I saw a quote the other day that really stuck out to me: “Addiction shouldn’t be called ‘addiction.’ It should be called ‘ritualistic comfort-seeking.’” Amazing, right?
That quote is attributed to Dr. Daniel Semrok, who treated Vietnam veterans who became hooked on drugs and alcohol in the 1980s to cope with the PTSD they developed from the war. His point is simple: addiction is as normal of a response to trauma as bleeding is to being cut. When we begin to realize the connection that addiction and trauma have, we can take better steps to meet more of our patients’ needs than what they may have initially come in for.
ACEs and addiction often go hand in hand.
A growing body of Adverse Childhood Experiences (ACEs) studies reveal that 64% of people have at least one ACE, which doubles or quadruples their likelihood of using drugs or alcohol, particularly at a young age. An ACE score of four nearly doubles the risk of heart disease and lung cancer, with your likelihood of becoming an alcoholic increasing by 700%. Individuals with an ACE score of 5 or higher are seven to 10 times more likely to use illegal drugs and become addicted.
ACEs are common and occur throughout the state of Arkansas and in all types of families and communities. Poverty, homelessness, discrimination, and violence are some of the most common ACEs. Arkansas ranks first for children who have experienced at least one ACE (56%) and among the highest for children who have experienced three or more ACEs. Arkansas also ranks highest in opioid prescription rates and substance abuse disorders. Are you seeing a pattern?
Different combinations of ACEs produce the same statistical results.
Substance abuse by a family member in the home is a cause of significant toxic stress, household dysfunction, and, most commonly, intergenerational trauma. The family member who is using drugs and alcohol to cope with their childhood trauma passes on trauma to their children in the household. The cycle seems almost inescapable unless we consider addressing a patient’s trauma in tandem with their addiction.
Many doctors already know that individuals who have suffered traumatic stress have higher rates of depression. Higher rates of depression lead to higher rates of addiction. We also know that stress impacts the body, often causing increased heart rate, high blood pressure, and a release of glucose. It’s also important, however, to remember that stress affects the body and the mind. In fact, during stress, your body often goes into “fight or flight mode.”
When children are in the crucial stages of brain development within their first five years of life, experiencing prolonged active stress leads to hypervigilance and perceived threats that may or may not be real. This has a tremendous impact on the development of the neocortex, which controls decision-making, thought, and episodic memory. Hyperexposure to stress at a young age also affects the body’s limbic system, which controls various emotional behaviors such as fear, rage, and anxiety.
Let's talk physiology.
Your response to stress starts in the brain. When you face danger, such as an oncoming car as you’re about to cross the street, your eyes and ears (or sometimes, both) send information to the thalamus of the limbic system, where it is relayed by the amygdala and neocortex. The amygdala is your brain’s alarm system that detects threats before you’re even aware they’re there. As soon as the amygdala detects a threat, it signals the hypothalamus to release dopamine, making you hypersensitive, heightening your senses, and preparing your body to face the danger ahead of you. There’s a bit more to it than that, but I want to focus on one specific part of the body’s stress response.
Addictive substances hijack your body’s reward system, causing your brain to release dopamine. This is what causes cravings and addiction. Methamphetamines increase the release of dopamine tenfold. With such high levels of dopamine in your body, your brain’s ability to differentiate the threatening from the non-threatening leads to the triggering of the brain’s survival mechanism.
What we think of as “bad behaviors” are actually maladaptive behaviors that a person has developed to survive when supportive or trusting relationships are non-existent.
People who struggle with addiction are sick, not twisted.
Addiction is often seen as a “moral failure” in our society. People who struggle with addiction are often singled out, ridiculed, and seen as bad people. What many may not realize is just how powerful addictive substances can be. To some, drugs and alcohol become more important than food and water. Addictive substances can be very hard to overcome.
A better understanding of the impact of trauma on the developing brain leads to a better understanding of how people become addicted as a response to trauma. It also builds empathy among health care providers, who make the trauma-informed shift from asking, “What is wrong with you?” to “What happened to you?” Understanding the science behind the body’s reaction to stress and perceived threats improves our treatment for patients dealing with addiction.
Patients need to be understood, not judged. Appropriate screening, diagnosis, and referral for treatment increase the likelihood of success. Many of the outcomes we struggle to improve with our patients, both physical and mental, will not improve without addressing ACEs, trauma, and addiction together. Our patients also suffer a myriad of other addictions that need to be brought to life. An ACE screening is a good way to assess past trauma and improve doctor-patient relationships and outcomes. Appropriate referrals to substance abuse treatment and community-based supports increases the likelihood of success.
Adults recognizing and addressing their own trauma can help the next generation and prevent the vicious cycle of intergenerational trauma. Health care providers should also recognize their own trauma and any concurrent addiction and seek the appropriate help. Doctors, nurses, and other health professionals cannot take good care of patients without taking good care of themselves.
Addiction is a personal struggle that requires not just personal resilience but also the support and understanding of the resources available in the community. While recovery may be challenging, it is always possible, and seeking help is a vital first step. Together, by understanding the connection between stress and addiction, raising awareness, eradicating stigma, and offering a helping hand, we can work toward improved empathy and health outcomes for our patients instead of judgment and isolation.
Content for this blog was based on discussion and writing by Dr. Chad Rodgers, CMO, AFMC.
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