Substance Use and Trauma
Substance use can play a significant role in both the lives of trauma victims as well as in the lives of those who traumatize others. For example, victims often use substances in reaction to trauma and many perpetrators of child abuse, neglect, domestic violence and other acts of antisocial behavior use substances prior to and during these incidents. Additionally, both victims and perpetrators who use substances have an increased risk of being involved in further and worsening episodes.
Self-Medication and Trauma
Many individuals with substance disorders have a history of childhood abuse. This includes physical, sexual, emotional and psychological trauma. Also, many individuals who abuse substances and those who are substance dependent, report that their substance use began during a period of prolonged trauma or just after a traumatic event.
Survivors of trauma often turn to substance use to sedate or numb the effects of traumatization. Self-medication in these instances is an effort to mediate painful memories and feelings associated with adverse events and situations. For many, substance use is viewed as having been an essential part of their psychological and emotional coping with victimization.
Substance use while victimization is ongoing medicates the fear and anxiety experienced between episodes of abuse. Substance use after abuse has ended can dull the symptoms of a trauma reaction. Intrusive thoughts, distressful memories, flashbacks and emotional pain can be ‘managed’ temporarily with substance use. Many survivors also use substances to ‘medicate’ sleeplessness and nightmares caused by traumatization.
Substances and Vulnerability
Individuals who become intoxicated while continuing in abusive relationships become more vulnerable to further abuse. They are also vulnerable to experiencing episodes of more severe abuse when using substances. Impaired by intoxication, they may become less submissive, less vigilant and less able to use their usual coping skills. While not able to prevent their victimization or control their abusers, victims are sometimes able to appease the abuser, exit unsafe situations and can occasionally minimize the abuse they experience in any given episode. Intoxicated victims who are in actively abusive relationships, however, are less able to attempt such self-protective measures.
Intoxicated victims are also typically less responsive to the abuser’s more ‘subtle’ forms of control. Abusers can use this lessened responsiveness to justify escalation, violence or more severe forms of violence. An example of the increased risk to victims who use substances is the increased dangerousness in domestic violence when victims are intoxicated. Intoxicated victims of intimate partner violence may fail to effectively implement safety plans. Consequently, they may sustain greater injury when they are impaired by substance use.
Substances and the Perpetrator of Abuse
In domestic violence, some batterers are less dangerous when intoxicated. This is, however, rarer than the other, more dangerous effects of substance use by a batterer. Typically, men who batter are considered significantly more dangerous when using, abusing or dependent upon substances. This is particularly true when alcohol is used by the batterer. The risk of serious injury to the battered victim increases significantly when abusive men use alcohol. The potential for lethality also dramatically increases when the batterer is under the influence of alcohol.
Substance use tends to ‘permit’ batterers to avoid responsibility for their abusive behaviors. Rationalization of the abuse and denial of its significance as a problem apart from substance use can prolong abuse. This dynamic is also seen in individuals who perpetrate sexual assault. As in domestic violence, the risk of sexual assault incidents occurring dramatically increases when sexual perpetrators are using substances. This is true for those who sexually assault children as well as for those who sexually assault adults.
Children are also at risk for emotional and physical abuse if they are cared for by adults with substance disorders. Attempts to discipline children when under the influence of substances can be motivated by disinhibition, impulse, anger and impaired judgment. Verbally abusive interactions with children and physically abusive discipline can result.
Child Neglect and Substance Use
Incidents of child neglect dramatically increase when caregivers are using, abusing or dependent upon substances. Impaired by intoxication, parents and other adults responsible for the care and protection of children are less engaged, less vigilant and less protective. Consequently, neglected children are at significant risk for multiple types of traumatization. These include forms of trauma within the relationship with neglectful adults as well as outside of it. Neglected children are also at risk for trauma experiences during childhood as well as in later life.
Children of addicts and alcoholics are vulnerable to emotional and psychological neglect which interferes with normal childhood development. Such interrupted development can lead to involvement in other traumatizing relationships in later years. Additionally, prolonged parental addiction exposes children to many high risk situations while still dependent upon their parents. Some of the risks include traumatization through poverty, poor nutrition, school failure, poor peer relationships, inadequate socialization and the lack of physical safety. The appropriate development of skills for intimacy, problem-solving and emotional management necessary to be safe and successful later in life is often inadequate for these children.
The Traumatic Experience of Addiction
Addicted individuals are at risk for various traumatic experiences while intoxicated and as a result of the adverse consequences of prolonged substance use. Loss of relationships, removal of children, financial problems, unemployment, homelessness, incarceration, hospitalization, sexual assault, physical assault, accidents, infectious disease and other illnesses, unwanted pregnancies, miscarriages and serious injury to unborn babies are some of the possible traumatic experiences that can occur as a direct result of addiction.
Individuals who use substances are also at risk for psychiatric problems. These include depression, anxiety, substance-induced mood disorders, substance-induced psychotic disorders, impulse control problems and exacerbations of other mental health conditions. Additionally, problematic behaviors resulting from these and other substance related issues such as anger management problems can cause difficulties in all areas of one’s life. Untreated psychiatric problems may lead to a compromised standing in the family, community and one’s professional life due to impaired functioning, aggression, suicidality or legal consequences. For some, psychiatric hospitalization is an additional traumatic experience.
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