Key Takeaways
- Research indicates that up to 75 percent of people in addiction treatment have experienced significant trauma.
- Trauma-informed care shifts the clinical question from "what is wrong with you?" to "what happened to you?"
- Evidence-based trauma therapies like EMDR and CPT can be safely integrated into addiction treatment.
- Unaddressed trauma is one of the leading predictors of relapse after completing treatment.
- A trauma-informed environment prioritizes safety, trust, collaboration, and empowerment at every level.
The Connection Between Trauma and Addiction
The relationship between trauma and substance use disorders is one of the most well-documented findings in addiction research. Studies consistently show that individuals who have experienced adverse childhood experiences, physical or sexual abuse, combat exposure, or other traumatic events are significantly more likely to develop addiction. The Adverse Childhood Experiences study, one of the largest public health studies ever conducted, found that individuals with four or more ACEs were seven times more likely to develop alcoholism and nearly five times more likely to use illicit drugs compared to those with no ACEs.
Trauma alters the brain in ways that make substance use particularly appealing. Chronic stress and traumatic experiences dysregulate the hypothalamic-pituitary-adrenal axis, the body's primary stress response system. This dysregulation leads to elevated cortisol levels, heightened anxiety, and difficulty regulating emotions. Substances like alcohol, opioids, and benzodiazepines provide temporary relief from these symptoms by dampening the stress response, creating a powerful neurobiological incentive for continued use.
At Trust SoCal in Orange County, clinicians understand that addiction rarely exists in isolation. The majority of clients who walk through our doors in Fountain Valley carry trauma histories that directly contribute to their substance use. Treating the addiction without addressing the underlying trauma is like treating the symptoms of an infection without prescribing antibiotics; the surface-level improvement will be temporary, and the root cause will continue to drive relapse.
What Is Trauma-Informed Care?
Trauma-informed care is not a specific clinical technique or therapy modality. Rather, it is an organizational framework that guides how a treatment program operates at every level, from front desk interactions to clinical programming to discharge planning. SAMHSA identifies six key principles of trauma-informed care: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and cultural and gender responsiveness.
In a trauma-informed treatment setting, every staff member, whether clinical or non-clinical, understands the prevalence and impact of trauma and modifies their behavior accordingly. This means avoiding language that could be perceived as shaming, providing advance notice before potentially triggering activities, respecting boundaries, and offering choices whenever possible. The goal is to create an environment where clients feel safe enough to do the difficult work of healing without being retraumatized by the treatment process itself.
Trauma-informed care also recognizes that trauma affects people differently based on factors like age at the time of the traumatic event, duration and severity of exposure, cultural context, and the availability of support systems. A one-size-fits-all approach is inherently incompatible with trauma-informed principles. Each client's treatment plan must be individualized to account for their unique trauma history and its specific impact on their substance use patterns.
Trauma-informed care does not require every staff member to be a trauma therapist. It requires every staff member to understand how trauma affects behavior and to interact with clients in ways that promote safety and trust rather than inadvertently causing harm.
Evidence-Based Trauma Therapies Used in Addiction Treatment
Several evidence-based therapies have been developed specifically to address trauma and have been adapted for use within addiction treatment settings. Eye Movement Desensitization and Reprocessing, known as EMDR, helps clients process traumatic memories by engaging bilateral stimulation while recalling distressing events. Research has shown that EMDR can significantly reduce PTSD symptoms in as few as six to twelve sessions, and it has been endorsed by the World Health Organization and the Department of Veterans Affairs for trauma treatment.
Cognitive Processing Therapy is another front-line trauma treatment that helps clients identify and challenge the distorted beliefs, known as stuck points, that developed as a result of their traumatic experiences. For example, a sexual assault survivor may hold the belief that they are fundamentally damaged or that the assault was their fault. CPT provides a structured framework for examining and revising these beliefs, which in turn reduces the emotional distress that drives substance use.
Seeking Safety is a present-focused therapy designed specifically for individuals with co-occurring trauma and substance use disorders. Unlike EMDR and CPT, which involve direct processing of traumatic memories, Seeking Safety focuses on building coping skills, establishing safety in relationships, and developing grounding techniques. This makes it an appropriate starting point for clients who are not yet stable enough for trauma reprocessing work.
When Is It Safe to Begin Trauma Processing?
Timing is crucial when integrating trauma work into addiction treatment. Clients need to have sufficient emotional stability, coping skills, and sobriety before engaging in direct trauma processing. Premature exposure to traumatic material can overwhelm a client's capacity to cope and may actually increase the risk of relapse. Clinicians at Trust SoCal carefully assess each client's readiness for trauma work and begin with stabilization-focused interventions before progressing to reprocessing therapies.
A general guideline is that clients should have at least two to four weeks of sobriety, a solid foundation of coping skills, and a therapeutic alliance with their clinician before beginning EMDR or CPT. During this stabilization phase, clients learn grounding techniques, emotional regulation strategies, and distress tolerance skills that will serve as resources during the more intensive trauma work that follows.
How Trauma-Informed Care Changes the Treatment Experience
For clients, the difference between a trauma-informed treatment center and one that does not incorporate these principles can be profound. In a traditional treatment setting, a client who becomes agitated during group therapy might be viewed as noncompliant or resistant. In a trauma-informed setting, the same behavior is understood as a potential trauma response, and the clinical team responds with curiosity and compassion rather than consequences.
Practical examples of trauma-informed practices include offering clients a choice of seating positions in group rooms so no one has their back to the door, using person-first language that avoids labeling, providing clear explanations before any physical contact such as a medical exam, and creating quiet spaces where clients can decompress when they feel overwhelmed. These seemingly small adjustments communicate a powerful message: you are safe here, and your experience matters.
Trust SoCal in Fountain Valley has embedded trauma-informed principles throughout its organizational culture. From the way phone calls are answered to the way groups are facilitated, every interaction is designed to promote safety and trust. This commitment extends beyond clinical staff to include administrative personnel, maintenance workers, and anyone else who interacts with clients during their treatment experience.
The Risk of Not Addressing Trauma in Addiction Treatment
When trauma goes unaddressed in addiction treatment, the consequences can be severe. Unresolved trauma is one of the strongest predictors of relapse because the emotional pain and neurobiological dysregulation that drove substance use in the first place remain intact even after a period of abstinence. A person may successfully complete a 30-day treatment program, but if the traumatic memories and associated triggers have not been processed, the first stressful event they encounter after discharge may push them back toward substance use.
Research published in the Journal of Traumatic Stress found that individuals with co-occurring PTSD and substance use disorders who received integrated trauma and addiction treatment had significantly better outcomes than those who received addiction treatment alone. Integrated treatment was associated with greater reductions in both PTSD symptoms and substance use, higher treatment retention rates, and lower rates of relapse at six-month and twelve-month follow-ups.
This evidence underscores the importance of choosing a treatment center that not only acknowledges the role of trauma in addiction but actively incorporates trauma-specific interventions into its clinical programming. When you call Trust SoCal at (949) 280-8360, ask about the trauma-informed approaches used in their treatment programs and how trauma work is integrated into the overall recovery plan.
If you have a history of trauma and are considering addiction treatment, prioritize programs that offer evidence-based trauma therapies delivered by clinicians with specialized training. Not all treatment centers have this capability.
Building a Trauma-Informed Recovery
Trauma-informed recovery extends beyond the walls of a treatment center. It involves developing a long-term relationship with healing that acknowledges how past experiences continue to influence present behavior. This might include ongoing individual therapy with a trauma-specialized clinician, participation in support groups for trauma survivors, and the development of a personal safety plan that identifies triggers and outlines coping strategies.
At Trust SoCal in Orange County, the aftercare planning process includes specific recommendations for continued trauma work after discharge. This may involve referrals to community-based trauma therapists, participation in trauma-focused support groups, or continuation of EMDR or CPT with an outpatient provider. The goal is to ensure that the trauma healing process initiated during treatment continues throughout the recovery journey.
Courtney Rolle, CMHC
Clinical Mental Health Counselor
