TRAUMA AND ADDICTION: A TRAUMA INFORMED PERSPECTIVE.

Herb Cohen

TRAUMA AND ADDICTION

When I do an intake on someone seeing me for therapy, I always take history from birth to present. I create a timeline of traumatic events and mark the onset of maladaptive coping in response. For example: age 14, I was raped and that year I started cutting and getting high. When life is presented this way it is easy to connect the dots between negative events and maladaptive behaviors. They suddenly make sense. Something bad happened to me and I needed to deal with that, usually by avoiding behaviors. It is NORMAL to want to avoid pain.

Avoidant behaviors may work for a while, and help us survive but in time may be trouble by themselves. Avoidant behaviors not only get stuck, but carry shame and that is problematic.

Traumatic memory is stored differently than other types of memory. It is important that it is stored in a way that we can easily recall, yet not delete it as we may need to reference it to light up a fight- flight response to protect ourselves in the future. Encoded within those permanently stored memories are negative beliefs about ourselves along with
body sensations, smells, pictures, sounds etc. of the event as if it just happened. They are stored as fragments with core memory in the right frontal cortex and other fragments in the respective sensory cortexes. At the moment of recall, all the parts come together to paint a picture though not entirely accurate. These negative ideas are always irrational and generalizable to other aspects of our life.

Some examples are: I was sexually abused as a child but because it was done in a loving manner and my body responded pleasurably, I must have wanted it and caused it to happen. It was my fault, becomes–everything that goes wrong is my fault. Or I felt dirty thus I do not deserve as I am not worthy. I am not lovable, thus I am not capable of receiving or giving love. These negative beliefs are shame based and painful. Ironically we often choose behaviors that help us avoid them that are also shame based. If I drink until I cannot think, I will feel shame afterwards especially if I do something I would regret if sober. Now I have the intrinsic shame of my traumatic memory driving drinking which brings on more shame. That’s shame upon shame. I cannot cope with so much shame so I need to avoid that too.

Shame is stressful. Stress causes dopamine cells to fire. Dopamine is a common brain chemical that seeks more of whatever gives us pleasure. Dopamine cells do not have any judgment of what is good bad, safe etc. They just want more. Stress is pain and so dopamine cells say “let’s avoid” and remember that moment we felt relief when we first cut, drank, ate or smoked etc. A memory can be triggered by anything that reminds us of it or the negative idea we have associated to it. Both light up, triggering
a need to avoid. Dopamine elicits a memory of what worked in the past and that creates a craving. If we do not give in to the craving-more stress builds until it is intolerable and we must give in. Cravings are 90% memory. So let’s take a look at this memory that is lighting up dopamine.

Dr. Robert Miller has hypothesized addiction and compulsive behaviors as being created by “Positive Feeling States” or PFS. A PFS is created when a positive condition ( in response to a negative condition, like those fixed negative beliefs attached to trauma memories) develops in combination with a highly desirable outcome combined with the dopaminergic surge from getting high, etc. and if it is illegal or bad we may get an adrenaline rush from that excitement. These states synergize into a fixed state that becomes frozen just like our trauma memories. An example would be someone who has been the black sheep of his family who feels unaccepted and unloved. As a teen he is confronted by a group of older teens who call him over and offer him a cigarette. He tries it even though he has never smoked before. He coughs, the others laugh but one puts his arms around him as if to say” it’s OK, you’re one of us now”. He gets a little buzz from smoking, he knows he should
not be doing this and that causes excitement and the feeling of being accepted. All the physical and emotional details synergize together into a fixed PFS. His cravings going forward all reference this PFS. There can also be other Positive Feeling States created in regard to his smoking, fostering compulsive smoking behavior.

Dr. Millers says that when these Positive Feeling States are identified and delinked, followed by processing the negative conditions corresponding to the desired state, i.e. not accepted, the compulsion then dissolves. This means processing the trauma associated with the negative idea. Processing in this case means using EMDR, Eye Movement Desensitization and Reprocessing.

EMDR is a special therapy used to treat trauma and addiction. It works on memory and can release fixed memories such as trauma to be processed into neutral states with no charged negative associations. As memories become neutral, the desire to avoid no longer has any reason for being. Adaptive responses stop. Addiction using PFS Protocols may take a few weeks to extinguish verses years of trying to manage addictive behaviors.

For those with no access to EMDR, do a timeline, identify Positive Feeling States and see if you can remove shame from your reactions to events. Shame is a big motivator so removing shame is big. Add coping skills like breath-work, grounding and stress management to manage stress. If you can manage stress that will help diminish cravings and dopamine triggers.

Herb is a Registered, Board Certified, and Licensed Creative Art Therapist. He is trained in EMDR and is a Certified Level II practitioner. Herb is the Director of Stepping Stones PROS Program in Huntington, LI for Family Service League and also manages a part time private psychotherapy practice. Herb Co-Chairs the Long Island Committee on Sexual Abuse and Family Violence. He is the Regional Co-Chair for EMDR for the Long Island region. Herb is a tireless advocate for advancing and integrating trauma informed care and EMDR in government and community based agencies and institutions.

Herb has studied Eastern healing arts and not only teaches Tai Chi, Chi Kung and Meditation, but integrates those methods into his practice. Herb has also studied Gestalt and Sensorimotor therapy approaches as well has a strong neurobiological foundation.