Many people afflicted with a substance use disorder have histories of trauma, as well. The impact of trauma on the individual depends on the age and developmental stage of the person at the time the trauma occurs, the interpretation of harm the victim experiences, the frequency and severity of the trauma, and the response of caregivers when the trauma occurs. The ACE’s study further verified this and listed the negative outcomes associated with childhood trauma. These include mental illness, substance abuse, criminal activity, aggression, negative health behaviors and physical problems throughout the lifespan.
When one experiences trauma, cortisol levels rise and the autonomic system goes into overdrive. The Cortex or the thinking side of the brain stops working effectively or efficiently. This is a normal reaction to extreme stress, crisis or trauma. When the trauma is frequent or severe, cortisol remains high and the brain becomes chronically over-aroused. The stress response in this case interferes with brain development and the development of social, emotional, and communication skills.
For instance, trust in caregivers and the development of the primitive brain for safety and basic life skills occur between the ages of 0 and 2 years. If there is severe and/or chronic trauma at this age (including severe neglect), there is damage to the development of these skills and essential parts of the brain that regulate emotions, cognition, trust, and behavior.
Severe trauma from 2 – 4 years will interfere with the development of communication, social skills and delayed gratification. Without resolving the trauma, people often can remain at this earlier social developmental level while the body grows at a normal pace. In that way, people that are 16 to 100 years old can act as if they are 2-4 years old in their interactions with people and the world. They are developmentally delayed. The attitude represented by “I want what I want and I want it now and if you have it, I am going to take it” can occur at any age when one has a history of severe trauma, however sharing with others should be developed by the time children enter school when those children have not been traumatized.
Additionally, the brain becomes either hyper-aroused (out of control and acting out behaviors) or hypo-aroused (withdrawn). A chronically hyper-aroused brain cannot learn anything effectively because it directs the body’s energy to flight, fight, or freeze, not developing necessary coping skills and not learning well in school. To turn on the cortex of the brain for cognitive thinking and logic, and regulating behavior, trauma must be resolved and the brain must learn to regulate itself. It takes calm and focus to attend to school or work tasks. This develops when a caregiver soothes a child and teaches him to sooth himself and his brain. Empathy for others cannot develop without these building blocks. Therefore, there are people of any age that are behaviorally and emotionally not well regulated or out of control (inwardly or outwardly).
The brain must learn to regulate the various parts of itself before it can regulate behavior, have effective relationships with others and restart the developmental process. The amygdala is underdeveloped so the ability to regulate one’s emotions is impaired. Because the emotions are out of control, some people turn to mood altering drugs and alcohol to manage their feelings.
It is estimated that as much as 80% of the people with substance use disorders have unresolved childhood (parental abuse or neglect), teen (bullying and rejection by peers), and adult trauma (difficulty in establishing a relationship with a significant other or job).
Consequently, stage 1 of trauma work is safety, helping the brain regulate itself and building trusting relationships. You must help the brain to learn to regulate and soothe itself before it can restart the developmental process and before you begin to deal with any trauma specific therapy narrative. A positive, supportive relationship is needed to establish the ability to trust. Effective interventions include using rhythmic, soothing activities, such as: mindfulness, Yoga, meditation, comfort and support, relaxation, music, dance, drumming, biofeedback and neurofeedback, taking walks, art, EMDR, karate practice, play, and rocking in a rocking chair.
Our clinics have used these techniques and have had marvelous results. One woman reported that she had not had a full night’s sleep in 20 years and she was too anxious to talk about her trauma. After a few biofeedback sessions she began talking about and processing her trauma and sleeping through the night. Another struggled with substance abuse, had a difficult relationship with his parents and trouble holding down a job. He has a much better relationship with his parents, has a regular job, and is clean and sober. Additionally, one of these devices is FDA approved for reducing the symptoms of opiate withdrawal. Methods of soothing and regulating the brain include the use of biofeedback techniques. There are several biofeedback methods on the market, such as Cranial Electro-stimulation, neuro-mapping and neuro-stimulation, EEG technology, and meditation apps for your phone or tablet.
Stage 2 is trauma work and deals directly with exploring the trauma narrative and should not be started before stage 1 is accomplished.
Stage 3 is reconnection with home, community, and purpose (3 of SAMHSA’s wellness domains). It will take a variety of methods to meet all of these needs and reduce the negative effects of the social determinants of health problems.
In my 5 clinics, I encourage comfort, soothing, support and positive relationship, as well as setting proper boundaries to occur from the waiting room to the therapy session. That means all staff showing respect and support and good boundaries at all times. Showing a person empathy helps them develop their own empathy. Additionally, a calm approach to the interaction with others helps the brain allow the Cortex (thinking part of the brain) to work more effectively so that people can learn more easily. The bottom line is that it takes multiple types of activities to support recovery. It also takes a higher intensity of services, such as Intensive Outpatient Services.
Dr. Kathryn Seifert is a Psychologist, author, lecturer, and owner of 5 Public Behavioral Health Clinics. She has appeared on CNN, Fox News, and Discovery ID. Dr. Seifert wrote 2 books on youth violence and developed the CARE-2, a trauma informed treatment planner for “at risk” youth which can be found at