What is the relationship between trauma and addictions?

Since psychotherapy works with addictions, there has always been a suspicion that it is the experience of traumas during childhood one of the predisposing factors to suffer drug addictions adult.

There are not a few people who were sexually abused or were victims of parental neglect who, when they reach adulthood, have a severe substance use problem or have fallen into behavioral addictions such as gambling, sex or meal.

The relationship between trauma and addictions has been addressed especially investigated during the last 20 years, reaching a few very valuable conclusions in this regard.

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The relationship between trauma and addictions

It has been suspected for a long time that childhood trauma predisposes to fall into adult addictions, something that has ended up being confirmed by science. Numerous studies have established a relationship between suffering from traumatic experiences during childhood and presenting addictive behavior in adulthood, a topic that has been arousing the interest of the community for 20 years specialized.

One of the most notable studies that confirmed this relationship was the research by Felitti and colleagues (1998). In their work, they referred to trauma as “Adverse Childhood Experiences” (AEI), defined as traumatic experiences lived before the age of 18. Among these EAIs would be found physical, emotional, and sexual abuse, parental neglect, loss of a parent, witnessing intimate partner violence, and/or living with a family member with a mental disorder.

The work of Felitti et al. is already a classic and in it they explained that, as the number of ACEs increased, the risk of consuming substances in adulthood also increased. During the more than 20 years after this work, research based on the idea of ​​IEAs has found a strong relationship in having multiple childhood traumatic experiences and developing addiction in the adulthood. Regardless of the type of addiction on which the focus is placed, everything points to the fact that more EAI, greater risk of addiction as an adult.

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Dysregulation of the stress system

Suffering traumatic experiences during childhood can affect the individual in multiple ways. The effects vary from person to person, depending on factors such as the type of trauma, duration of the traumatic experience, age at which it occurred, gender, and presence or absence of a caregiver comprehensive. Heredity also plays a role, with individual differences in how genetically predisposed one is to show resilience to unpleasant events.

The specific impact of childhood trauma is complex and each individual experiences it in a unique way; however, yes it is possible to find a common effect in the form of dysregulation of the stress system. This system is largely governed by the hypothalamic-pituitary-adrenal (HPA) axis, a set of structures whose mission is to prepare the body to respond effectively to situations experienced as threatening.

When we are presented with a danger or stressor, the HPA axis and other associated systems prepare us to engage in fight or flight behavior. To do this, different stress hormones are released, including adrenaline and glucocorticoids, which induce changes at the physiological level: it increases blood pressure increases, heart rate increases, breathing accelerates, there is hyperactivity and, ultimately, a feeling of alarm.

These physiological changes also include the sending of blood and energy to muscles and brain areas that may be useful for fight or flight. Brain structures that can offer immediate assistance and facilitate quick and little-thought-out actions are prioritized, unlike the slower prefrontal cortex, which controls executive functioning and self-regulation. It is the automatic responses, not the deeply thought-out ones, that help us respond quickly to a situation where seconds can make the difference between living and dying.

The problem is that the stress system acts against us if it is constantly activated, as is the case with persistent traumatic situations in which the threat is never resolved (for example, sexual abuse by years). The individual is constantly exposed to an unpleasant situation, a prolonged childhood trauma that causes chronic stress. This ends up causing deregulation of the stress system.

If the HPA axis is constantly activated, it means that there will also be a prolonged increase in stress hormones and the accompanying neurophysiological effects. This means that children who experience situations of abuse and other forms of trauma end up presenting very high levels of anxiety, hypervigilance, arousal and continuous alertness.

Childhood is a period of development, a few years in which the child's body is still forming. Therefore, dysregulation of the stress system due to trauma is especially critical during childhood. This dysfunctional situation can have extremely detrimental effects on the immune system, emotional regulation skills, cognitive development and executive functioning and, as if that were not enough, it also increases the risk of suffering from diseases neurodegenerative.

Trauma at an early age can alter the regulation of the hormones oxytocin and serotonin. The former is involved in attachment and emotional intimacy, while the latter influences mood making it more positive. That there is an alteration in the release of these hormones during childhood translates into attachment problems and an increased risk of suffering from depression.

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The core of the link between trauma and addictive disorder

The main reason people, with or without psychopathology or a history of trauma, take drugs is due to their immediate psychological effects. When we take drugs or engage in rewarding behaviors, one of the first effects we notice is that they bring us pleasure and subsequently reduce our discomfort. The first effect can be understood as positive reinforcement, while the second is negative reinforcement.

in search of calm

For people with a history of trauma, with dysregulated stress systems, drugs offer relief from their chronic hyperactivity and anxiety. In simpler words, they calm their nerves. Neurodepressant substances such as alcohol, opioids, benzodiazepines, and cannabis have calming effects and even have the ability to slow down the central nervous system.

Too we must talk about gambling, especially slot machines. These devices have colored lights and striking sounds, hypnotic stimuli that induce their players into a kind of trance that helps them forget their discomfort and ignore the people around them. around. Gamblers, when they play, forget everything that is not the machine.

People with a history of trauma are more vulnerable to addiction because substance use and certain behaviors help regulate their mood. Taking drugs prevents intrusive thoughts, reduces their anxiety and lowers their level of arousal. Using substances and incurring in certain types of addictive behaviors they enter a state of numbness and apparent calm, a temporary state that does not solve the underlying problem that makes them feel bad.

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In search of activation

But not all people with trauma take the same drugs or for the same reason. Many have a different reaction and, instead of hyperactivation, end up dissociating or using depersonalization strategies. This people feel chronically numb, disconnected from reality. They can even feel no emotion at all, as if they were turned off.

These people do not want to calm down, quite the opposite. They want to feel an increase in energy and alertness, stop being in OFF mode. For this reason they would take drugs with stimulating effects, such as cocaine, amphetamines, nicotine or synthetic drugs. In addition, behaviors such as non-suicidal self-harm, sex and gambling can bring these types of people out of states. of numbness and allow them to experience sensations, although it does not help them to solve the problem of bottom.

conclusion

Thus, people with a history of trauma are more vulnerable to addiction, mainly because drugs and rewarding behaviors modify mood, varying whether they are consumed to calm nerves or to feel something. Addictive behaviors may be an individual's best attempt to cope with the biological and neurobiological consequences of childhood trauma, whether it is hyperarousal or depersonalization.

Taking this into account, the treatment of addiction will require, in the first place, to know what effect the experience of a past trauma has had on the patient. The patient will take drugs or do rewarding behaviors to feel good, something also shared with people who are not addicted. The key question is to know what type of drug you use or what addictive behavior you engage in, whether you do it to reduce your anxiety or to have sensations, and relate it to the childhood traumas that have caused, once an adult, to present this type of behavior pathological.