Understanding the Link Between Trauma and Substance Abuse

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Published on August 21, 2023

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Depressed woman drinking a glass of beer — Robert Essel NYC / Getty Images

Language Note

Substance use professionals have moved away from terms like “substance abuse” and refer instead to “substance dependence,” as the term “abuse” is considered blaming and stigmatizing. The diagnostic term for substance use and dependence that interfere with functioning is “substance use disorder.” This article refers to “substance dependence” rather than “abuse” due to this stigma.

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 and substance use and dependence.

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
Witnessing the event as it happens to someone else
Learning of a traumatic event happening to a close friend or family member
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 or 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) are events that occur between birth and age 17 that 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 issues with substance use and dependence.

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 as a way to regulate unpleasant moods brought on by trauma symptoms. The substances may provide comfort and positive emotions. Essentially, substance use can be a form of self-medication following a trauma or series of traumatic events.

Following trauma or 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

Substance dependence and substance use issues can manifest in many different ways depending on the individual. 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.
The 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 of the substance to have the same effect.
Withdrawal when not using the substance.

If you notice an increase in your 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. If you 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 be a sign that your substance use is related to trauma.

How to Get Help

If you struggle with your 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 difficult 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 out providers with expertise in treating substance dependence and substance use disorders. In addition, search for providers who have training and expertise in treating trauma and providing trauma-informed care.

Some survivors of trauma and those who struggle with their 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.

If you or a loved one are struggling with substance use, addiction, and/or trauma, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Dass-Brailsford P, Myrick AC. Psychological trauma and substance abuse: the need for an integrated approach. Trauma, Violence, & Abuse. 2010;11(4):202-213.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-5-TR. American Psychiatric Association Publishing; 2022.
Centers for Disease Control and Prevention. What Are Adverse Childhood Experiences?
Khoury L, Tang YL, Bradley B, Cubells JF, Ressler KJ. Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress Anxiety. 2010;27(12):1077-1086.
Weber K, Rockstroh B, Borgelt J, et al. Stress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry. 2008;8(1):63.
Sippel L, Pietrzak R, Charney D, Mayes L, Southwick S. How does social support enhance resilience in the trauma-exposed individual? Ecology and Society. 2015;20(4).

By 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. She is certified in TF-CBT and telemental health.

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