Understanding addiction and trauma

Addiction is a mental health condition. This is the checklist I devised and work with every day. 

1. Is your behaviour seriously harming your well-being? (and you know it)
2. Has the “high” diminished significantly? (or gone entirely)
3. Do you lack control over the behaviour? (and cannot stop it permanently)

The extent of the "harm", the lack of the "high" and the degree of "control" help me understand the severity of the addiction.

When I began counselling, I did 250 hours of therapy for a free service offering help to sufferers of addiction. It was revelatory. Most of my clients had come into contact with groups offering support – like AA, NA or GA. Some had undergone supervised detox and/or periods in rehab. For the vast majority, our sessions were the first one-to-one therapy they had ever had. It became clear to me that one-to-one therapy, far from being an outlier in treatment for addiction, should be front and centre.

In my experience of talking to hundreds of addiction sufferers, there is a clear cause of addiction or barrier to recovery from addiction with every single one. And trauma (what happened to me and how did it affect me?), in that first placement, became a key instigator for my belief that there needed to be a new way to approach addiction.

Once you have identified what “your” cause or barrier is then you can move to making changes to your life based on this new understanding of yourself. Therapy and change became, as a result, of this experience, the pillars of my approach. 

Bessel Van Der Kolk’s book, The Body Keeps The Score,is a masterpiece and a seminal work on trauma. In it, he explains how trauma is not just an event that happened in the past, it is also the imprint left by that experience on mind, brain, and body.

This imprint has ongoing consequences for how the human organism manages to survive in the present.

- Bessel Van Der Kolk

He talks about how survivors of trauma can become "managers" or "firefighters". The part of us that holds the memories of trauma are“exiles”. We manage or firefight our way through life to avoid having to confront those exiled memories of trauma (and associated sensations, beliefs and emotions).

Firefighters who use an addictive behaviour to not have to confront their trauma are shockingly common and I’ve met many.

The victim of child abuse who came to me with an alcohol and cocaine problem. The victim of rape who came to me with an opiate addiction.The victim of childhood violence who used alcohol, weed and Benzodiazepines. The victim of a series of abusive relationships who used alcohol and cocaine. The victim of multiple sexual assaults while they were exploring their sexuality who came to me with a cocaine problem.

“Managers are all about staying in control while firefighters will destroy the house in order to extinguish the fire. The struggle between uptight managers and out-of-control firefighters will continue until the exiles, who carry the burden of the trauma are allowed to come home and be cared for” Bessel Van Der Kolk, The Body Keeps The Score.

As Bessel puts it, firefighters would rather, tragically, burn everything down to the ground rather than have to confront their exiled experiences. And as anyone suffering addiction can testify an addictive behaviour can give full rein to this.

The heart of Bessel’s work is how he worked to ameliorate therapeutic change with his clients and that... “For real change to take place the body needs to learn that the danger has passed and to live in the reality of the present…. Without integrating the experience, they continue to be there and didn’t know how to be here, fully alive in the present. When you can’t be fully here, you go to the places where you did feel alive – even if those places are filled with horror and misery.”

There have been some transformative moments in sessions where I have seen that helping victims find the words to describe what has happened to them, be believed, not stifled with sympathy, but gently encouraged has shifted where that person’s “exile” lives. This can be the starting point for engagement in a series of small, but in aggregate, life trajectory changes. Abuse of drugs and alcohol can often feel like, at the close of this process, one of many barriers to living that therapy and change have overcome.

In my experience, every addiction has a cause or a barrier to recovery. They tend to sit in four areas. They may sit in one area, or from all four. 

1. Trauma - What happened to me and how did it affect me?
2. Behavioural – How do I change long-standing habits ingrained in my life?
3. Self-image – Who am I? How do I feel about myself?
4. Existential – What is the purpose of my life?

Once you have identified what “your” causes or barriers are then you can move to make changes to your life based on this new understanding of yourself. Understanding yourself leads to changing yourself. And this makes abstinence stick. And more likely to make your recovery successful and final.