Table of Contents
The Beginnings of Trauma Theory
The foundation of associating trauma with mental disorders are thought to be the brainchild of Jean-Martin Charcot; a Neurologist who worked with traumatized women during the late 19th century. Charcot’s interest in hysteria, a disorder which around that period was frequently diagnosed in women, led him to believe that trauma had a direct effect on women’s symptomatic hysterical behavior; these symptoms of hysteria included paralysis, amnesia, sensory loss, and convulsions, (White, 1997). Because hysteria was commonly diagnosed in women, physicians and neurologists thought that the cause of these symptoms came from the woman’s uterus. Charcot was the first to denote psychological vulnerability in these women, and tied their hysterical and dissociative symptoms to having sustained agonizing traumatic experiences (van der Kolk, 1994).
The Beginnings of Substance Use Disorder
In the United States psychiatric field of medicine, The Diagnostic and Statistical Manual of Mental Disorders (DSM) is held as the benchmark for mental health diagnosis. Substance Use Disorders (SUDs) is one of hundreds delineated in this manual (Robinson & Adinoff, 2016). For the purposes of this academic paper, the author will exclusively use the SUD portion of it and possibly others if needed. Although the DSM identifies SUDs as primary mental health disorders, it is important to inform the reader that SUDs were, prior to DSM’s third publication, hypothesized as indicators of underlying primary psychopathology (American Psychiatric Association, 1980). Substance use has an extraordinarily long historical context. Taking into consideration the length of history and the complexity of human substance use, mental health diagnosis and evidenced-based interventions are surprisingly new for this psychiatric illness (Robinson & Adinoff, 2016).
A Trauma-informed Theoretical Perspective of Substance Use
Augmented knowledge and increased incidences of the dual-diagnosis of substance use disorders, and the mental health diagnosis of trauma has lead researchers to take a closer look at the interaction of these disorders within the field of mental health, (Brady, Back & Coffey, 2004). Stressors of the extreme such as, accidents, life or death experiences, loss of loved ones and illness diagnoses (e.g., cancer, HIV, MS,) are traumas that many individuals endure throughout life. Substance use in many cases is used by these individuals in order to cope with the lasting psychological effects of the trauma.
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Substance Use and Trauma in Childhood, Adolescence and Young Adulthood
Child abuse is one of the more severe and damaging public health problems in America. Most friends and family members I grew up with experienced child abuse in one form or another. Many child abuse victims end up using drugs as a way to cope with the long lasting psychological effects of the trauma. Over all, costs of childhood trauma in America exceeds that of cancer and heart disease. If childhood trauma would to be eradicated, depression cases would be reduced by half in adults, alcoholism by two thirds, and drug use by three quarters (Van der Kolk,2014). In a recent study done by Loyd & Turner (2003) found that a lifetime exposure to traumatic events posed significant risk factors for drug abuse in adolescence and young adults.
Six types of traumas associated with major events were connected with higher risk of drug use and 90% of the life traumas were predicators of drug use. Among whites, sexual molestation and physical abuse were the highest predictors, and among blacks having been shot. Other variances emphasized in the study were gender risk factors. It found that exposure to violence was higher among young men, and molestation, rape, or physical abuse being highest among young women. In adolescence who were diagnosed with attention deficit and hyperactivity disorder (ADHD) and other psychiatric disorders to which associations of childhood trauma exist, were also found to have a correlation with drug abuse.
Children who are brought up in environments that frequently expose them to traumatic events, experience an intensified fear that inhibits their physical and psychological state of being; essentially keeping them from finding a sense of peace and normalcy. As adolescence sets, these kids find ways to cope; searching for that elusive peace and normalcy, ultimately finding it in drugs and or alcohol (Mulvihill, 2005). In another study, 300 male and female youth aged 14 to 24 were evaluated during substance abuse treatment and found that half of the females and 10% of males had suffered sexual abuse, 50% of females and 26% of males suffered physical abuse, and more females than males reported commencement of drug abuse after the traumatic events (Ballon, Courbasson & Smith, 2001). Among the subjects who reported substance use for coping, suicidal ideation and anger issues were more common.
Through my literature review and research, I have found that there is a high prevalence for drug and alcohol abuse among youth who have experienced significant trauma in their lives. They use drugs and alcohol to mask the pain. Through substance use they are able to cope and manage debilitating symptoms that come from the ongoing trauma or a significant traumatic event.
Substance Abuse and Trauma in Women
Up until the ending of the Vietnam war much of the studies that had been done on trauma had been on veterans of war. Few studies of women and trauma commenced thereafter. However, it was only until the mid 1990’s that the medical profession and its researchers began to notice the high prevalence of SUD’s in woman with significant histories of trauma. Awareness brought attention to the problem and significant research began to take place. The research revealed a convincing correlation between interpersonal trauma and substance use.
During these studies of SUD’s and trauma in women it was reported that ‘as many as 80 percent of women who were seeking treatment for substance use disorders reported a lifetime history of sexual assault, physical assault, or both’ (Cohen & Hein, 2006). In many instances sexual assault victims try to cope with the trauma of the event and its intrusive memories by using substances to numb the symptoms that are torturing them. Studies reveal that victims of sexual abuse are 13 times more likely to abuse alcohol and 26 times more likely to abuse drugs than those who have not been sexually abused (Alcohol Rehab, n.d.). Another common form of trauma that has been extensively studied in women is intimate partner violence (IPV).
Approximately 25% of women in the U.S report having experienced IPV in an adult relationship with a male partner ( Levendosky, Lannert & Yalch, 2012). The literature reveals that IPV is a predictor of imminent substance abuse. ‘Substance abuse is more prevalent among women who experience IPV compared to women who have not experienced IPV’ (Miller & Downs, 1993). Furthermore, it is estimated that victims of this particular type of trauma are 70% more likely to abuse substances. IPV is at the forefront of concern within the public health spectrum. Substance abuse (a consequence of IPV) is often hard to treat, especially if the perpetrator of the violence is still living with the victim or even worse, abusing substances right alongside of them. Lastly, women who have been abused as children are more likely to have the unconscious mechanism of normalizing IPV and thus creating another barrier for treatment.
