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Linking Childhood Trauma and Substance Abuse

The link between trauma and increased risk for substance use disorders has been documented in research for many years. People with a history of trauma use more substances and are at higher risk for dependence, substance use disorders, and related complications compared to those without trauma history. Understand more about the connection between trauma substance use and addiction.

What Is Trauma?

Trauma refers to events that are distressing, disturbing, or otherwise upsetting. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines a traumatic event as “exposure to actual or threatened death, serious injury, or sexual violence.” This can occur in four different ways: Directly experiencing the event or having it happen to you

  1. Witnessing the event as it happens to someone else

  2. Learning of a traumatic event happening to a close friend or family member

  3. Repeatedly being exposed to extreme details of the traumatic event, such as first responders following a disaster or therapists hearing about trauma stories from clients

Traumatic events can be a single event, like a car accident, the traumatic death of a loved one, or a long-term stressor, like living in an abusive household. Trauma can occur at any time across the lifespan and can happen to anyone.


Adverse childhood experiences (ACEs) occur between birth and age 17, can be traumatic, and impact a child’s stress level over time. According to the Centers for Disease Control and Prevention, ACEs include:

  • Physical abuse

  • Emotional abuse

  • Sexual abuse

  • Physical neglect

  • Emotional neglect

  • Caregiver with untreated mental illness

  • Violence against the mother, stepmother, or maternal figure

  • Loss of parent through abandonment, separation, divorce, death, et cetera

  • Incarceration of a household member

  • Substance dependence by a household member

ACEs are fairly common, with almost two-thirds of adults reporting at least one adverse childhood experience. They can contribute to many issues, including mental health diagnoses, medical problems, poor social support, unemployment, substance dependence, and early death.


How Does Trauma Lead To Substance Dependence?

Some people who experience trauma develop mental health issues as a result. For many, trauma manifests as hypervigilance, re-experiencing the trauma, and other symptoms of post-traumatic stress disorder (PTSD). Although substance use is not an official symptom of PTSD, about 59% of people diagnosed with PTSD develop substance use and dependence issues.


When trauma occurs earlier in life, the risk for substance use issues increases. Additionally, the more traumas a person has experienced, the more likely they are to develop issues with substances.


Individuals who experience trauma may turn to substances to regulate unpleasant moods brought on by trauma symptoms. The substances may provide comfort and positive emotions. Substance use can be a form of self-medication following a trauma or series of traumatic events.


Following trauma or a series of traumatic events, social support, and immediate intervention can reduce the likelihood and severity that an individual will develop trauma symptoms. These interventions also reduce the risk for substance use issues, supporting the theory that substance use is a form of coping with trauma symptoms.


Signs of Trauma-Related Substance Use

Depending on the individual, substance dependence and substance use issues can manifest in many ways. According to the DSM-5-TR, substance dependence may include many of the following behaviors and symptoms:

  • The substance is taken in larger amounts or over more time than initially intended.

  • There are repeated unsuccessful attempts to eliminate, reduce, or control the use of the substance.

  • Significant time is spent trying to obtain, use, and recover from the effects of the substance.

  • When not using the substance, the individual experiences cravings or urges to use it.

  • Substance use causes functional problems, including the inability to fulfill obligations.

  • Continued use despite negative consequences resulting from substance use.

  • Giving up social, occupational, or recreational activities due to substance use.

  • Risky or unsafe use.

  • Continued use despite knowledge of the negative consequences resulting from the substance use.

  • Increased tolerance, such as needing more substance to have the same effect.

  • Withdrawal when not using the substance.

If you notice increased substance use following a traumatic event, your substance use may be related to the trauma. If you find yourself using the substance to cope with trauma triggers or memories, there may be a connection between your trauma and substance use. Tend to use the substance (or use more of the substance) following triggers, such as contact with a perpetrator or on trauma anniversaries. This can also indicate that your substance use is related to trauma.


How to Get Help

If you struggle with substance use and have a history of trauma, help is available. Many people who experience these issues benefit from treatment and have enjoyable, fulfilling lives. It can be challenging to ask for help but know that you deserve support and care.


Both trauma symptoms and substance use disorders are mental health issues. They are not indicative of your value as a person. Regardless of your symptoms, you are worthy of help.


If you decide to see a therapist, seek providers with expertise in treating substance dependence and substance use disorders. In addition, search for providers with training and expertise in treating trauma and providing trauma-informed care.


Some trauma survivors and those who struggle with substance use benefit from group therapy or peer support in their recovery. Your therapist or general practitioner might have information about local resources.


The Substance Abuse and Mental Health Services Administration has a directory of clinicians and national resources. Their website additionally has information about supporting loved ones, seeking help in a crisis, harm reduction, and educational information about substances and substance use.


Call Us if you or a loved one are struggling with anxiety, substance abuse, or addiction and need help. Our non-profit offers free Clinical Evaluations and Case Management services to individuals and families needing them.

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Contributing Source:

Amy Marschall, PsyD

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes, among others.


Published on August 21, 2023

Medically reviewed by

Yolanda Renteria, LPC


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