What is the connection between trauma, PTSD, and addiction?
Trauma and addiction are biologically and behaviorally interconnected through shared neurological pathways. The relationship operates through multiple mechanisms:
- Self-medication: Individuals with PTSD use substances to manage intrusive memories (opioids for emotional numbing), hyperarousal (alcohol and benzodiazepines for sedation), sleep disturbances (alcohol, cannabis), and emotional pain (all substances). An estimated 46.4% of individuals with lifetime PTSD also meet criteria for a substance use disorder.
- Neurobiological overlap: Trauma and addiction both involve dysregulation of the HPA (hypothalamic-pituitary-adrenal) axis, altered cortisol response, amygdala hyperreactivity, and prefrontal cortex dysfunction. Chronic trauma exposure produces the same neuroadaptations in stress circuitry that addiction produces in reward circuitry.
- Kindling effect: Substance use increases vulnerability to PTSD by impairing the brain's ability to process and integrate traumatic experiences. Intoxication at the time of trauma exposure increases the likelihood of developing PTSD.
- Retraumatization: Active addiction exposes individuals to high-risk environments — increasing the likelihood of additional traumatic experiences (assault, overdose, accidents, witnessing violence).
Types of trauma commonly seen in addiction treatment include childhood physical, sexual, and emotional abuse; neglect; domestic violence; sexual assault; combat exposure; accidents and injuries; witnessing violence; sudden loss of a loved one; and medical trauma.
How does EMDR work for trauma and PTSD?
EMDR (Eye Movement Desensitization and Reprocessing) is an evidence-based psychotherapy recognized by the World Health Organization, the American Psychiatric Association, the Department of Veterans Affairs, and the Department of Defense for PTSD treatment.
EMDR was developed by Francine Shapiro in 1987 and operates through the Adaptive Information Processing (AIP) model. The therapy posits that traumatic memories are inadequately processed and stored in a maladaptive form — producing intrusive memories, emotional distress, and negative self-beliefs. EMDR facilitates the reprocessing and integration of these memories through a structured 8-phase protocol:
- Phase 1-2: History taking and preparation — establishing safety, teaching self-regulation skills, and identifying target memories
- Phase 3: Assessment — activating the target memory along with its negative cognition, positive cognition, emotions, and body sensations
- Phase 4: Desensitization — bilateral stimulation (typically guided eye movements) while the client processes the target memory. The distress level (measured on the 0-10 SUD scale) decreases as reprocessing occurs.
- Phase 5-6: Installation of positive cognition and body scan — strengthening adaptive beliefs and resolving residual somatic disturbance
- Phase 7-8: Closure and re-evaluation — ensuring stability and assessing progress
Meta-analyses demonstrate that EMDR produces significant, rapid reduction in PTSD symptoms — often in fewer sessions than traditional talk therapy. At Ascend, EMDR is integrated into a comprehensive treatment plan that simultaneously addresses substance use.
Questions About How does EMDR work?
Call our 24/7 admissions line or verify your insurance online.
What is trauma-informed care?
Trauma-informed care (TIC) is a clinical framework that recognizes the widespread impact of trauma and integrates this understanding into every aspect of treatment delivery. SAMHSA defines trauma-informed care through four key principles:
- Realizes: The organization understands that trauma is pervasive and affects neurological, biological, psychological, and social development
- Recognizes: Staff can identify the signs and symptoms of trauma in clients, families, and colleagues
- Responds: The system integrates knowledge about trauma into policies, procedures, and clinical practices
- Resists re-traumatization: The organization actively avoids practices that could re-traumatize individuals
At Ascend, trauma-informed care is not a specific therapy — it is the lens through which all treatment is delivered. This means:
- Every client is screened for trauma history during intake
- Treatment environments are designed for physical and psychological safety
- Power dynamics between staff and clients are acknowledged and managed
- Client choice and autonomy are prioritized
- Cultural, historical, and gender-specific trauma are recognized
- All staff receive trauma-informed care training
“Trauma is the engine that drives most of the addiction we see. You can treat the substance use all you want, but if you don't address the trauma underneath, the person will relapse. EMDR and trauma-informed care are not optional additions to addiction treatment — they are essential components.”
What does integrated PTSD and addiction treatment look like at Ascend?
Ascend provides concurrent treatment for PTSD and substance use disorder delivered by a unified clinical team:
- EMDR therapy: Individual EMDR sessions 1-2x per week, targeting traumatic memories identified as connected to substance use patterns. Timing of trauma processing is clinically managed — stabilization and safety must be established before reprocessing begins.
- Cognitive Processing Therapy (CPT): A structured 12-session protocol that addresses trauma-related cognitive distortions ("stuck points") including self-blame, trust issues, safety concerns, power/control beliefs, and intimacy difficulties.
- Seeking Safety: An evidence-based group therapy model designed specifically for co-occurring PTSD and substance use. Focuses on present-oriented coping skills across cognitive, behavioral, and interpersonal domains.
- Psychiatric medication management: SSRIs (sertraline and paroxetine are FDA-approved for PTSD), prazosin for trauma nightmares, and mood stabilizers as clinically indicated. Medication decisions account for co-occurring substance use disorder.
- Somatic interventions: Yoga, mindfulness-based stress reduction, breathwork, and body-based therapies that address the physiological impact of trauma stored in the body.
The clinical sequence matters: stabilization and safety first, followed by trauma processing (EMDR/CPT), followed by integration and relapse prevention. Premature trauma processing without adequate stabilization can destabilize recovery. Ascend's clinical team manages this sequencing for each individual.
