Substance Abuse Issues:
“The process of learning how to stay sober and abstinent in a state of psychophysiological dysregulation is a process that brings with it a powerful sense of mastery, of triumph over what once felt impossible. The survivor may have been helpless to prevent what happened in the past, but she is not helpless when it comes to forging a healthy present” – by Janina Fisher (Addictions & Trauma Recovery, 2000).
Do you relate to the following?
- Have you struggled in your substance abuse recovery with ‘emotional sobriety’ leading to relapses when ‘triggered’?
- Have your trauma symptoms related to anxiety or depression worsened once you stopped drinking alcohol?
- Do you feel ‘outside help’ is needed to support you in your 12 Step Recovery program in order to continue to stay sober or bring your recovery to the next level?
One of the core effects of trauma and unprocessed emotional wounds is the interference with the ability to self-regulate emotionally, psychologically, and somatically. Psychological development then becomes mired with defensive and protective strategies in an attempt to prevent further injury and to keep from being emotionally flooded.
There are both proactive and reactive coping strategies that emerge to serve a protective function. Substance abuse may be viewed as a reactive compensatory survival strategy to numb or distance from the emotional pain when it gets activated. In the recovery process it’s important to appreciate the adaptive value that alcohol or substances may have served to manage trauma symptoms in order to then find alternative strategies. And, when there is more healing from the core wounds there is less need for self-medication to produce numbing effects.
From the Addictions and Recovery model that I work from, the first premise asserts that addictive behavior begins as a survival strategy; as a way to self-medicate, dampen painful feelings, wall off intrusive memories, self-soothe, increase hypervigilance, or combat anxiety and depression. The addiction later results as the psychoactive substances require continued increased dosages and amounts to maintain the same effect or to ward off the physical and emotional withdrawal. The substance use gradually acquires a life of its own where it increasingly becomes more disruptive to one’s functioning until it is a greater threat to the individual than the symptoms it attempts to keep at bay.
There is a high correlation between individuals with childhood emotional wounding and substance use problems. In my practice, I specialize in working with women who have used alcohol as a way to cope with emotional pain. In the work we start to understand which trauma symptoms she has been attempting to treat through drinking. That is, what functions has the alcohol served to cope with trauma? Often these symptoms will be exacerbated once she becomes sober. There is an appreciation for the ways this served a protective function to survive so that a sense of compassion develops. This can then counteract guilt or shame that is so often a byproduct of an addiction and trauma history.
A hyperarousal symptom that is often the most problematic and destabilizing for one in early sobriety is what are termed ‘emotional flashbacks’. These are sudden and painful regressions to a feeling state in one’s childhood but it’s not linked to any narrative memory. Rather, it’s held in the body and emotions. Once it is triggered it tends to run its course and one often feels helpless to control it from overwhelming and flooding her. This is when the individual is extremely vulnerable to reaching for alcohol or a chemical barrier to induce a numbing effect even if there has been some sustained sobriety.
One of the often overlooked aspects of substance abuse to control one’s trauma symptoms is that she does not have to depend on anyone: “she did not need to trust or to ask for help or feel needy or abandoned when help is not forthcoming” (Janina Fisher, 2000). She was in control in this way. In the recovery from alcohol abuse there needs to be a sense of regaining mastery over her symptoms through the acquisition of new skills and inner and outer resources. And, healing the core emotional wounding, in turn, mitigates the reaching for alcohol or other substances to self-medicate, numb, or cope.
AA (Alcoholics Anonymous) views alcoholism as a disease and asserts that only a spiritual experience with a Power greater than oneself can bring about inner and outer changes in recovery. The disease is believed to be progressive. Recovery is the “high road to a new freedom.” It asserts that more than human power is needed to bring about the “psychic change.” While this particular 12 Step program is not for everyone with an alcohol problem, it may be of tremendous support and value to some in the recovery journey. And, there are several other community based recovery support groups which I have listed on the Substance Abuse Resource page.
The 12 Steps for Recovery
Step 1: We admitted that we were powerless over alcohol – that our lives had become unmanageable.
Step 2: Came to believe that a Power greater than ourselves could restore us to sanity (wholeness).
Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him.
Step 4: Made a searching and fearless moral inventory of ourselves.
Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Step 6: Were entirely ready to have God remove all these defects of character.
Step 7: Humbly asked Him to remove our shortcomings.
Step 8: Made a list of all persons we had harmed, and became willing to make amends to them all.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others.
Step 10: Continued to take personal inventory and when we were wrong promptly admitted it.
Step 11: Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Step 12: Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
In the Big Book of AA it is stated in the chapter entitled, The Keys of the Kingdom, “In learning to practice these steps in my daily living, I began to acquire faith and a philosophy to live by. Whole new vistas were opened up for me…It is a way of life…a program for living that allows for limitless expansion” (page 275).
Self-Assessment Questionnaire to determine a Substance Use Disorder with Alcohol:
The following questionnaire is based on the DSM-5 (Diagnostic and Statistical Manual of Substance Use Disorders). The list of behavioral symptoms has been compiled by psychiatrists, psychologists, and addiction treatment specialists to give mental health professionals a standard by which to diagnose substance use disorders like alcoholism.
Answer ‘yes’ or ‘no’ to the following questions –
(1). Do I regularly drink more than I plan to?
(2). Have I been unsuccessful at quitting before?
(3). Has my drinking interfered in my personal relationships?
(4). Do I spend a lot of time seeking opportunities to drink, drinking, or dealing with hangovers?
(5). Does my drinking or the aftereffects of drinking keep me from my responsibilities?
(6). Do I prefer drinking over other activities I used to enjoy?
(7). Is my drinking causing health problems and do I keep doing it anyway?
(8). Do I drink in risky situations?
(9). Have the effects of drinking alcohol diminished over time or is more alcohol required to have the same effect as before?
(10). Do I have cravings or urges to drink alcohol?
(11). If I stop drinking, do I experience uncomfortable physical and mental symptoms?
Add up the ‘yes’ answers.
2-3: A mild substance use disorder could be diagnosed.
4-5: This indicates a moderate substance use disorder.
6 or more: Addiction or another type of severe substance use disorder is likely.
*If only a few answers are ‘yes’ this doesn’t necessarily mean there isn’t a problem.
While you may have identified that there is a problem with alcohol for you, there is hope and a pathway to recovery that leads to freedom.