Alcohol and drug use are not uncommon in people who have suffered tragic losses and traumatic events. In one 2010 study, a sample of 587 patients with traumatic childhood events was found to abuse cannabis (44.8%), alcohol (39%), cocaine (34.1%) and heroin/opiates (6.3%).[i] It is understandable to try to ease one’s pain by numbing it with alcohol or drugs like cannabis, cocaine, and opiates. Post-traumatic stress disorder (PTSD) and grief can be very upsetting and painful experiences and may involve reliving the traumatic experience or loss repeatedly, leaving a person to feel out of control and miserable. However, one of the many downfalls of self-medicating one’s psychological distress is that it never gets fully resolved because it is always avoided and shelved for a later time. Unfortunately, that later time never seems to come, unless a person has a crisis and is forced to get treatment because of their behavior. For example, people who store their pain and ignore it until they can’t stand it any longer can do self-destructive things like self-mutilation and suicide, or become so intoxicated that they have to be hospitalized or go to a rehabilitation facility. At that point, the person might be willing to give up their substance of choice and learn some new coping skills. However, even then, some people are not ready to stop and abstain completely.
When many people think of trauma, they think of veterans and people in the military. Indeed, there is a high prevalence of both PTSD and substance abuse in veterans[ii], but there are traumatic events that are not related to combat as well. Sexual and physical abuse, neglect, and emotional abuse in childhood can leave emotional scars on people that is tempting to dim with alcohol or drugs. Domestic violence, moving vehicle accidents, extremely contentious divorce, and being bullied as a child can also lead to post-traumatic stress.
Some of the things that people use alcohol and drugs for when they have PTSD or experience a traumatic loss are
- Distraction from the disturbing stimulus
- Decreasing anxiety
- Decreasing the intensity of reliving the trauma through intrusive thoughts, body sensations or memories
- Being able to be amongst people without being hypervigilant
- Managing their energy levels
- Being able to sleep at night
Many people are using drugs or alcohol to soothe themselves and try to function better in life. Wanting to change all these things is a positive sign of self-love in a person. However, alcohol and drugs only temporarily take care of these important psychological and behavioral functions. They are not a long-term solution.
I respect the pain that my clients suffer and understand that the coping skills they use when they come to see me are the best they could come up with so far. However, I also think that if we’re going to work effectively together, they need to be open to trying healthier ways to cope and to resolve the trauma or loss so it doesn’t keep bothering them. I find that letting go of drug or alcohol use, while difficult at first, makes it easier for them to make good decisions about managing their mental health symptoms. When a person is numbing their pain with drugs or alcohol, the exposure part of therapy can’t really happen, so that the person can’t learn to tolerate painful feelings and thoughts, and change their response to that. It can be a vicious cycle whereby the person avoids and avoids, never feeling ready or capable of confronting the pain, so the pain remains buried longer and longer. This makes it less and less desirable to face the music, so to speak, and the person who is actively trying to block the pain ironically lives with it longer. They often make the people in their lives unhappy in the process too, since there are many things the person cannot face, talk about or do because of their avoidance.
Dialectical Behavioral Therapy (DBT), developed by Dr. Marsha Linehan, can be useful in developing skills to tolerate negative feelings and thoughts. It is a combination of Cognitive-Behavioral Therapy (CBT) and uses Eastern principles such as mindfulness to learn to be with one’s pain while being able to observe it and make good decisions about how to respond to it. By gradually becoming aware of and tolerant of one’s internal experience, through awareness of thoughts, feelings, and body sensations, a person can build resilience to the changing tides that cross their mind/body. That resilience makes it easier to do the work of resolving trauma and traumatic loss.
If you are interested in learning about these methods, please give me a call at 661-233-6771. If you need help in becoming sober, I recommend that you use AA/NA to assist you in sobriety.
[i] Khoury, L., Tang, Y., Bradley, B., Cubells, J. and Ressler, K. (2010). Substance abuse, Depression and Anxiety, 27(12): 1077-1086.
[ii] Meisler, A. (1996). Trauma, PTSD and Substance abuse. The National Center for Post-traumatic Stress Disorder PTSD Research Quarterly, 7(4): 1-3