Trauma and addiction: Understanding the connection

The complex relationship between trauma and addiction

For many people who enter addiction treatment, substance use didn’t begin as recreation. Instead, substances became a way of coping with pain, fear, shame, or memories that felt impossible to live with any other way. 

If that sounds familiar, it’s worth knowing that this pattern is one of the most common things we see in addiction treatment. At Houghton House, the vast majority of people who come to us with mood or anxiety disorders alongside addiction have also experienced developmental trauma. 

Treating the addiction without addressing that trauma tends to produce short-lived results. For long-term recovery, we need to address the underlying trauma alongside the addiction.

What is trauma, and how does it connect to addiction?

Trauma is the lasting emotional and psychological response to events that overwhelm a person’s ability to cope. The severity of the trauma is defined more by the impact of the event than by the event itself. The same experience can be deeply traumatic for one person and far less so for another, depending on factors including:

• Their age at the time
• Whether they had support around them
• Their previous experiences
• Their individual biology and nervous system

Trauma responses vary widely. In the short term, they include emotional numbing, hypervigilance, intrusive thoughts, and difficulty managing emotions. 

For some people, these responses fade over time. For others, they persist and develop into post-traumatic stress disorder (PTSD), depression, anxiety, or other mental health conditions.

The link between trauma and addiction runs through the brain’s stress and reward systems. Substance abuse and compulsive behaviours can temporarily quiet the symptoms of unresolved trauma: numbing emotional pain, reducing hyperarousal, helping with sleep, or simply offering relief from a state of chronic distress. But over time, what starts as self-medication becomes a dependency.

Adverse childhood experiences and addiction risk

Some of the strongest evidence linking trauma to addiction comes from research on Adverse Childhood Experiences (ACEs). The ACE framework was developed through a large study in the United States in the 1990s and has since been replicated across many countries. ACEs include:

• Physical, emotional, or sexual abuse
• Neglect
• Witnessing domestic violence
• Growing up with a parent who had a mental illness or substance use disorder
• Parental separation, divorce, or incarceration
• Suffering the loss (death) of a parent

The relationship between ACEs and addiction is dose-dependent: the more adverse childhood experiences a person has had, the higher their risk of developing a substance use disorder as an adult. 

A 2023 systematic review in the Journal of Multidisciplinary Healthcare found that among patients with addiction problems, the rates of having experienced at least one ACE ranged from 85.4% to 100%.

This doesn’t mean that everyone with a difficult childhood will develop an addiction. Nor does it mean that everyone with an addiction had a difficult childhood. 

What it does mean is that early adverse experiences significantly raise the risk, and effective addiction treatment takes that history seriously.

PTSD and addiction: A common dual diagnosis

Post-traumatic stress disorder and substance use disorder frequently co-occur. Research into the comorbidity of PTSD and substance use disorders (SUD) found that among individuals seeking treatment for SUDs, 30-50% meet the criteria for chronic PTSD. Additionally, individuals with PTSD are 4–5 times more likely to have a substance use disorder.

The relationship runs in both directions. PTSD raises the risk of developing a substance use disorder, often through self-medication. Substance use, in turn, can worsen PTSD symptoms, impair the processing of traumatic memories, and increase exposure to further traumatic events.

Each condition can feed and maintain the other. This is why treating them separately, or focusing on one while ignoring the other, rarely leads to lasting recovery.

How trauma changes the brain

Trauma not only affects how a person feels; traumatic experiences produce measurable changes in brain structure and function. These changes help explain why people with a trauma history are more vulnerable to addiction, and why recovery is harder without addressing it.

Key areas affected include:

• The amygdala — which controls threat detection and response — becomes overactive, producing stronger fear responses and emotional reactivity
• The prefrontal cortex — which handles rational decision-making and impulse control — becomes less effective at regulating emotions
• The hippocampus — which is central to memory consolidation — may shrink under chronic stress, affecting how you store and recall traumatic memories
• The hypothalamic-pituitary-adrenal (HPA) axis — the body’s stress response system — can become dysregulated, leading to persistently elevated stress hormones like cortisol

Substances and addictive behaviours can temporarily calm these systems, which is a big part of why they feel so compelling to someone living with unresolved trauma. This also helps explain why willpower alone is rarely enough for long-term recovery, and why trauma needs proper clinical attention.

Trauma-informed addiction treatment: what it means in practice

Trauma-informed care is a treatment approach that shapes every aspect of treatment around an awareness of trauma and its effects. 

A trauma-informed approach doesn’t require that every patient have a formal trauma diagnosis. Rather, it means that the treatment environment, assessment processes, and therapeutic relationships are carefully designed to avoid re-traumatisation. Trauma-informed treatment actively supports the patient’s sense of safety, choice, and control.                       

In practical terms, trauma-informed addiction treatment involves:

• Assessing trauma history as a standard part of the intake process
• Treating co-occurring PTSD and addiction at the same time, not one after the other
• Using therapies designed to help patients process traumatic memories
• Maintaining a treatment environment that feels safe, both physically and psychologically
• Training clinical staff to recognise trauma responses and respond without judgement

Therapeutic approaches for trauma and addiction

Several evidence-based therapies are effective for co-occurring trauma and addiction. Most treatment programmes use a combination of therapy modalities tailored to the individual’s needs.

Trauma-focused CBT

Developed specifically for people dealing with the psychological effects of trauma, trauma-focused CBT (TF-CBT) is an adapted form of cognitive behavioural therapy (CBT). Standard CBT works by helping you identify and change unhelpful thought patterns.

TF-CBT adds a structured focus on the negative beliefs and interpretations that trauma leaves behind: that the world is inherently dangerous, that you are somehow to blame for what happened, or that you are permanently changed by it. 

Left unchallenged, these beliefs can shape behaviour long after the traumatic event itself.

In a TF-CBT programme, therapy typically moves through three phases: 

1. Building coping skills and stabilising distress
2. Carefully processing the traumatic memories in a safe therapeutic environment
3. Integrating what you’ve learned so you can move forward 

In addiction treatment, this process is particularly valuable for breaking the link between traumatic memories and the urge to use. When a smell, a place, or a feeling no longer triggers an uncontrollable chain reaction, the need to reach for a substance to manage that reaction starts to lose its grip.

EMDR 

Eye movement desensitisation and reprocessing (EMDR) is a therapy modality developed by psychologist Francine Shapiro in the late 1980s. 

In an EMDR session, a therapist guides you through recalling distressing memories while following a series of guided eye movements. The theory behind EMDR is that traumatic memories can get stuck in the nervous system in an unprocessed state. This is why memories can feel as vivid and distressing years later as when you experienced the traumatic event. 

EMDR’s bilateral stimulation appears to activate the brain’s natural memory-processing mechanisms — similar to what happens during REM sleep — allowing those memories to be integrated rather than repeatedly re-experienced.

In the context of addiction, this is particularly relevant because unprocessed trauma memories are often key triggers for substance use. As those memories lose their emotional charge, the urge to reach for something to manage the distress tends to weaken. 

EMDR has a strong evidence base for treating PTSD and receives the highest recommendation in current clinical guidelines. 

Somatic therapies

Somatic therapies are based on the understanding that trauma isn’t only stored in the mind but also held in the body. People who have experienced trauma often carry it as chronic physical tension, unexplained pain, or a nervous system that seems permanently stuck in a state of high alert. 

Conventional talk therapies can struggle to reach this layer of experience, because the body’s response to trauma operates below the level of conscious thought.

Developed by Dr. Peter Levine, Somatic Experiencing is an approach that helps you gradually tune into your physical sensations in a controlled way. Rather than diving directly into traumatic memories, Somatic Experiencing focuses on the body’s felt senses. It teaches you to notice where your tension lives, how it shifts, and how to gently guide your nervous system back towards a state of calm. 

Over time, this builds what therapists call a wider “window of tolerance”: the ability to experience difficult emotions and sensations without becoming overwhelmed or shutting down. 

In addiction treatment, this expanded capacity for tolerating discomfort is central to recovery, since the impulse to use is often a response to overwhelm.

Dialectical behaviour therapy (DBT)

Developed by psychologist Marsha Linehan, dialectical behaviour therapy (DBT) is built around a core tension: learning to accept yourself as you are, while also committing to change. The word “dialectical” refers to this balance between acceptance and transformation. 

Linehan originally developed DBT for people with borderline personality disorder, many of whom had significant histories of trauma. DBT has since been widely adopted in addiction treatment.

DBT teaches practical skills across four areas: 

• Mindfulness – noticing thoughts and urges without immediately acting on them 
• Distress tolerance – getting through a difficult moment without making things worse 
• Emotional regulation – understanding and managing intense feelings
• Interpersonal effectiveness – maintaining healthy relationships without putting recovery at risk 

For people whose trauma has left them with a hair-trigger emotional response, these skills offer something concrete and learnable. Rather than waiting to feel better, DBT gives you tools to act differently even when the feelings are overwhelming.

Houghton House’s approach to trauma and addiction

At Houghton House, every patient undergoes a comprehensive intake evaluation that includes a full assessment of trauma history, using validated clinical tools like the Hamilton Anxiety Rating Scale. 

Because Houghton House is a fully licensed psychiatric hospital with on-site medical and psychiatric staff, co-occurring trauma and mental health conditions get clinical attention within the same programme. There’s no need for separate referrals or waiting to address one thing at a time.

When we treat trauma and addiction together, outcomes are substantially better than when we treat either in isolation. That’s why dual diagnosis treatment forms the basis of how we work.

Frequently asked questions about trauma and addiction

Does everyone with an addiction have a history of trauma?

Not necessarily, but the overlap is substantial. Research consistently shows that adverse childhood experiences and adult trauma significantly raise the risk of developing a substance use disorder, and most people who seek addiction treatment do have some trauma history.

Can addiction treatment work if you don’t address the trauma?

Unlikely. While addiction treatment alone can produce short-term results, long-term recovery is much harder without it. Unresolved trauma is one of the most common drivers of relapse. Any treatment plan that doesn’t factor in trauma is working with an incomplete picture.

What is EMDR, and is it available at Houghton House?

EMDR is an evidence-based therapy that uses guided bilateral stimulation to help patients process distressing memories. Speak to our team about which therapeutic approaches are available as part of your or your loved one’s treatment plan.

Is trauma treatment available through medical aid?

Yes, Houghton House offers treatment for trauma, and medical aid will cover it if it co-occurs with specific conditions, including depression and bipolar disorder. Because we’re a fully licensed psychiatric hospital, our patients can claim from medical aid for a broader range of services than at a standard rehab centre. We also typically waive copayments if medical aid schemes only partially cover a patient’s treatment. Contact us to find out what your specific plan covers — we handle pre-authorisation for you.

 

Get help for trauma and addiction at Houghton House

If you’re living with the effects of trauma alongside an addiction — or trying to support someone you love who is — you can get integrated treatment that addresses both at Houghton House. 

Our clinical team includes psychiatrists, psychologists, and addiction counsellors with experience in trauma-informed care, all working together within a single rehabilitation programme designed to give you back control over your life.

Call us at +27 11 787 9142 or fill in the contact form on our website.