with processing trauma and the longer the use and the more excessive the use of alcohol (and other drugs), the more likely that it will result in an additional issue affecting one’s health, relationships and ultimately daily functioning and work.

Those who have been there, know how hard it is to climb out of the hole and they know that they could not have done it alone. Prevention is the better way and for that we need to reach out to each other.

Do not be afraid, many get it. Speak up and seek help. You are important!

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