Treating Underlying Trauma During Substance Abuse Recovery

Trauma may be an influencing factor for people battling addiction. There are several ways to treat underlying trauma during substance abuse recovery.

Treating Underlying Trauma During Substance Abuse Recovery

Unresolved trauma is one of the most common underlying factors of substance use disorders (SUDs). 

Addiction treatment programs that don’t address a person’s underlying trauma may not be focused on the actual cause of the drug or alcohol abuse, and the risk of relapse will be higher. 

There are several effective treatments for people coping with trauma, including trauma-informed therapies and co-occurring disorder care.  

What Is Trauma?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma is exposure to actual or threatened events involving death, serious injury, or sexual violence.  

People who have not directly experienced a traumatic event may still become traumatized by the experiences of someone else. 

Types Of Trauma

Trauma can be organized into three categories based on the nature of the traumatic experience. 

  • acute trauma — a single life-threatening event such as a car accident or natural disaster 
  • complex trauma — repeated exposure to experiences that cause severe distress or fear including abandonment, chronic neglect, sexual or physical abuse, and torture
  • chronic trauma — is repeated exposure to a dangerous or stressful event such as chronic medical illness, bullying, domestic abuse, homelessness, or starvation 

Post-Traumatic Stress Disorder (PTSD)

PTSD is a psychiatric disorder that may develop in people who have experienced or witnessed a traumatic event. 

People with PTSD typically avoid situations that remind them of the event and may have strong negative reactions, flashbacks, anxiety, and recurring nightmares.

When left untreated, the long-term effects of trauma and PTSD can have severe effects on mental and physical health. 

Symptoms Of Trauma 

Below are some of the symptoms that may present in people who have experienced trauma.

Symptoms of trauma may include:

  • overwhelming fear
  • insomnia
  • social withdrawal or isolation
  • confusion
  • fatigue and exhaustion
  • sexual dysfunction 
  • irritability and aggressive behavior
  • feelings of guilt or shame
  • intrusive thoughts
  • extreme alertness
  • panic attacks
  • obsessive-compulsive behaviors
  • emotional numbness
  • depression
  • tachycardia (fast heartbeat)
  • nightmares
  • loss of memory

Some people may notice that their symptoms dissipate over the days and weeks following the traumatic incident, while others may develop increasingly severe symptoms that last for years. 

How Underlying Trauma Influences Substance Abuse

Due to the severe emotional, psychological, and physical distress that may result from trauma, many people who haven’t sought professional help turn to substance use as a coping mechanism.  


There is a myriad of prescription and illicit drugs that, when ingested, will immediately produce feelings of well-being and happiness. 

The euphoria of drug or alcohol use may momentarily relieve the symptoms associated with trauma, but will ultimately only make the situation worse as the person develops an addiction.

Co-occurring Mental Health Disorders

Many people with SUD are also in need of treatment for a mental health condition, as substance abuse exacerbates the symptoms of mental health disorders and vice versa. 

While it’s difficult to pinpoint which disorder developed first, there is plenty of research that has shown how SUD and mental disorders are risk factors for one another.   

Treating Trauma During Addiction Recovery

A drug and alcohol rehab program may offer many different treatment options for chemical dependency while also addressing any underlying trauma.

Trauma-Informed Behavioral Therapy

Behavioral therapy is a common evidence-based treatment for people with addiction and a history of trauma

Dialectical behavior therapy (DBT) is effective for people who have difficulty regulating their moods and experience intense emotions. This is particularly effective in the treatment of PTSD. 

Trauma-informed cognitive behavioral therapy (CBT) helps a person process traumatic memories, overcome problematic behaviors and thoughts, and learn coping skills for addiction recovery

CBT for trauma was originally utilized for children who had been sexually abused. Now, both adults and adolescents who have experienced physical or mental abuse benefit from this therapy.  

Eye Movement Desensitization And Reprocessing (EMDR) Therapy

EMDR therapy is a mental health treatment technique that works by moving your eyes in a specific way while you process traumatic memories. 

Organizations such as the American Psychiatric Association (APA) recommend EMDR for people with PTSD, anxiety, and severe phobias. 

Exposure Therapy

Exposure therapy works by exposing the client to stimuli that cause fear in a safe environment. There are four types of exposure therapy used by therapists. 

Types of exposure therapy include:

  • real life (in vivo) exposure — this involves being exposed to the feared object or situation in real life
  • virtual reality (VR) exposure — in situations where real-life exposure is impractical or impossible, using virtual reality technology may be used instead   
  • imagined exposure — imagined exposure involves using the imagination to vividly re-create the traumatic event in the mind with the therapist present
  • interoceptive exposure — interoceptive exposure provokes sensations associated with anxiety and panic attacks such as hyperventilating or aerobic exercise to increase heart rate

Dual Diagnosis Treatment

Dual diagnosis treatment is an umbrella term for treating both SUD and mental illness at the same time. 

This treatment approach will differ with every client depending on their diagnosis. Behavioral therapy and prescription medications are commonly used in co-occurring disorder care. 


Psychotherapy, also known as talk therapy, can help eliminate or control symptoms of mental illness or emotional difficulty. 

Therapy settings may include one-on-one sessions, group therapy, or family therapy. Clients will share personal feelings and thoughts during therapy and may be prescribed medication. 

Psychotherapy has been shown to help people with a history of trauma cope with daily life. 

Other Common Addiction Treatment Services

Below are some of the other behavioral health services commonly offered at rehab centers. 

Treatment options may include:

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