Photo Credit: Rafik

The cycle of trauma and addiction can be interrupted by mental health professionals who combine trauma-informed care with stigma-free care.

People with substance use disorder (SUD) often have co-occurring mental health disorders, complicating treatment from both the patients’ and professionals’ perspectives. Further complicating matters is the significant issue of stigma related to addiction both in society and the health care system. Trauma also may have a critical influence on the onset, course, and relapse of mental illnesses directly related to addiction. Therefore, it is important to understand how stigma interacts with trauma in mental illness and addiction, the issues that integration poses to both patients and practitioners, and how they can address those issues to improve overall mental health.

Stigma & Addiction

Stigma, the attitude about a behavior or condition that is considered socially unacceptable, is one of the major barriers to the prevention and treatment of addiction. Society often sees drug abuse from a moral standpoint. Moreover, the issue of substance dependence is, in many instances, considered a deficiency in self-control and a moral failing. The National Institutes of Health (NIDA) asserted in a 2020 survey of addiction treatment that people with addiction often avoid seeking treatment due to fear of being scorned or shunned by providers or even by their own families and acquaintances.

Additionally, many negative perceptions that are attached to addiction can worsen mental health disorders by increasing anxiety and depression. This can also contribute to feelings of loneliness. Internalized stigmas are exclusive and self-fulfilling as well.

Addiction & Trauma

SUDs are often related to trauma, especially that which happens to young children. ACEs, or Adverse Childhood Experiences, is a term that describes elements such as abuse, neglect, and household instability and their impact on the risk of developing an addiction later in life. The ACE study, administered by the Centers for Disease Control and Kaiser Permanente, discovered that people who experienced four or more adverse childhood events had an increased risk for alcoholism and drug abuse.

Trauma may motivate individuals to start using drugs and alcohol and render them helpless to stop. For many, the substance acts as a temporary salve, repressing trauma, resulting in a paradox whereby the desire to erase emotional pain fuels the dependence on the substance.

Trauma & Mental Illness

Trauma is also a major risk factor for the onset of several mental illnesses, such as depression and post-traumatic stress disorder (PTSD). A trauma-informed model of care is imperative for use by mental health practitioners who work with people who have experienced overwhelming trauma. This concept involves understanding the prevalence of trauma within an at-risk population, components for highlighting the presence of trauma in the clinical picture, and the importance of the effect of trauma in all phases of the treatment. A trauma-informed model of care promotes doing no further harm to the individual during the treatment or therapy process and also encourages an environment conducive to healing the individual.

Trauma, Stigma, & Addiction

The presence of stigma is an added burden for those battling addiction while trying to recover from a traumatic experience. Survivors of trauma often experience shame and guilt, which societal stigma can amplify. The spiral of stigma and treatment makes it harder to engage in therapy, which breeds self-hatred and self-loathing, adding to the challenges of recovering from addiction.

Role of Mental Health Professionals

Addiction professionals are crucial in alleviating biases towards addiction and the people suffering from it. When select therapeutic processes are employed, individuals can be encouraged to talk about their problems in an appropriate environment without the risk of being judged. Some of these approaches include:

Psychoeducation

Providing education for individuals and families regarding biological, psychological, and social factors that explain addiction helps in combating the idea that addiction is a vice.

Empathy and Validation

Giving credence to the suffering and pain of patients and providing assistance without judgment.

Policy Advocacy

The involvement of mental health professionals in promoting policies aimed at mitigating stigma and enhancing access to trauma-informed treatment for addictions can not be overemphasized. Harm reduction programs, decriminalization of strategic substance abuse, and advocating for better mental facilities provisions can help tackle stigma related to addiction. Mental health providers can lobby for changes in the system, including increased resources, access to care, and the reduction of stigma in the treatment of addiction and mental health.

Trauma-Informed Care

Understanding that people with substance abuse or mental health disorders may have been traumatized in the past, therefore, should be treated in a manner that does not lead to re-traumatization. The essential features of a trauma-informed approach are safety, trust, collaboration among patients and providers, and support from peers. While acknowledging that trauma exists and understanding how deeply it affects people is the first step in trauma-informed care, the second step is addressing trauma through the implementation of treatment. Mental health professionals may do so in a variety of ways:

• Recognizing symptoms of past trauma, even in instances where the patient does not mention it.
• Providing a positive environment for healing in which the client feels safe from the possibility of further trauma.
• Providing therapy for empowerment and utilization of the client’s potential.
• Integrating opportunities for peer support and community engagement.
• Providing education and building awareness regarding the intricate relationships of trauma, addiction, and stigma.
• Embedding elements of treatment techniques for both trauma and addiction in treatment protocols, such as cognitive-behavioral thermotherapy, eye movement desensitization and reprocessing, and dialectical behavior therapy.

The cycle of trauma and addiction can be interrupted by mental health professionals who combine trauma-informed care with stigma-free care, allowing patients to exist in an atmosphere of empathy and encouragement.