Therapy for Trauma and Alcohol Addiction Recovery Outcomes

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Treatment for an alcohol use disorder includes therapies to address all factors related to why someone began misusing alcohol or continued to use it. Physical, psychological, environmental, and social factors may play a role. Trauma is another major factor.¹Trauma therapies help a person heal from the emotional, psychological, and behavioral responses to trauma and alcohol addiction.¹

Trauma Explained

Trauma occurs after exposure to an incident or situation that is so distressing and overwhelming it affects the person’s ability to cope emotionally. Traumas can occur at any time in a person’s life, as a child or an adult.²

In a study of over 70,000 participants, 70% reported experiencing a traumatic event at some point in their lives. Traumas may be verbal, sexual, and physical mistreatment. Traumas may also include:²

Accidents or injuries
War-related events
The death of a loved one
Witnessing a loved one experience a trauma

You can experience trauma firsthand or indirectly when you are exposed to it repeatedly as it happens to someone else.

“Big T” and “Small T” Types of Traumas

Traumas have been categorized into “big T” and “small t” to help define and assess life experiences. This does not mean “small t” traumas aren’t as significant; all traumas impact how you function emotionally.

The main difference is whether the trauma is life-threatening. People with “big T” traumas have usually survived a major event. Examples of “big T” traumas include:³

Hurricanes, tornadoes, wildfires, floods, and other natural disasters
Cancer, heart attacks, strokes, and other life-threatening illnesses
War combat, concentration camps, or terrorist attacks
Assaults involving abuse or exposure to abuse of any kind, robbery, and unexpected attacks or assault
Major accidents in your car, on the job, at home, or in the community

“Small t” traumas are not life-threatening but can change the way you process emotion. They may include:³

Divorce or parents’ divorce
Loss of a loved one
Breakup of a relationship
Ongoing financial stress
Constant abuse in relationships that is either verbal, physical, or sexual
Relocating to a new home in a new culture
Legal troubles
Being bullied
Living with someone who has a mental health disorder or substance use disorder, or both

“Big T” and “small t” traumas can occur at any time and to anyone. Mental health professionals also recognize the impact of the same or similar traumas happening repeatedly over time—such as in the case of bullying or protracted legal proceedings.

A “small T” trauma can also follow a life-threatening trauma and act as a trigger for an emotional downturn. For example, someone may survive a natural disaster and appear to cope well, but may experience a relationship break that seems to devastate them. Both traumas can affect emotional regulation, increase difficulty concentrating, cause memory issues, and alter sensations in the mind and body.³

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Trauma and Alcohol Misuse

Individuals who have experienced trauma have a high rate of alcohol misuse. Three-quarters of those who survive abuse or violent traumas and one-third of those who experience accidents, illnesses, or disasters misuse alcohol. Individuals with post-traumatic stress disorder (PTSD) are also more than two times more likely to misuse alcohol than those who do not survive a trauma.⁴

Different types of traumas can lead to the development of an alcohol use disorder (AUD). Theories supporting this include the development of alcohol misuse as a coping mechanism, either as a form of self-medication or to manage the distressing symptoms of trauma.⁵

Some traumas occur after a person begins misusing alcohol. Early substance misuse as a child or teen, or exposure to substance misuse behaviors by an adult in your home of origin, can be a trauma. Both substance use during early neurological development and observed patterns of substance misuse alter the structure of the brain.⁶

When to Get Trauma Therapy

Without effective treatment, the effects of both unprocessed trauma and alcohol use disorder are considered progressive–that is, both trauma and alcohol use disorder not only affect how you function today, but are likely to affect your ability to function in multiple areas of life in the future as well.

You can seek trauma therapy at any time. Because the brain’s response to trauma can lead to both acute and chronic symptoms, early intervention can minimize, eliminate, or prevent some of the symptoms you may experience due to trauma.⁷

Even if you are not ready to enter alcohol addiction treatment, you can still receive treatment for trauma. Trauma therapies are often a part of a more extensive treatment plan. Some people receive trauma therapies while in a treatment program for other mental health or substance use disorders. Some receive trauma therapy on an outpatient basis in an aftercare program following rehab.

Signs You May Need Trauma Therapy

Signs of trauma can be mental, behavioral, or physical. If you have experienced trauma, avoid automatically attributing symptoms you experience to everyday stressors. Some symptoms may be tied to your traumatic history and indicate that you would benefit from tools, resources, and support to cope with that trauma. These signs may include:⁷

Sleep disturbances such as insomnia, nightmares, or oversleeping
Feeling on edge most of the time, like you cannot relax
Difficulty regulating emotions, such as becoming angry or agitated quickly, being easily startled, or going from feeling happy to upset in a short period of time
Having anxiety when there is no apparent reason for feeling uneasy or nervous
Having flashbacks of the trauma, or reliving some part of the traumatic experience as if it is currently happening (e.g., smelling a scent that is not actually present or feeling a memory of pain as if you have that injury now)
Disassociating, or disconnecting from reality in some way (e.g., feeling as if you are watching events happen to yourself or losing your sense of time or location)
Avoiding people, places, or things that remind you of the trauma, even if you cannot articulate why or in what way you find them distressing
Using alcohol or other mind-altering substances to manage these or other symptoms that affect your ability to interact with others, perform daily living activities, and fulfill your responsibilities

A trauma specialist can assess your current symptoms to determine if you would benefit from trauma therapy.

Common Types of Trauma Therapy

Various types of trauma therapy exist to meet the needs of individuals with very different traumas and substance use disorders.⁸ There are several common types of trauma therapies that support alcohol use disorder recovery.

Prolonged Exposure

Prolonged exposure therapy assists those who have chronic or long-term symptoms of trauma. It is a form of cognitive-behavioral therapy (CBT) and involves gradually reducing how sensitive you are to the trauma.

Treatment consists of exposure to reminders of the trauma in a safe, controlled environment with a behavioral therapist who specializes in prolonged exposure therapy. The more exposure you have in an environment where you can control your interaction with the triggering item, idea, or imagery, the more empowered you are to see the trauma as less threatening to your present self and less fear-inducing.⁹

Seeking Safety

Seeking safety is another CBT-based trauma therapy. This therapy was developed for co-occurring disorders and can be provided at any level of treatment. It teaches you how to seek protection and get out of traumatic situations. Seeking safety is an educational therapy that teaches skills like taking back your power, setting boundaries, and self-care.¹⁰

Transcend

Transcend is a form of CBT that is best used in co-occurring disorder treatments. It typically occurs in a partial hospitalization program and helps you learn how to regulate emotions by restructuring traumatic memories. Transcend works well in combination with other therapies.⁸

Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing (EMDR) is psychotherapy that a certified EMDR specialist performs. The specialist uses this treatment, which often shows rapid results, to help you recall painful events and then redirect them. By reprocessing the trauma, you become desensitized to it.¹¹

You recall a traumatic event while engaged in a type of bilateral stimulation—usually eye movements like watching an object that moves from one side of your field of vision to the other. EMDR is believed to accelerate an individual’s own emotional and intellectual processes to help them intentionally change their automatic and internal associations with the trauma.¹¹

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a method in which the therapist works with you to change negative thought patterns to more positive ones. Doing so will lead to positive behaviors. Practicing mindfulness-based activities, emotion regulation skills, and other tactics help those with a wide range of issues, including suicidal ideation and substance misuse.¹²

Treatment Programs for Trauma and Alcohol Use Disorder

When you start searching for a treatment program for trauma and alcohol use disorder, look for integrative care that includes the following.¹³

Multi-Level Treatment Options

Medical detoxification—Medically supervised detox is used if medicine is required to alleviate withdrawal symptoms associated with alcohol misuse.
Inpatient rehabilitation—Inpatient or residential rehab is where you can receive trauma-focused treatment, including continued medication detox, while living in a treatment facility.
Partial hospitalization program (PHP)—PHPs provide six or more hours a day, or 20 or more hours a week, of individual and group education and therapy. You are able to stay home on nights and weekends in this program and family therapy sessions are often available.
Intensive outpatient program (IOP)—IOPs offer 10–20 hours of treatment a week. Like with PHP, you are able to stay home on nights and weekends and have the option of family therapy sessions.
Outpatient counseling—Outpatient services occur once or twice a week with just you and a counselor. Family therapy can take place in individual counseling if it is appropriate.
12-step group participation—Peer support groups include 12-step groups for alcohol use disorder and community support groups for trauma. Peer support is an essential resource in recovery.

Qualified Treatment Staff

Treatment team staff for trauma, alcohol misuse, or both must have training beyond their initial degrees in the field of substance use, trauma-focused therapies, and co-occurring disorders. Most specialized staff will hold certificates or continuing education credits reflecting additional training in this field.¹³

Evidence-Based Treatment Modalities for Trauma and Alcohol Use Disorder

Aside from the trauma therapies mentioned, treatment teams should provide traditional and alternative methods of healing co-occurring disorders. Examples may include:¹⁴

Cognitive-behavioral therapies and all subtypes that are available in group and individual settings
Education on how trauma and alcohol affect the brain and the body
Education for family members on trauma and alcohol use disorder
Creative therapies that involve art, equine or animal therapy, music, writing, exercise, and more
Early recovery skill-building
Relapse prevention skill-building
Medication management if necessary
Aftercare planning

If you have experienced trauma, you can learn how to overcome the symptoms impacting your daily life, including how to replace alcohol misuse with new coping skills. Treatment is available for trauma and alcohol misuse.

You can find an alcohol addiction treatment center today by calling 800-948-8417 Who Answers? , available 24/7.

Resources:

Center for Substance Abuse Treatment (2014). Understanding the Impact of Trauma. Treatment Improvement Protocol (TIP) Series, No. 57. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
Kleber R. J. (2019). Trauma and Public Mental Health: A Focused Review. Frontiers in psychiatry, 10, 451.
The University of New York, University at Buffalo Social Work. (2013, December 04). EMDR Rapid Healing of small “t” and big “T” trauma.
gov: Veterans Affairs. (2019). PTSD and Problems with Alcohol Use.
Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and anxiety, 35(9), 851–860.
Parolin, M., Simonelli, A., Mapelli, D., Sacco, M., & Cristofalo, P.. (2016). Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early. Frontiers in psychology, 7, 887.
National Institute of Health News in Health. (2018). Dealing with Trauma: Recovering From Frightening Events.
Flanagan, J. C., Korte, K., Killeen, T., & Back, S. (2016). Concurrent Treatment of Substance Use and PTSD. Current psychiatry reports, 18(8), 70.
Markowitz, S., & Fanselow, M. (2020). Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment. Brain sciences, 10(3), 167.
Substance Abuse and Mental Health Services Administration. (2020).
Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D., & Kiernan, M.. (2018). The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder-A Systematic Narrative Review. Frontiers in psychology, 9, 923.
Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont (Pa.: Township)), 3(9), 62-68.
Center for Substance Abuse Treatment. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series, No. 42. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
Wahbeh, H., Senders, A., Neuendorf, M.S., & Cayton, J. (2014). Complementary and Alternative Medicine for Posttraumatic Stress Disorder Symptoms: A Systematic Review. Journal of Evidence-Based complementary & alternative medicine, 19(3), 161-175.