Trauma Treatment
Useful Links
Many people who struggle with alcohol or drug use have experienced trauma at some point in their lives. Using substances to cope with difficult memories, overwhelming emotions or painful experiences is a common and understandable response – it’s not a personal failing or a sign of weakness.
This article explores the relationship between trauma and addiction, how trauma informed and integrated approaches to care can support recovery and what evidence based treatment may involve. Whether you are considering treatment for yourself or supporting someone you care about this guide aims to provide clear compassionate information based on current clinical knowledge.
Understanding the relationship between trauma and addiction
Trauma can take many forms. It may be a single distressing event – a serious accident, sexual assault, natural disaster or a one off event – or repeated prolonged experiences such as childhood abuse, domestic abuse or combat exposure. What makes an event traumatic is not just what happened but how the person experienced it and how it affected their sense of safety, trust and control.
When someone experiences trauma the brain and body’s stress response systems can become dysregulated. This means the nervous system can remain on high alert making it hard to feel calm or safe. Over time chronic stress can affect brain structure and function and how individuals process emotions, memories and threats.
Key terms explained
Trauma: An emotional and psychological response to events that are deeply distressing, overwhelming or life threatening. Traumatic experiences can have lasting effects on mental health and wellbeing.
Post traumatic stress disorder (PTSD): A mental health condition that can develop after experiencing or witnessing traumatic events. Symptoms include intrusive memories, avoidance, hyperarousal and changes in mood and thinking.
Complex trauma: Arises from prolonged repeated interpersonal traumas often beginning in childhood. It can lead to pervasive difficulties with emotion dysregulation, self concept and relationships.
Addiction (substance use disorder): A pattern of substance use that causes significant impairment or distress characterised by difficulty controlling use, cravings, tolerance and withdrawal.
Prevalence and co-occurrence
Research suggests trauma and substance use disorders often occur together:
International studies indicate 25-40% of people with PTSD also have a co occurring substance use disorder
In addiction treatment settings rates of trauma exposure are higher than in the general population* 50-60% of people seeking help for drug addiction or alcohol dependence report a history of trauma
But not everyone who experiences trauma develops an addiction and not everyone with addiction has a trauma history. Many factors – genetics, family history, social support, access to resources – influence how we respond to adversity.
The sections below will explore how trauma informed and integrated approaches to treatment can support safer more stable recovery for those affected by both.
Childhood trauma, ACEs and later addiction risk
Adverse childhood experiences (ACEs) are potentially traumatic events that occur during childhood. These can include:
Physical, sexual or emotional abuse
Physical or emotional neglect
Witnessing domestic abuse
Growing up with a parent who misuses alcohol or other drugs
Living with a family member with a mental disorder
Parental separation or incarceration
Why ACEs matter
Repeated childhood trauma can affect brain development during critical periods particularly areas involved in stress response, emotional regulation and cognitive development. Children exposed to ongoing adversity may develop heightened stress reactivity and difficulty managing negative emotions – patterns that can persist into adulthood.
Key findings from ACEs research include:
Multiple childhood adversities increase the likelihood of later alcohol and drug problems
Individuals with high ACE scores may be 2-4 times more likely to develop a substance use disorder
Early trauma can disrupt attachment patterns making it harder to form trusting relationships and seek help
Children of parents who misuse substances may also learn to use substances as a coping strategy. Growing up in chaotic, frightening or neglectful environments can normalise drug use and limit access to healthier ways of managing distress.
If you see yourself in this description please know it’s never too late to seek support or start treatment. What happened in childhood was not your fault and healing is possible at any stage of life.
How trauma drives addictive behaviour
Many people who have experienced trauma describe using substances to try to manage symptoms they find overwhelming. This pattern – sometimes called “self medication” – involves using alcohol, prescription drugs or illicit substances to cope with:
Intrusive memories or flashbacks
Hyperarousal, anxiety or panic
Emotional numbing or feeling disconnected
Shame, guilt or self blame
Sleep disturbance and nightmares
Substances can provide temporary relief. Alcohol may calm anxiety; opioids may ease emotional pain; stimulants may counteract feelings of numbness or low energy. But this relief is short lived and comes at a cost.
The vicious cycle
Withdrawal and the after effects of substance use can intensify the very symptoms people are trying to escape. For example:
Alcohol withdrawal can worsen anxiety and disrupt sleep
Stimulant comedowns can deepen depression and paranoia
Opioid withdrawal can heighten physical and psychological distress
Over time this creates a vicious cycle: trauma symptoms drive substance use, which worsens symptoms, which drives further use.
Trauma can also lower self esteem, disrupt relationships and increase exposure to further harm. People struggling with addiction may find themselves in unsafe environments, experience violence or exploitation or engage in behaviours that lead to additional traumatic stress.
Some people may also develop addictive behaviours beyond substances – such as gambling, compulsive sex or gaming – for similar reasons: to escape, feel in control or numb difficult emotions.
Treating addiction in isolation without acknowledging trauma may leave the underlying drivers of substance use unaddressed. This is why integrated trauma informed approaches are increasingly recognised as essential.
Trauma, PTSD, complex trauma and dual diagnosis
Dual diagnosis” refers to the co occurrence of a mental health condition and a substance use disorder. When someone has both PTSD (or complex trauma) and alcohol or drug dependence they are considered to have co occurring disorders.
Common co-occurring difficulties
People with trauma and addiction often experience other challenges including:
Depression and anxiety disorders
Self harm and suicidal thoughts
Personality difficulties
Physical health problems
Social isolation and relationship breakdown
This complexity means comprehensive assessment is key. In UK clinical practice safe care usually involves multidisciplinary teams – doctors, nurses, psychologists, counsellors and social workers – working together on an integrated plan. Effective treatment considers safety, stabilisation, substance use and trauma symptoms together, not in isolation. This is the foundation of integrated treatment models.
Trauma informed addiction treatment
Trauma informed care is not a specific therapy; it’s an approach that recognises the prevalence and impact of trauma and prioritises safety and choice in every aspect of treatment.
Core principles of trauma informed care
Principle | What it means in practice |
|---|---|
Safety | Creating physical and emotional environments where people feel safe |
Trustworthiness and transparency | Being clear, consistent and honest in all interactions |
Collaboration | Working alongside people rather than doing things to them |
Choice | Offering options and respecting people’s decisions about their care |
Empowerment | Building on strengths and supporting people to take an active role |
Cultural sensitivity | Recognising how culture, identity and background shape experiences |
What trauma informed care looks like
In a trauma informed addiction service you might expect:
Staff trained to recognise trauma responses and avoid actions that could be re-traumatising
Calm, predictable environments with clear routines
Respectful, non judgemental communication
Collaborative treatment planning that involves the person at every stage
Sensitivity to triggers and careful pacing of interventions
Trauma informed does not mean rushing into intensive trauma processing therapy. It first means creating conditions of stability and safety where healing can begin.
PCP’s residential rehab programmes aim to apply these principles throughout detox, psychosocial groups, one to one work and family support. For some people – particularly those with complex trauma – treatment may need to be phased and take longer than a single episode of care. This is a normal part of safe clinical planning.
Integrated treatment models for trauma and addiction
Integrated treatment means treating trauma and substance use within one plan, not in separate services or at separate times.
Moving beyond sequential approaches
Older models often insisted people had to be completely abstinent before any trauma work could start. While stabilisation is important, research suggests carefully planned concurrent treatment can be safe and effective for many people.
What integrated care includes
Stabilisation: Managing withdrawal, supporting sleep, ensuring physical safety
Relapse prevention: Building skills to manage cravings and high risk situations
Trauma focused interventions: Evidence based psychological treatments when appropriate Meta analyses such as Project Harmony which looked at 36 randomised controlled trials found that integrated trauma focused therapies produced the greatest reductions in both PTSD symptoms and substance use compared to treatment as usual or single disorder approaches.
In practice integrated care often involves close collaboration between addiction specialists, mental health clinicians and GPs with clear communication and shared decision making with the patient.
Evidence based therapies for trauma and addiction
Different therapies suit different people and stages of recovery. No single approach is right for everyone and psychological treatments are often tailored to individual needs, preferences and readiness.
Trauma focused cognitive behavioural therapy (TF-CBT)
This structured therapy helps people understand the links between thoughts, feelings and behaviours. It typically progresses through phases:
Psychoeducation and building coping skills
Gradual exposure to traumatic memories through narration and processing
Consolidation and where relevant family sessions
TF-CBT has been trialled numerous times and can produce significant reductions in PTSD symptoms, depression and avoidance.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is an NHS endorsed therapy for PTSD. It uses guided eye movements or other bilateral stimulation while the person recalls aspects of traumatic memories. This process appears to help the brain reprocess distressing experiences reducing their emotional charge over time.
Dialectical behaviour therapy (DBT)
DBT informed approaches focus on skills for:
Distress tolerance
Emotional regulation
Mindfulness
Interpersonal effectiveness
These skills can be particularly helpful for people with intense emotions, self harm risks and complex trauma histories.
Stabilisation and safety focused interventions
Before or alongside deeper trauma processing many people benefit from:
Grounding techniques
Crisis and safety planning
Sleep hygiene support
Harm reduction or abstinence planning
These interventions help establish the stability needed for trauma therapy to be effective.
Integrated programme models
Some structured programmes combine trauma and addiction work within a unified framework:
COPE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure): Integrates prolonged exposure therapy with relapse prevention
Seeking Safety: A present focused model that emphasises coping skills and safety without requiring detailed trauma processing
TAMAR: A group based curriculum that incorporates journaling, creative expression and self regulation skills
These models reflect the research that supports concurrent treatment for many people with co occurring disorders.
Medication can also play a role, for example, in withdrawal management, alcohol relapse prevention or treating depression and anxiety but this article focuses on psychosocial approaches.
Phased and stabilisation-first approaches
Phased treatment is a widely used framework that typically moves through three stages:
Stabilisation and safety: Establishing physical and emotional stability
Trauma processing: When safe, working through traumatic memories
Consolidation and recovery support: Building on gains and planning for the future
What stabilisation involves
In a residential or community setting the stabilisation phase may include:
Medically supervised detox where appropriate
Crisis and risk management
Sleep support and attention to nutrition
Building basic coping skills for managing distress
Establishing routines and predictability
Why pacing matters
Moving too quickly into intensive trauma processing while someone is still using heavily, withdrawing or very unstable can increase psychological distress and undermine both trauma recovery and addiction recovery goals.
For people with complex trauma or high levels of dissociation the stabilisation phase can be lengthy—and this is a valuable part of treatment not a delay. Research including trials comparing Risk Reduction through Family Therapy (RRFT) with TF-CBT has shown that structured phased approaches can produce strong outcomes for PTSD symptoms and substance use days.
Decisions about when and how to begin trauma focused treatment should be made collaboratively taking into account:
The person’s preferences and readiness
Current safety and risk
Substance use patterns and stability
Support systems available
PCP’s clinical teams can help people plan realistic next steps after a residential stay such as community psychological therapy, peer support or GP follow-up to continue phased work.
Safety considerations: why untreated trauma can undermine recovery
Many people have tried to stop using substances before and returned to use when traumatic memories or overwhelming emotions became too difficult to bear. This is a common experience not a sign of failure.
How unaddressed trauma can trigger relapse
When trauma symptoms remain untreated they can:
Intensify cravings during periods of heightened stress
Disrupt sleep increasing vulnerability to relapse
Lead to emotional numbing or dissociation making it hard to engage with recovery support
Create a sense of hopelessness that undermines motivation
The existing literature highlights that past trauma can maintain a vicious cycle with substance misuse where each reinforces the other.### Risks if trauma and addiction are not treated
Untreated trauma and addiction can lead to:
Self-harm and suicidal thoughts
Domestic abuse and exploitation
Accidental overdose
Social isolation and relationship breakdown
Risk assessment and safety planning are crucial.
Disclosure at your own pace
If you are seeking treatment, you don’t have to share everything about your trauma history straight away. Disclosure should happen at your own pace in a safe environment. Clinicians should never pressure you to talk before you’re ready.
If you are in immediate danger, call 999 or contact NHS 111, your local mental health crisis team or the Samaritans (116 123).
Recovery is a gradual process. Setbacks don’t mean treatment has failed – they can be opportunities to refine safety plans and strengthen support for long term recovery.
What trauma-informed support looks like in UK addiction services
In the UK, trauma-informed addiction support typically involves: assessment, detox (if needed), psychosocial treatment and aftercare.
Assessment
A thorough assessment should gently explore:
Patterns of substance use and history
Mental health symptoms and history
Medical conditions
Trauma exposure (at your own pace)
Current safety, including housing, relationships and risk
You can choose what you share. A good clinician will explain why they’re asking and how the information will be used.