Trauma & Alcohol
and Drug Use
by Peter Goetz, MFT
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 its 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 theyre doing it, certainly not us. Alcohol
is our cultures predominant legal drug; it functions as
a drug so thats 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
Drugs are used as resources to modulate, enhance, regulate or obliterate
memories, dissociation, dysphoria, activation and numbing that
arise from trauma. Like any resource, theyre 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 isnt enough; they experience hitting
the wall doingthe best that they can in coping with after-effects
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 its 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 Were 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 doesnt 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:
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
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.
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.
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.
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
survivors who cant dissociate, that is, distance themselves
from an activated state learn to numb themselves with alcohol.
avoidance, stemming from an on-going need to protect oneself
from whats 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).
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
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
individuals 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 users 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 Whats There
The leading indicator of drug use is availability, that is whats
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
thats 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.
2001, by Peter Goetz
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