What is the relationship between trauma and addictions?

This is how trauma and addictive disorders complement each other and damage mental health.

Since psychotherapy works with addictions, there has always been the suspicion that the experience of trauma during childhood is one of the predisposing factors to suffer addictions as an adult.

There are many people who were sexually abused or were victims of parental neglect who, in adulthood, have a severe substance abuse problem or have fallen into behavioral addictions such as gambling, sex or food.

The relationship between trauma and addictions has been the subject of much research over the past 20 years, with a number of very important conclusions being reached.and a number of valuable conclusions have been reached in this regard.

The relationship between trauma and addictions.

There has long been a suspicion that childhood trauma predisposes to addictions as an adult, something that has been confirmed by science. Numerous studies have established a relationship between suffering traumatic experiences during childhood and presenting addictive behavior in adulthood, a subject that has been arousing the interest of the specialized community for the last 20 years.

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" (ACEs), defined as traumatic experiences lived before the age of 18. These ACEs would include physical, emotional and sexual abuse, parental neglect, loss of a parent, witnessing intimate partner violence and/or living with a mentally disturbed family member.

The work of Felitti et al. is now a classic, and they explained that as the number of AIEs increased, so did the risk of substance use in adulthood. In the more than 20 years since this work, research based on the idea of AIEs has found a strong relationship between having multiple childhood traumatic experiences and developing addiction in adulthood. Whichever type of addiction is the focus, the more IAS, the greater the risk of addiction, the greater the risk of addiction as an adult..

• You may be interested in, "What is trauma and how does it influence our lives?"

Dysregulation of the stress system

Suffering traumatic experiences during childhood can impact 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 the presence or absence of a sympathetic caregiver. 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, it is possible to find a common 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 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: Blood Pressure rises, heart rate increases, breathing accelerates, there is hyperactivity and, ultimately, a sense of alarm is produced.

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

The problem is that the stress system works against us if it is constantly activated, as in the case of persistent traumatic situations in which the threat is never resolved (e.g., sexual abuse for years). The individual is constantly exposed to an unpleasant situation, a prolonged childhood trauma that provokes chronic stress.. This eventually leads to dysregulation 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. As a result, children who experience abuse and other forms of trauma end up with very high levels of anxiety, hypervigilance, arousal and constant alertness.

Childhood is a developmental period, a time when the child's body is still forming. Therefore, dysregulation of the stress system due to trauma is especially critical during infancy. 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 neurodegenerative diseases.

Early trauma 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 alteration in the liberation of these hormones during the infancy is translated in attachment problems and increase in the risk of suffering depression.

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 because of their immediate psychological effects. When we take drugs or perform rewarding behaviors, one of the first effects we notice is that they cause 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

In the case of people with a history of trauma, with dysregulated stress systems, drugs offer them relief from their chronic hyperactivity and anxiety. Simply put, 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.

Also We must also talk about gambling, especially slot machines.. These devices have colored lights and flashy sounds, hypnotic stimuli that induce their players into a kind of trance that helps them forget their discomfort and ignore the people around them. Gamblers, when they play, forget everything but the machine.

People with a history of trauma are more vulnerable to addiction because taking substances and engaging in certain behaviors helps them regulate their mood. By taking drugs they avoid intrusive thoughts, their anxiety is reduced and their level of arousal is lowered. Consuming substances and engaging in certain types of addictive behaviors they enter a state of numbness and apparent calm, a temporary state and that does not solve the underlying problem that makes them feel bad.

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, they end up dissociating or using depersonalization strategies. These people feel chronically numb, disconnected from reality. They may even feel no emotion at all, as if they were turned off.

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

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 used 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.whether it is hyperarousal or depersonalization.

With this in mind, addiction treatment will first require knowing what effect the experience of past trauma has had on the patient. The patient will take drugs or do rewarding behaviors to feel good, something shared also with people who are not addicted. The key question is to know what type of drug he/she takes or what addictive behavior he/she engages in, knowing whether he/she does it to reduce his/her anxiety or to have sensations, and to relate it to the childhood traumas that have caused him/her, as an adult, to present this type of pathological behavior.