When I first started working in mental health related work, we were taught and trained about mental health related disorders in a very singular fashion. Each disorder has its own structure and behaviours associated with it. Each is separate from the other and distinctly different. There are many reasons for this. Understanding how these different disorders work and impact a person’s life is extremely important. The danger however is that treatment is often singular in nature as well. You might receive treatment for depression or anxiety or mood related issues. Unfortunately, for people struggling with a history of trauma, co-occuring disorders are common and this can create challenges for both the person suffering and the person trying to help.
The term co-occuring disorder is often used to describe someone who has a dependency on and/or abuses a substance such as drugs or alcohol and also has a mental health issue or disorder. This is so common for trauma victims that co-occuring disorders should probably be considered the norm versus the exception. Statistics suggest that about 20% of people who experience mental health issues will also struggle with a substance related issue or dependency. Research also tells us that having post-traumatic stress disorder is a risk factor for substance abuse and dependency. Not surprisingly, people who have a history of post-traumatic stress also have a higher chance of having a co-occuring disorder.
A common thread with post-traumatic stress is the recurrence of painful memories and emotions combined with overwhelming anxiety and stress. These recurrences can be extremely difficult to deal with and create a heightened sense of distress and instability. One of the reasons why substance abuse and trauma are so closely connected is due to the fact that substances can be (for some) extremely effective at numbing the pain and suffering that stays with the trauma victim. If you treat the substance abuse without treating the trauma, you stand the risk of not dealing with the very thing that motivated a person to engage in substance in substance abuse in the first place. This can make treatment very difficult since one issue can trigger the other issue.
For instance, let’s say a person dealing with both addictions issues and post-traumatic stress disorder is able to become sober with some support. With sobriety often comes a flood of unresolved issues, feelings, memories and pain that were numbed through whatever substances were used. This makes it difficult to stick with sobriety since learning new coping mechanisms can take some time and some practice. If the treatment team is not aware of and working with both issues but takes a singular approach then only half of the work that is needed might be completed leaving both the victim and the helper frustrated and overwhelmed.
What we now know about trauma is that there are many people struggling with a variety of mental health disorders and challenges that have a history of some form of unresolved trauma from their childhood. Child abuse and neglect are viewed as triggers that can contribute to virtually all types of mental illness. In fact, it is common to hear stories from survivors of childhood abuse who have been misdiagnosed and / or mistreated within the mental health system due to the vast number of issues and the level of complexity their symptoms present.
Brain research also shows that specific changes that happen to the brain as a result of child abuse (physical, verbal and / or sexual) and neglect might leave an individual more prone to depression, addiction and post-traumatic stress disorder. In fact, being exposed to high levels of stress often associated with abuse makes the brain less capable of coping with stress later on in life.
The damage to a person’s internal stress system seems to help contribute to both anxiety and a fear of a lack of pleasure which helps motivate an individual to turn to substances to cope.
All this research is helping to mold how all helping organizations understand and respond to trauma and that is a very good thing. What it should also be helping us to do is recognize the significant barriers placed on individuals who grow up in abusive and / or neglectful homes. Hopefully this understanding will also help shape how we chose to support and protect the youngest victims of all.
For more information, please visit Mind Your Mind