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Chapter 1: Addiction and Trauma

© Dori Digenti. 2021. All rights reserved.

“Not all traumatized people become addicted, but all addicted people, including those addicted to opioids, were traumatized in some way. That is the reality of our culture, where addiction, like trauma, is so commonplace that most people also don’t recognize its presence.” – Gabor Mate

“As long as their map of the world is based on trauma, abuse, and neglect, people are likely to seek shortcuts to oblivion.” – Bessel Van Der Kolk

In this chapter, we will delve into the connections between addiction and trauma. It is well-known that people with addictions come from all family backgrounds, economic classes, educational levels, and ethnicities. It is a false belief that addiction disproportionately affects any particular class or race. While Latinos, Native Americans, and African-Americans have been the target of profiling and mass incarceration, and have been less able to avoid the legal consequences of drug use, those with resources and privilege are able to hide their addictions and avoid legal jeopardy much more easily.

If you have suffered trauma in your life, the next sections may be difficult. Know that this information is intended as a necessary background to understand why yoga is particularly well-suited to ease and provide healing from addiction. 

 

What is Addiction?

A concise definition of addiction given by Dr. Judson Brewer is “continued to use a substance or to behave in a repeated manner, despite negative consequences.”[i] Why would someone engage in something repeatedly, knowing that the result will be bad for them? It boils down to the reward centers in our brain, and how they can be hijacked to drive us to behaviors and actions that overcome our own control, common sense, and even our reality.

In Brewer’s model, the steps that lead to addiction can be viewed as a simple behavioral cycle termed the “habit loop”: Trigger – Behavior – Reward.[ii] Something initiates our need to seek resolution: the trigger. In most cases, what triggers us is a negative experience, something that is painful. Common examples of triggers are traumatic events (see in detail below), disappointment, anxiety/worry, sadness, or lack of self-worth. When we are triggered, we act to resolve the effect of that trigger. From a yoga perspective, we would say that the behavior, while it might be harmful over time, is our way to return our system to balance, safety, and well-being. We might choose a variety of behaviors to respond to a trigger. But if we tend to resolve triggering events through substances or repetitive habitual behaviors for the reasons outlined below, we might drink, take a pill, overeat, or gamble, among other options. Our rewards would most often consist of relief, numbness, or euphoria. Then, in the addictive cycle, another trigger comes along (which could be the fading of the feeling of the reward), and the behavior is repeated.

Note that the reward could also be what we would perceive as a negative. How can this be? Let’s take this example: if our sense of self is based on believing that we are unworthy of love, then we may seek behaviors unconsciously that will reward and reinforce that sense of unworthiness through always finding unrequited relationships. Strangely, that conditioning to feeling unloved or unworthy may feel familiar, and the familiarity in itself may provide relief and reinforce a sense of safety. In other words, our misery can become our comfort.

As we continue to perform the habit loop, we end up addicted to it. But what if we don’t perceive the negative consequences of the repeated behavior? Most likely, we are ignoring or rationalizing the negative consequences of the addiction. We may be a high-functioning person with addictions, and even believe our addictive behavior makes us better. We might surround ourselves (and probably do surround ourselves) with people who reinforce that perception. We might live our entire lives “handling” our addictions and the underlying conditions that led to addiction. Or, one day we may have a conversation, health event, skilled counselor, relationship breakup, or yoga class that reveals the negative role of addictive behavior in our lives. That is the start of a recovery journey.

Are There Really Behavioral Addictions?

Beyond the headlines of the opioid and other current drug crises, there are other, more hidden addictions. Addiction can also occur in relation to a habitual behavior or activity. For example, as we further understand the role of technology in modern life, there are new studies emerging that are ringing alarms about technology addictions.[iii] We are aware of video gaming addictions, to which young males seem to be particularly vulnerable, leading to extreme cases of not eating, not sleeping, and withdrawing from daily life. This is the far reach of technology addiction. More common are those who spend many hours per day glued to social media, and literally panic when their cell phones are misplaced. Or the friend who has their phone always in hand, and is immediately ready with an answer from Google or a comment from social media about everything.  These instruments and their software are designed to be highly addictive, and the free use model makes it so easy to allow our attention, time,  and emotions to be manipulated for profit.

Other examples of behavioral addictions that are rife in modern societies:

  • Workaholism is often lauded as “ambition,” “dedication,” and “drive,” but overworking (karoshi) is an official cause of death in Japan.[iv]
  • Disordered eating, or food addiction, straddles the line between substance misuse and a range of mental health disorders.
  • Sex/love addiction can co-occur with other mental health disorders like stalking or domestic violence.
  • Gambling, shopping, and spending addictions speak to the reward system of money in our society.
  • Even music can be addictive. Gabor Mate spends pages in this book In the Realm of the Hungry Ghosts[v] exploring his addiction to purchasing, researching, hunting for, and listening to classical music.

And the list goes on. These are just a few of the patterns of harmful behaviors that do not necessarily involve a “substance.” These difficult addictions may seem intractable. It is understandable if we feel hopeless or simply overwhelmed at the thought of overcoming all the various forms of addiction that seem part and parcel of life. But there are new approaches coming to light, and they bring with them ancient wisdom that has stood the test of time.

Trauma as the Root Cause of Addiction

“Trauma is not a flaw or a weakness. It is a highly effective tool of safety and survival. Trauma is also not an event. Trauma is the body’s protective response to an event—or a series of events—that it perceives as potentially dangerous.” – Resmaa Menakem, My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies

We often talk about peeling back the layers of the onion when we’re trying to understand a complicated system. When it comes to trauma and addiction, then, we will start with the individual, and then expand to bring in the impacts of collective trauma under systems of oppression, and finally move to a discussion of intergenerational trauma.

There are many sources of trauma, from war, violence, natural disasters, accidents, or sexual abuse to the accumulated experiences of neglect, abandonment, co-dependency, caregivers’ addiction/mental health issues, racism, poverty, and emotional abuse. With a traumatic experience, we can be thrust into a fundamental rupture in expectations or, at the extreme, a threat to survival. Psychologists name this rupture “dissociation.” The result of dissociation is that parts of ourselves can end up split off and rendered into silence, can manifest as physical illness or numbing, or are merely forgotten.

We may choose to seek relief from the effects of trauma with habitual responses or addiction, which can take mild or severe forms. We respond to traumatic life circumstance by secretly and silently attempting to maintain “normal” social function, all the while developing unskillful coping mechanisms and ignoring what we can. Those of us who have trauma histories, according to Van Der Kolk, can feel “chronically out of sync with the people around them.” Rather than risk experimenting with new options, we might stay stuck in the responses we know, even though they may result over and over in recreating dangerous and painful situations.

Adverse Childhood Experiences (ACEs)

The Kaiser-Permanente ACE study was a breakthrough in understanding childhood trauma. The study has provided strong evidence for the connection between childhood trauma and susceptibility to addiction. There is much to explore in the ACE report and a host of trainings and follow-on studies that shed further light on the ACE-addiction connection. We can see a strong correlation between age of first drug or alcohol use, and the potential for damaging addiction to set in: “Compared to a child with no ACEs, one with six or more [ACEs] is nearly three times more likely to be a smoker as an adult. A child with four or more is five times more likely to become an alcoholic and 60% more likely to become obese. And a boy with four or more ACEs is a whopping 46 times more likely to become an IV drug user later in life than one who has had no severe adverse childhood experiences.”[vii] And further and most importantly: The higher the ACE score, in a dose-response ratio, the higher the risk for alcoholism and drug addiction.[viii]

Figure: The Truth About ACEs Infographic. Used with permission.[ix]

In drawing a causal connection between trauma and addiction,[x] the connection could be rendered invisible because of the differing types of trauma experiences. Little “t” traumas can accumulate over time but fall under the radar of conscious remembering. Or, a child who is raised in a resource-poor community may experience mistreatment whose source is unclear to them (for example, the idea of being from “the wrong side of the tracks”). Invisible trauma can include the possibility of epigenetic trauma across generations, prebirth trauma, and early attachment issues in infancy. In all these cases, it is very possible that a person could exhibit a low ACE score and potentially have no known (to them) history of trauma.

One other possible factor in addiction is indicated in understanding the highly sensitive person (HSP, also called Sensory Processing Sensitivity, SPS.) In her book The Highly Sensitive Person: How To Thrive When The World Overwhelms You,[xi] author Dr. Elaine Aron states that “the highly sensitive person (HSP) has a sensitive nervous system, is aware of subtleties in his/her surroundings, and is more easily overwhelmed when in a highly stimulating environment…. they process everything around them much more—reflect on it, elaborate on it, make associations.” She continues “It also means you are more easily overwhelmed when you have been out in a highly stimulating environment for too long, bombarded by sights and sounds until you are exhausted.” While I couldn’t find specific research on the connection between HSP and addiction, there is a logical connection between the need to downregulate (reducing the response to a stimulus – “chilling out”) the overactive nervous system and addictions). Whether HSP is just a flavor of being more introverted than is either typical or socially acceptable is a valid question. Or could the development of highly sensitive responses be an effect of early childhood trauma?

To sum up, many experts agree that trauma and addiction have a strong cause-effect linkage. If we wish to reduce the terrible impacts of addiction, we need to understand all the causes of trauma that affect us. And further, we need to deepen our knowledge of how trauma impacts the mind/body/emotions through the nervous system’s response mechanisms.

 

The Polyvagal Theory

Our knowledge of the Autonomic Nervous System (ANS) is growing and changing with the advancement of scientific knowledge. For many years, the ANS was considered a binary response system, consisting of the “aroused” state: the sympathetic nervous system (SNS), and the “resting” state: the parasympathetic nervous system (PNS).

In the older, binary view, the SNS is engaged when we are presented with excitement, fear, danger, or threat. Adrenaline and stress hormones (especially cortisol) are released. When the arousal of the SNS is a response to danger or fear, we experience the “fight or flight” response for escape or defense. Respiration, heart rate, and muscular and brain signals all increase in responsiveness. When the arousal event ends, we experience an automatic re-engagement of the PNS. The system slows down and our maintenance activities take over (for example: sleep and digestion).

With the Polyvagal Theory,[xii] Dr. Stephen Porges expanded on this binary model. He proposed that the PNS, which is controlled by the Vagus nerve, actually has two branches, rather than a single branch, with two different response mechanisms. What is the Vagus nerve? The Vagus (thus PolyVagal) nerve is the 10th cranial nerve. The Vagus nerve extends from the base of the skull down through the lungs, heart, diaphragm, and stomach and up to connect with nerves in the neck, throat, eyes, and ears. The Vagus regulates the engagement of the PNS system.

Porges calls these two PNS branches the Dorsal Vagal, which is the controller of the immobilize response, and the Ventral Vagal, which controls Social Engagement. The table below outlines this Polyvagal system.

Branch

 

Ventral Vagal

Sympathetic

Dorsal Vagal

Neuroception (Perception of)

Safety

Danger

Life Threat

Activity

·  Social Engagement

·  Play (hybrid with Sympathetic)

·  Intimacy (hybrid with Dorsal)

·  Fight-Flight

·  Freeze (hybrid with Dorsal)

Shutdown

Affect

Connected, calm

High energy, polarized

Collapsed, numb

Location

Face, head, senses

Spine, legs, adrenals

Torso, gut

Table. The Autonomic Nervous System as seen by the Polyvagal Theory

Porges sees the Ventral Vagal as the most recent development in mammals, including humans. In normal conditions of safety, the social engagement system is active and allows play, creativity, intimacy, and socialization. Social engagement develops in the infant to connect with the mother/care provider through hearing, vocal tone, facial expression, and speech. When the social engagement function is working well, creative and playful connection, activation, and rest and calm are balanced, and responses flow naturally.

When we perceive danger, though, we send out a call to the systems of the ANS, and the responses to that call cascade down through the three parts of the system according to the level of threat. According to Porges,[xiii] Social Engagement (Ventral Vagal) is the first to respond. We use the physical, sensory system to check for safety through vocal tone, facial expression, and eye contact with whatever or whomever is approaching. In other words, we first check to see if there is any real danger through sensory cues, and whether there is a support system present – parent, family, or tribe. If social engagement fails, if we perceive that the danger is real, then the defensive system (Sympathetic) kicks in and our body prepares for action – running away or fighting. Finally, if we perceive life-threatening danger, then the most primitive system engages to immobilize us and we shut down (Dorsal Vagal). This cascade of responses is shown in the “Autonomic Ladder.”[xiv]