Getting to the root of substance abuse
By Deborah Jeanne Sergeant
Substance abuse is still very much prevalent in the U.S.
In 2022, 48.7 million Americans ages 12 and older experienced a substance use disorder (including drug and alcohol abuse) in the previous year, according to www.addictiongroup.org, a site that helps those struggling with addiction.
It further states that only “9.1% of those with co-occurring mental health issues and substance use disorders receive treatment for both conditions.”
Mental health issues are not the only reason that people abuse substances. Some people begin abusing drugs like fentanyl because of physical addiction to prescribed opioid painkillers such as after an injury or surgery. But others experience untreated mental health problems stemming from trauma and end up using substances as a harmful coping mechanism.
“Addressing underlying trauma is important as it is one of the most concurring disorders when it comes to substance use disorders and its potential treatment options,” said Linda Terrazas, licensed clinical social worker and owner of Linda Terrazas LCSW, PLLC in Syracuse. “Whether it is exposure to trauma, complex trauma from childhood, chronic PTSD or PTSD, there is a high probability someone presenting with a substance use disorder has been impacted by trauma within their lifetime, even when using as it brings many high-risk situations. By seeing the underlying possible cause of the SUD, such as unresolved trauma, we can then treat the obsessive and compulsive pattern many people develop when they turn to alcohol and drugs, whether it be to experience pleasurable times or to escape quality of life disrupting symptoms.”
She added that some people may not even realize they experience trauma responses like high anxiety, sleep issues, and intrusive thoughts or memories. This can increase their risk of relapse, disengaging from treatment and continuing use substances.
Terrazas believes that treating the biopsychosocial factors contributing to substance use is the only way for a good chance of recovery. By using trauma-informed care, an experienced provider can “help a client process, understand, become aware of what contributes to their [behavior] patterns,” she added.
Fortunately, more providers have begun looking at the root of why someone abuses substances.
“In the last 15 to 20 years, what we’ve seen in mental health and behavioral health is taking more of a trauma-informed approach to helping all people who present” [for care], said Shiann Brown, licensed clinical social worker in private practice in Syracuse. “I think that’s being intertwined in the substance use disorder field as well.”
She explained that people with substance use disorders try using substances to regulate their nervous systems that have been deregulated by trauma. Substance use does not have to include illegal drugs bought on a street corner. Some people believe that vaping or using marijuana recreationally is safe because it’s legal. Some self-medicate their anxiety or depression or other mental health issues with over the counter or prescription medication that’s not their own or indicated for their condition.
“Drugs and alcohol do a good job of regulating nervous systems, but with major life consequences,” Brown said.
But that’s not addressing the root cause, which often is trauma. Brown said that trauma is subjective. What’s traumatic for one person may not affect another person as deeply. But it’s a perceived or actual threat that dysregulates the person’s nervous system.
Working through trauma and building healthy coping mechanisms takes time. Unfortunately, many insurers provide coverage for only a few weeks, a factor which Brown said limits a person’s ability to resolve and overcome their trauma history and substance use problem.
“Getting to the root is a long-term process for aiding someone,” she said.
It takes time to create an environment where the patient feels supported and validated and ready to tap into community resources that help them continue in sobriety, even after their insurance will no longer cover their treatment.
“When someone has experienced some trauma or adverse trauma, they may not qualify for post-traumatic stress disorder, but they may have hypervigilance, belief systems that are negative and more,” Brown said. “Those are things that keep people from thinking they can go into recovery.”
She believes that a communitywide philosophy of trauma-informed care will help professionals in medical and mental health settings respond to people with substance use disorder in a way that supports recovery and healing.
“We’ll approach it in a way that makes it easier for people to want to work with us and collaborate to achieve the goals they want for themselves and that we want for them as citizens,” Brown said.