Childhood Trauma and Addiction Treatment

It might seem obvious, given the prevalence of childhood trauma among addicts, that the recovery industry should be exceptionally trauma-sensitive. If half to two-thirds of substance abusers have histories of childhood trauma, then surely the institutions entrusted with their care should lead the way in developing techniques that, at the very least, do not exacerbate that damage. Unfortunately, many treatment centers stress confrontation, despite the fact that decades of research show that it produces only negative results.[1] It’s an article of faith in these communities that all addicts are “in denial” of the nature and severity of their problem and must be bullied into recognizing its full scope in order to have any chance of achieving lasting sobriety. A complementary view is that “hitting bottom” is necessary for recovery to begin, so strategies that make the addict feel lower, hence closer to this mythical bottom, are beneficial, a form of “tough love.” Often “the addict” is distinguished from “the person” to make confrontation more brutal while absolving participants of cruelty. Both “addict” and “person” are called “you,” though, so experientially there’s no distinction.

Confrontational techniques vary, but they all involve socially (and sometimes physically) isolating the addict and orchestrating accusations from counselors, family members, and other addicts. The addict is accused of lying, of minimizing her addiction and the depravity with which she maintains it. She must acknowledge faults she may or may not possess and admit actions she may or may not have committed. The fact that some addicts committed them means that she probably did, too—or will soon. She must not respond, except to endorse the accusations and express shame. To do anything else is to exhibit “defensiveness,” an additional fault and a warrant to redouble the accusations. If this description sounds like a description of emotional abuse, that’s because it is emotional abuse, and it retraumatizes survivors just when they are most vulnerable. Research proves conclusively that shaming, frightening, and humiliating addicts drives them further into their addictions. It not only makes recovery less likely in the short term but less likely overall, as the addict now associates treatment with trauma, rather than with healing.

Survivors of abuse who seek inpatient or outpatient treatment (and have some choice about where to go) should look for the designations “trauma-informed” and “trauma sensitive.” Some facilities treat trauma along with addiction, so these are also good choices, as are the few mindfulness-based programs. (Not surprisingly, some of these groups overlap). Outside of these programs, be careful; confrontation remains a staple of many treatment regimens. A facility’s promotional material usually doesn’t indicate whether it uses confrontation, but you can always ask by phone or email. If it does, even if it claims confrontation is “gentle,” find another facility. At the very least, it means the facility is not keeping up with current research in addiction treatment, another serious problem in the recovery industry.

The obvious next question is: do you need a formal treatment program at all? That depends. Many find it helpful, especially those with longstanding addictions. At the same time, there’s plenty of research demonstrating that people can overcome even quite serious addictions on their own. I do, however, think that every addict needs support, and here options are proliferating, starting with twelve-step programs for a host of addictions, including Buddhist and meditation-based groups. A good secular option is SMART recovery (I don’t recommend Rational Recovery, which regards addiction as self-indulgence). And there are more online groups than I can count, some associated with real-world organizations such as A.A. and some on internet forums such as Reddit. In all of these groups, real-world or on-line, look for a culture of empathy. Empathy, not confrontation, is what helps survivors of childhood trauma deal with their addictions.

One thing I must say before we leave the topic of treatment is that anyone with a serious addiction to alcohol, a barbiturate, or a benzodiazepine such as Xanax or Valium should be under a under a doctor’s care while in acute withdrawal. Detoxification from long-term use of sedatives—and alcohol is a sedative—can kill. With other drugs, use your judgment about whether your detoxification should be medically managed, but, when in doubt, err on the side of caution. Withdrawal is not only unpleasant but also potentially neurotoxic, so protect your brain by getting a doctor’s help if you need it.

[1] A 2007 article observes, “Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations.” William L. White and William R. Miller, “The Use of Confrontation in Addiction Treatment: History, Science, and Time for Change,” Counselor, 2007, 8(4), 12-30.

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