When I was twenty-eight, I entered treatment and got clean and sober from an advanced addiction to alcohol and cocaine. After coming home, I continued in therapy and while there, bit by bit, revealed various traumatic experiences growing up in an alcoholic home. My father’s bloody self-destructiveness, sneering verbal abuse and offhand physical abuse butchered my self-esteem. Adding to my already outsized shame, when I was seven I was sexually abused. I vowed to never tell anyone. If nobody else knew, what difference did it make? Or so I thought. I carried the over-weighted secret for twenty years and then it spilled out anyway, a burden too onerous to carry anymore.
How does one convey traumatic experiences with a goal of helping others similarly afflicted? Perhaps a starting point is to find an adequate definition. A quick web search produced some ideas: “Complex trauma is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature.” Complex trauma in children is often referred to as “developmental trauma,” the point being that healthy development is damaged in the formative years. Another definition noted that childhood complex trauma is “pervasive.” An apt adjective that captures how trauma’s insult to the healthy sense of self is profound.
School was one place where I began to pay the price for my trauma. From the outset, I hated it. It’s crowdedness and noise, its rules and expectations. I interpreted the environment as hostile and a place where I was regularly exposed as defective, less than my fellow students. Most days I was highly anxious there. If I understood something academic immediately then fine, if I didn’t, I’d just shut down convinced that I lacked the intelligence to solve problems. I was perceived as obstreperous thus inviting the wrath of my teachers which only reinforced my sense of inadequacy. Not surprisingly, I did poorly, and felt that adults were only interested in those that achieved more readily.
Emotionally, from childhood to adolescence and on into my late twenties I was depressed, angry, anxious and full of shame. There is a Greek word, alexithymia that translates roughly into “no words for feelings,” or lacking emotional vocabulary. Alexithymia may be a byproduct of trauma and is also prevalent for those growing up in an abusive, alcoholic or drug addicted homes where needs are ignored, discouraged or even beaten down. Early in therapy, I felt as if my jaw was wired shut and it was impossible for me to convey the complex Gordian knot of all my trauma-related emotions. Alexithymia keeps us isolated and fraught with negative thought patterns.
Another problem was that boys of my generation were raised to be stoic, unflappable and impervious to pain. The ideal certainly wasn’t to talk about difficult feelings. We were taught to “shake it off” and keep moving forward, no matter what. To open up and talk about traumatic experience was counterintuitive and doing so was to invite scorn. To my detriment, I pushed on, silently. What does the traumatized, emotionally pent up lacking self-esteem adolescent do? Often they start to self-medicate their “intense negative affect states.” Because trauma goes untreated for the aforementioned reasons, teens continue to self-medicate and over time develop substance use disorders. Several studies have found that substance use disorders developed following trauma exposure in anywhere from 25%–76% of individuals. Risk factors include: chronic stress, childhood trauma and family history of addictions.
Because we are bound up in our trauma and the guilt, self-loathing and intensity of our anger and other feelings that go along with it, substances often become a balm that we rely on because at first they are so damn effective. What led me to self-medicate was that I was disconnected, alienated and full of distorted information about my self-worth.
And, we have no other method to rely on. Feeling marginalized and unable to ask for help we seek other solutions. I remember my first alcohol-related buzz. Nothing relieved my suffering so readily and completely. I fell in love with the glowing warmth and quick dissipation of my alienation and loss. I didn’t know that alcohol and other substances would create a host of major problems as I became deeply dependent. It’s like a bad relationship we are compelled to despite its destructiveness. We forever persuade ourselves that if we just stick with it, in the end somehow, everything will be fine. This is the path I chose starting in early adolescence. Before I hit twenty, I was an early stage alcoholic and drug addict. I didn’t emerge from the utter destruction of my addictions until I was twenty-eight. The cost: a marriage, temporary custody of my daughter, IRS demanding owed taxes, financial destruction and a trail of broken relationships.
Two other problems face the traumatized addict/alcoholic and confirm their unworthiness: the first is the inevitable loss of self-respect as the user puts the substance ahead of money, job, spouses, children, freedom and health. One sees himself self-sabotaging his life but is terrified to face the trauma and so continues. The other is the stigma of the alcoholic/addict or more commonly known as the “drunk” or “junkie.” Others judge us based on the images those names conjure: the bum in the street who has passed out and pissed himself or the unkempt guy in the alley with a needle hanging out of his arm; the guy who’d do anything for a fix. The judgment comes without compassion for what has driven us to the behavior to begin with.
According to the National Institute of Drug Abuse, 43.7 million people in the United States needed treatment for substance use disorders in 2022 yet only 6.8% of those received it. It is fair to note that these numbers reflect a wide range of reasons including that many alcoholics and addicts simply refuse to access treatment, but just the same that 6.8% is paltry and pitiable. It’s well known and accepted that stigma marginalizes people struggling with mental illness and/or addictions.
Those with substance use disorders often face discrimination in health care settings and stigma reinforces our worthlessness. One example of this is the acronym GOMER which is a sometimes-used hospital code for Get Out of My Emergency Room that refers to people with substance abuse and/or mental health problems. Stigma is a significant societal barrier to wellness.
Speaking generally, people with co-occurring substance use disorder and post-traumatic stress disorder require treatment sufficient to meet the complexity of their disorders. Sufferers and their families need to know that treatment works and can restore the committed patient to a healthy and happy life. The challenge is to determine what treatment is needed and how to access it. A good first step is to have the client evaluated by a clinician with expertise in co-occurring disorders. This could be a therapist or social worker, psychiatrist and some primary care physicians who may be well-versed in mental health and addictions.
Someone with a substance use disorder will in all likelihood require detoxification and then trauma-informed rehabilitation. Depending on the severity of the substance use disorder and the PTSD this care will need to delivered on an inpatient basis.
When I got clean and sober back in 1984, treatment systems were very different. For one they were sharply “bifurcated,” meaning that addictions and mental health treatments were split and separated. Nowadays they are more integrated as it has been determined, correctly I think, that treating the conditions at the same time and recognizing they are interrelated leads to better outcomes. The way it worked for me was a 30-day substance abuse treatment program, then resuming outpatient care with my therapist. In those days there was no such thing as: “trauma informed care.” Trauma informed care provides a framework for agencies and clinicians to best treat trauma. (See resources below for more information)
I was extremely fortunate to have found my therapist. My trauma and addictions had reduced me to a point of profound despair. She was the most empathetic, patient and non-judgmental person I’ve ever known. Had she been any less so, I doubt I’d have stayed in therapy. Over time, I came to trust her absolutely and this trust and acceptance enabled me to open up and share what had happened to me. She affirmed the pain I’d been through and provided insight into how I’d been affected. She affirmed my better qualities and encouraged me to see them in myself. Over time, I reoriented my viewpoint from that of a victim to one of a person with his own agency. I healed. So, with the right therapist and your own commitment to getting well, you can too!
The other solution was to reconfigure my paradigm of what a healthy relationship was. As I progressed in recovery and in therapy I became aware of what to look for in others and to build the skills necessary to maintain relationships. In the past, I could find love, but I could not keep it.
My work in therapy enabled me to develop the necessary skills to find the right mate and stay married for thirty-two years and counting. Which brings me to another solution for people struggling with trauma: love. At first blush this may sound hokey but it’s true. To be accepted, valued and loved as I am has made all the difference. This is true in my marriage and the friendships I’ve maintained over the years. I am no longer satisfied with pleasing others at my own expense. I see that relationships, though they come with conflict, must be value added overall. If not then it makes no sense to persevere in them.
To summarize: treatment whether in or outpatient should be safe, patient, non-judgmental and encouraging. Patients with co-occurring disorders may need detox before admission to an integrated program that can treat simultaneously the addictions and PTSD. Individual sufferers need to be committed and patient knowing that complex PTSD does not remit overnight. Medications may or may not be useful tools. For patients with severe trauma and addictions long-term residential treatment with wrap around services is sensible.
As a society, and as individuals, how do we find compassion and the resources to care for our most afflicted people? It’s to our own betterment to do so. Prevention, early intervention before conditions become chronic and training of frontline workers would help. The bottom line cost of these conditions when untreated is astronomical in dollars, and more importantly in lives adversely affected and lost. We must do better!
After all, nobody escapes this world without trauma.
Resources:
A screening form to assess for PTSD
https://www.ptsd.va.gov/professional/assessment/documents/pcl5_standard_form.pdf
Adverse Childhood Experience (ACE) Questionnaire
https://www.rockefellerfoundation.org/wp-content/uploads/2021/03/ACE-Questionnaire.pdf
Information about trauma informed care
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Previously Published on Tim Lineaweaver’s blog and is republished on Medium.
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Photo credit: iStock
