Understanding the link between trauma and substance use
When you live with both trauma and substance use, it can feel like you are fighting on two fronts at once. Trauma can change how your brain responds to stress, how safe you feel in your own body, and how you relate to other people. Substances can then become a way to cope with overwhelming emotions or memories that feel too intense to face.
Research shows that traumatic experiences such as abuse, violence, neglect, or the death of a loved one increase the risk of developing a substance use disorder because you may turn to alcohol or drugs to self‑medicate painful symptoms, including anxiety, depression, or PTSD flashbacks [1]. Adverse childhood experiences, often called ACEs, are especially powerful. Early experiences like physical or sexual abuse, neglect, or growing up in a home affected by addiction can alter brain development and make it harder to manage stress later in life [1].
If you feel like your trauma and substance use are tangled together, you are not imagining it. Integrated trauma and substance use treatment is specifically designed for situations like yours, so you do not have to choose which problem to work on first.
How trauma shapes your recovery journey
Trauma is not only what happened to you, it is also how your body and mind had to adapt in order to survive. Those adaptations can show up in your recovery in ways that are confusing or discouraging until you understand them.
You might notice some of the following:
- You use substances to escape distressing memories, nightmares, or intrusive thoughts
- You feel on edge, numb, disconnected, or constantly in “survival mode”
- You struggle to trust others, including counselors or peers in treatment
- You feel intense shame, guilt, or self‑blame about your past or your substance use
- You experience strong urges to use whenever you are stressed or reminded of past trauma
Studies indicate that nearly half of people with a substance use disorder report a history of physical or sexual abuse, and women report even higher rates. Childhood physical abuse increases the risk of later substance use disorder by about 74 percent and childhood sexual abuse by about 73 percent [1]. These numbers do not define you, but they do highlight why your recovery may feel more complex.
If you also live with PTSD, you are not alone. Approximately half of individuals seeking substance use disorder treatment meet criteria for PTSD, and people with co‑occurring PTSD and substance use tend to have more intense cravings and quicker relapse if trauma is not addressed in care [2]. Understanding this connection is a first step toward choosing trauma and substance use treatment that truly fits what you are going through.
Why integrated trauma and substance use treatment matters
Trying to treat addiction without addressing trauma can leave you feeling like you are always circling back to the same pain points. Many people can stop using for a period of time, only to relapse when old trauma is triggered again. This is not a moral failure. Experts emphasize that relapse often functions as an automatic stress reaction linked to trauma, not a lack of willpower or character [3].
Integrated trauma and substance use treatment recognizes that both conditions influence each other. You work on your mental health and substance use together, instead of in separate silos. This approach is often called dual diagnosis treatment or co-occurring disorder rehab.
A 2024 systematic review found that trauma‑informed approaches in substance use treatment are associated with:
- Reductions in substance use
- Decreases in mental health and trauma symptoms
- Better retention in treatment
- High satisfaction among both clients and staff
These findings came from multiple community and residential settings, which suggests that integrating trauma care into substance use treatment can be effective across different levels of care [4].
When your treatment team understands both trauma and addiction, they can:
- Screen for trauma and PTSD from the start
- Avoid approaches that might unintentionally retraumatize you
- Help you build safety and emotional regulation skills before digging into specific memories
- Coordinate medications and therapies so they support each other rather than conflict
This kind of integrated care gives you a more stable foundation for long‑term recovery.
What “trauma‑informed” care looks like in practice
You might see the phrase “trauma‑informed” a lot, but it is important to understand what it should mean for you in real life. A trauma‑informed program does not assume that everyone in treatment has trauma, but it recognizes that many people do and shapes every part of the environment with that in mind.
In a trauma‑informed substance use program, you can expect:
- A focus on physical and emotional safety, including clear rules, respectful communication, and predictable routines
- Choice and collaboration in your treatment plan so you are not pressured into topics or approaches before you are ready
- Staff training on how trauma shows up in behavior, so your reactions are not misread as “resistance” or “noncompliance”
- Sensitivity to triggers such as loud noises, unexpected touch, or graphic war stories in group settings
- An emphasis on your strengths, resilience, and survival skills rather than on what is “wrong” with you
Leadership in these settings plays a critical role in keeping trauma‑informed practices consistent across the whole organization. Applying formal trauma‑informed implementation frameworks can help sustain these changes over time [4].
If you are exploring mental health & addiction care, asking providers specific questions about how they integrate trauma‑informed principles can help you find a program where you feel safer and more understood.
Evidence‑based therapies that address both trauma and addiction
You deserve treatment that is grounded in research and tailored to your specific needs. Not every therapy works the same for every person, but several approaches have shown promise for people with both trauma and substance use disorders.
Prolonged Exposure (PE) and trauma‑focused therapies
Prolonged Exposure is a form of trauma therapy that helps you gradually approach traumatic memories and reminders in a safe, controlled way instead of avoiding them. Early concerns suggested that exposure therapies might worsen substance use, but research has not supported that fear.
In people with co‑occurring PTSD and substance use disorders, PE has been associated with large reductions in PTSD symptoms, up to about 72 percent at 6‑month follow up in some studies, without worsening substance use outcomes [2]. When combined with addiction treatment, trauma‑focused therapies like PE can help you process what happened while also building skills to stay sober.
Skills‑based approaches and Seeking Safety
Skills‑based therapies focus on helping you stabilize and manage symptoms in the present. Seeking Safety, for example, is a well‑known, non‑exposure treatment that emphasizes coping skills and psychoeducation for both PTSD and substance use.
Randomized trials suggest that Seeking Safety is often not significantly better than robust treatment as usual or other healthy living programs in reducing PTSD symptoms or substance use [2]. However, some people still find its focus on safety, grounding, and practical tools helpful as part of a broader treatment plan. Your team can help you decide which combination of therapies fits your situation.
Body‑based and holistic therapies
Because trauma can be stored not only in memory but also in the nervous system, many integrated programs include body‑oriented therapies such as:
- Trauma‑sensitive yoga
- Mindfulness and breathwork
- Somatic or body‑based therapies
Clinicians at Northwestern Medicine use approaches like trauma‑sensitive yoga and memory reconsolidation therapy to help patients release emotional pain held in the body and update traumatic memories without retraumatization [3]. These modalities can be powerful complements to more traditional talk therapies.
Medications and co‑occurring disorders
If you live with trauma symptoms, substance use, and possibly other mental health concerns like depression or anxiety, medications may also play a role in your treatment plan.
Medication research for co‑occurring PTSD and substance use is still developing. Studies have found, for example, that:
- Some antidepressants, such as sertraline, do not always outperform placebo for people with both PTSD and substance use disorders
- Medications like naltrexone and disulfiram can reduce drinking days and support abstinence in people with alcohol dependence and PTSD, although their impact on PTSD symptoms varies [2]
What this means for you is that medications can be very helpful, especially for cravings, mood, or anxiety, but they work best when combined with therapy and a comprehensive plan. In an integrated setting, prescribers coordinate closely with your therapists so that your medical and psychological care support each other.
If you are dealing with specific conditions like anxiety or depression along with addiction, you may benefit from specialized programs such as anxiety + addiction residential or depression and addiction therapy. These services are designed to manage both mood symptoms and substance use in a unified way.
The role of family and support systems
Healing from trauma and substance use rarely happens in isolation. Your relationships, past and present, are deeply connected to how you cope, how you trust, and how you experience safety.
Family therapy can be especially valuable in trauma and substance use treatment. SAMHSA highlights that family involvement can:
- Improve communication and reduce conflict
- Help family members understand trauma responses and addiction as health conditions, not moral failures
- Build a more supportive environment that reduces the risk of relapse [5]
When safe and appropriate, family sessions can help your loved ones learn how to support your recovery without controlling it. At the same time, your treatment team should always respect your boundaries, especially if your trauma involved family members.
Beyond family, peer support and community can make a significant difference. Many trauma‑informed programs emphasize group work that focuses on respect, confidentiality, and mutual encouragement, so you can share your story at your own pace with others who understand.
Healing from trauma and substance use is not about erasing your past. It is about reclaiming your present and building a future where you do not have to rely on substances just to get through the day.
What to look for in a trauma‑informed rehab program
Not every program that mentions trauma offers truly integrated care. As you explore co-occurring disorder rehab or mental health & addiction care, it can help to ask specific questions so you can find a setting that aligns with your needs.
You might ask potential programs:
- Do you routinely screen for trauma, PTSD, and other mental health conditions during intake?
- How do you integrate trauma treatment with substance use treatment, rather than treating them separately?
- What evidence‑based trauma therapies do you offer, such as Prolonged Exposure or other trauma‑focused treatments?
- How do you ensure the environment is trauma‑informed and physically and emotionally safe?
- Are staff trained regularly in trauma‑informed care and co‑occurring disorders?
- How are medications managed for clients with both mental health and substance use conditions?
- Do you offer family therapy or education for loved ones, when appropriate?
If you have specific diagnoses like PTSD, depression, or anxiety, ask directly how the program addresses those conditions within dual diagnosis treatment. You deserve clear, concrete answers, not vague reassurances.
Taking your next step toward help
Reaching out for help with both trauma and substance use can feel intimidating, especially if you have had negative experiences with treatment in the past. Finding a setting that understands the full picture of what you are dealing with can make a real difference in how safe and hopeful you feel about recovery.
If you are in the United States and are not sure where to start, you can contact SAMHSA’s National Helpline at 1‑800‑662‑HELP (4357). This is a free, confidential, 24/7 service in English and Spanish that connects individuals and families with local treatment facilities, support groups, and community resources for mental health and substance use concerns [5]. The helpline does not provide counseling, but it can help you locate programs that align with your needs and insurance status, including state‑funded options or facilities with sliding fee scales.
As you consider your options, remember:
- You are not “too complicated” or “too broken” because you live with both trauma and substance use
- Your symptoms are understandable responses to what you have been through
- Integrated trauma and substance use treatment is designed with your kind of story in mind
With the right combination of therapies, medical support, and a trauma‑informed environment, you can begin to reduce your reliance on substances, work through painful experiences at a pace that feels safe, and build a life that is no longer organized around survival alone.
References
- (NIDA)
- (NCBI – PMC)
- (Northwestern Medicine)
- (PubMed)
- (SAMHSA)
