childhood trauma and substance abuse

While many people have casually observed it for decades, we now have research that has proven there to be a clear correlation between the experience of trauma during childhood and consequent substance abuse. There are, of course, multiple causes and contributing factors for substance misuse, but the experience of trauma, particularly during childhood puts the individual at far greater risk of developing a substance abuse disorder in later life.  Bellis and Zisk observe that, ‘trauma can affect the reward centers of our brain, making us more susceptible to substance abuse or other addictions.[1]’

Between 1995 and 1997, one of the most comprehensive studies of its kind was undertaken which looked at Adverse Childhood Experiences and consequent health and social problems. This ground-breaking study was carried out by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente’s Health Appraisal Clinic in San Diego. Over 17,000 people were surveyed. They were given a questionnaire which asked about various different types of childhood trauma.

The participants of the study were not what society considers to be stereotypical “drug addicts” – more than three quarters had graduated from college, were employed, and received good health care. For these people, the average number of ACEs experienced was 2.  However, the study was able to highlight a strong link between childhood trauma and addiction by studying the data of participants who had been in treatment for addictive behaviors. The individuals surveyed while in treatment scored an average of 6 ACEs, which means they had experienced 3 times more ACEs than the average (2) for the group.

Vincent J Felitti, MD looks at the ACEs study in his paper, “The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead.”  He notes that those people who had scored 6 or more ACEs were 4600% more likely to take intravenous drugs later in life.  Felitti’s authoritative statistics must raise questions about why this link between intravenous drug use and childhood trauma exists.  Are drugs simply ‘the best coping device a person can find?[2]’  Janina Fisher explores this theory in her paper “Addictions and Trauma Recovery.”  She suggests that addiction is a dysfunctional survival mechanism which victims of trauma use as a means of re-regulating a dysregulated nervous system.

So what precisely do we mean by ‘trauma’?  There are 10 major types of adverse childhood experience.  These include:


  • Physical
  • Sexual
  • Verbal.


  • Emotional
  • Physical.

Growing up in a home where:

  • There are adults with alcohol or drug use problems
  • There are adults who have mental health problems
  • There is domestic violence
  • There are adults who have spent time in prison
  • Parents have separated

There are also other types of childhood adversity that can have negative long term effects. These include bereavement, bullying, poverty and troubles within communities, such as living in a deprived area or neighborhood violence.

We now know that trauma experienced in childhood ‘interferes with the body’s ability to self-regulate both psychologically and somatically.[3]’ This profound dysregulation of the nervous system has a major impact on a person and possibly affects both psychological and physical functions.  In her paper, “Addictions and Trauma Recovery”, Janina Fisher suggests that in some cases, ‘psychological development is delayed or distorted, and identity formation must proceed along the “fault lines” that result from dissociative defenses and compartmentalization.[4]’

Thus, trauma has a severe impact upon an individual’s natural ability to function day-to-day.  They may struggle to manage their emotions, to handle normal stress in the workplace or to run their homes.  Survivors of trauma therefore find strategies which enable them to self regulate their minds and bodies. Without these self regulating strategies, life would be simply too overwhelming.

Self regulating strategies used by survivors are often behaviors learned during early childhood. Sometimes survivors reenact the trauma they experienced or use coping strategies such as self harm.  There is also a likelihood of ‘self medicating’ behaviors such as the misuse of alcohol, sex, drugs or gambling, which expediate the feeling of detachment by providing adrenaline and/or endorphins.  Adrenaline and endorphins cause a distraction and a temporary release from the feelings of depression, anxiety and fear, common to survivors of trauma. 

Clearly, for those struggling to cope with life, substance abuse makes sense on some level.  It provides the substance user with the desired ‘freedom’ from their own minds, albeit at a high price. Compared with other common forms of self destructive behavior such as self harm, eating disorders, sex or gambling addictions, drug abuse brings about a greater, more immediate dose of the desired brain chemicals. It is therefore an immediate way for the trauma survivor to find release.

When battling with invasive memories, fear, depression or anxiety, disembodiment or disassociation is a way of removing self from experiences, the body and the world. Therefore when these individuals pick up drugs or alcohol as a way to disassociate, they are taking them to simply feel normal and relieved of the pain. Without these substances they may be unable to deal with the psychological or physical symptoms which occur due to their trauma. Disassociation and ‘addictive behaviors are also ingenious ways of altering consciousness and changing psychophysiological experience.[5]’ Drug use could therefore be viewed as resourceful but also a  destructive survival method for those suffering with Complex PTSD.

Lamya Khoury’s study “Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population” also reiterates the link between trauma and substance abuse.  It reports that for people who have experienced significant traumas, the following lifetime dependencies existed[6]:

  • Alcohol: 39%
  • Cocaine: 34.1%
  • Heroin and other opiates: 6.2%
  • Marijuana: 44.8%

In fact, 70% of people receiving treatment for drug or alcohol abuse reported a history of trauma[7].

As we have seen, the misuse of drugs and alcohol starts off as a survival tactic but tolerance to such drugs increases with regular use. Thus, the quantity of the substance used will need to increase to continue to deliver the desired effect. Tragically, the substances gradually stop alleviating the pain of the trauma symptoms but the drugs are still needed to avoid physical and emotional withdrawals.  Dependency then takes control.  Progressive, destructive addiction can then of course become more threatening to the life of the trauma survivor than the original trauma symptoms.

Recognizing the prevalence of trauma in the general population and its relationship to drug and alcohol abuse gives us a solid foundation for knowing how to treat those suffering with substance misuse. It is through the use of trauma informed care that we can compassionately and comprehensively support these individuals.


  1. Bellis, M. D., & Zisk, A. (2014). The Biological Effects of Childhood Trauma. Child and Adolescent Psychiatric Clinics of North America, 23(2), 185-222. doi:10.1016/j.chc.2014.01.002 as discussed in Arabi, S. The Invisible War Zone: 5 Ways Children Of Narcissistic Parents Self-Destruct In Adulthood.
  2.  Felitti VJ. The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. Perm J. 2002;6(1):44–47
  3. ibid.
  4. ibid.
  5. Fisher J. Addictions and Trauma Recovery. Paper presented at the International Society for the Study of Dissociation, November 13, 2000. San Antonio, Texas.
  6. Khoury, L. , Tang, Y. L., Bradley, B. , Cubells, J. F. and Ressler, K. J. (2010), Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress. Anxiety, 27: 1077-1086. doi:10.1002/da.20751
  7. ibid.

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