What is Internal Family Systems Therapy?

The Internal Family Systems Therapy (IFS) model is a non-pathologizing approach to psychotherapy that applies systems thinking to work on inner relationships among parts inside an individual’s psyche.

IFS holds the perspective that every person’s mind is made up of relatively distinct sub-personalities, a little bit like what was portrayed in the Pixar film Inside Out. IFS also asserts that every person has a core Self, the true natural leader of the inner system. Self is the healing agent, and restoration of relationship between parts and Self is the goal of IFS.

Internal Family Systems is an evidence-based practice. IFS is used effectively to treat mental health disorders, trauma, and addiction. The goal of IFS is to restore inner wholeness, through reconnecting parts with the client’s Self, empowering Self to guide and harmonize the client’s inner world.

No Bad Parts

IFS was developed by a family therapist, Dr. Richard Schwartz, in the 1980s. The model has evolved since the early days, but it retains a core premise reflecting a revolutionary insight.

Schwartz’s insight was that all symptoms and behaviors, even the most destructive and damaging, are manifestations of an internal part that has positive intentions for the client. As the title of Dr. Schwartz’s latest book asserts, there are “No Bad Parts”.

Schwartz asserts that we get further in therapy with an attitude of curiosity and acceptance towards all symptoms, instead of picking sides or battling “bad” behavior. Only once we understand the positive intention of an extreme adaptation can we begin to shift dynamics of the inner system.

How Parts Become Extreme 

In the face of danger or threat, Parts take on extreme roles to help protect the inner system. Extreme roles can save a person’s life, but they carry burdens: painful emotions, somatic postures, and negative beliefs.

The pain of a role is not the same as the part itself. Parts wouldn’t naturally think negative thoughts or behave in self-destructive ways, but if they learn that it’s necessary for survival, they may take on these roles.

A way to understand this piece is to ask the question, “How might believing this painful thought, feeling this painful emotion, or performing this extreme behavior have helped me survive in my original environment?”

For example, as adults we may rail against our habit of eating too many sweets. One concerned or critical Part of us wants us to stop overeating, but we find we can’t, because another Part, different from the Part that wants us to stop, is doing the overeating. We can stay locked in an inner power struggle, one Part pitted against another.

But if we are willing to explore how the behavior of eating too many sweets helped us survive our original life circumstances, we may open up a series of discoveries that leads us to compassion and understanding of why we behave the way we do.

By asking the sweets-eating Part, with genuine curiosity and respect, how she is helping us respond to life adaptively by way of that behavior, she may give us a revealing answer. She might tell us that eating sweets helped us soothe bad feelings when we were small. Perhaps it wasn’t safe to have normal child emotions like sadness, fear, or anger in our home, so using food to numb emotions was adaptive. Or she may say that being a little bit overweight helps us feel safer from unwanted male attention.

We can’t know ahead of time what a Part’s answer will be – we have to ask.

Through open exploration, we may come to recognize that the sweets-eating Part, and other Parts like it, are still trying all these years later to help us be some version of us that was helpful once upon a time, when maximizing survival in our home environment.

Once we connect extreme behavior, beliefs and emotions and to a young Part of us that is doing her best in a difficult role, we tend to soften towards ourselves. That softening is the beginning of being able to heal the inner system.

Resolution comes when we give ourselves the kind of help now, Self-to-Part, that we actually needed then. Healing encounters happen organically in relationship among Self and Parts, once the burdens of false belief and painful emotion are recognized.

Self may spontaneously say to our little Part, Of course you were sad, of course you felt lonely and angry sometimes. You’re just a little girl! Those are normal, natural feelings for a child. For anyone! You don’t have to hide any of your feelings from me. That’s not your fault, you didn’t do anything wrong! Let me put my arms around you, I love you so much!

Through IFS, Parts are given the opportunity to “unburden”, or be released out of extreme roles. Released from a certain role, a Part no longer has to hold extreme beliefs or act in extreme ways. These changes have ripple effects throughout the whole inner system.

Internal Family Systems Therapy and Addiction

In IFS, addiction isn’t considered bad, per se. Addiction is viewed as an extreme behavior, coming from a Part trapped in an extreme role. Although the negative impacts of addiction are acknowledged, IFS makes a distinction between impact and intention. The intention of the Part within that uses substances is actually positive – to stop emotional pain from taking over the client’s inner system.

In IFS, there are different kinds of Parts. Some Parts protect the inner system, and other Parts carry the wounds and feelings of what happened to us. Protector parts act to keep wounded Parts and their pain out of conscious awareness, so that we don’t get overwhelmed and can carry on the tasks of daily life. Protector Parts can be either preventative, or reactive.

Preventative Parts protect us by making sure we behave in ways which reduce the likelihood of the bad things from our past happening to us again. Their motto is “Never again!”

Our Preventative Parts dedicate themselves to getting us to behave in ways that minimize the chances of getting triggered or hurt again. Preventative Parts have many ingenious strategies to keep our vulnerabilities shielded. Some examples of Preventative Parts include Perfectionist, Inner Critic, People Pleaser, Overplanner, Controller, Hypervigilance, Hardworking, or Caretaker Parts.

But no matter how hard our system works to prevent our pain-carrying Parts from getting triggered into conscious awareness, sometimes they do. When that happens, Preventative Protector Parts hand the job off to our Reactive Parts, whose job it is to manage pain once it has been triggered.

Reactive Parts kick into gear once the pain of a wound has gotten too close to the surface, and swift action is needed to soothe or suppress the feelings. Typical Reactive Parts include all the behaviors we might do that numb or modulate feelings: Substance Use, Eating Disorders, Self-Harm, Shopping, Internet/Phone Addiction, Binge Watching, Suicidal, Risk-Taking, Sexually Acting Out Parts, and so on.

How Internal Family Systems Therapy works for Women with Addiction

IFS maintains that we cannot expect our Reactive Parts to stop doing their jobs, until we have shown both the Preventative Parts and the Reactive Parts that the wounded Parts are ok now. And for those wounded Parts to actually be ok, they need to be retrieved from where they have been frozen in scary moments of the past, and brought into relationship with our core Self in the here and now. The Self is one within us who can be loving, kind, and wise.

IFS provides a pathway for Self-Part reunion to become a reality, by providing wounded Parts a chance to tell their stories to us. The healing for those wounded Parts comes through a restored relationship with us, which is a little bit like adopting our own little orphaned inner children from the past, to come live with us now in the present. Once those wounded Parts are healed through a restored relationship with Self, who helps the wounded Parts release their burdens of extreme beliefs and emotional pain, then Reactive Parts are freed from having to resort to extreme behaviors to soothe the wounded Parts’ pain.

While stabilization of destructive addiction behaviors is in progress, therefore, IFS actively pursues the underlying wound healing that will make the Substance Using Part (a Reactive Part), redundant in her role.

Convincing the Substance Using Part that she no longer needs to do her job for the client’s inner system is a process. A big portion of the therapy involves befriending the Substance Using Part as the protector that she really is. Befriending needs to be genuine, from Self-to-Part. The kind-hearted, wise Self within us befriends the Substance Using Part.

Befriending means that rather than shaming, judging, criticizing and blaming the Substance Using Part, we allow Self to fully acknowledge the Part’s adaptive role in helping us survive until now. This process of making friends with the Substance Using Part involves asking Preventative Parts that shame and judge us, such as the Inner Critic Part, to step back, to take a break from their job of trying to control our behavior through judgment.

Once fully thanked and understood, the Substance Using Part reveals which overwhelming experiences of the past she is protecting the client from reliving. When that “target” wounded Part is unburdened through restoration of relationship with Self, the Substance Using Part sees on her own, that her services are no longer necessary for survival.

Internal Family Systems Therapy at Villa Kali Ma

At Villa Kali Ma, we integrate Internal Family Systems Therapy methods and mindsets into our holistic residential and intensive outpatient programs for women healing from trauma, addiction, and mental illness. With its emphasis on each person having a Self, and its insistence on unconditional compassion for all Parts, we find it to be a natural fit with our philosophy!

If you’re curious to find out how IFS and other trauma healing modalities could help you recover your birthright to live freely and wholly, we warmly invite you to check out our many programs for women recovering from mental illness, addiction, and trauma.

According to Bessel van der Kolk, MD, trauma treatment pioneer and bestselling author of The Body Keeps the Score, research shows that when it comes to trauma, there is no one-size-fits-all solution.

For some people, working with bilateral stimulation to desensitize traumatic memories through Eye Movement Desensitization and Reprocessing (EMDR) will be the most expedient way to bring a problematic trauma narrative to its end.

When the time comes to heal deep attachment wounding, on the other hand, it may be more powerful to work on restoring inner relationships between burdened parts and the Self, through Internal Family Systems Therapy (IFS). During phases when stabilization are front and center, learning to shift polyvagal states or regulate arousal through breath, posture, and movement may be the most direct path to feeling better.

Trauma treatment means addressing multiple distinct systems of a person’s being. At the very least, trauma treatment will need to address the role of thoughts, physiology (the brain, nervous system, and other vital systems), emotions, and behaviors (including substance use).

Holistic Trauma Healing: A Whole-Person Approach to Recovery

At Villa Kali Ma, we also consider the role of spirituality, creativity, and nature. We look at intra-psychic (inner dynamics and relationship to Self), interpersonal (relationship with others), and transpersonal pieces (relationship to God/Source/Universe/Divine) too, when relevant for a woman’s journey.

Each of these systems may respond differently to different treatment approaches, and have different needs. Within any category, many wonderful treatment modalities can serve. Working with the body alone, we consider nutrition, exercise, mindfulness, somatic experiencing, massage, yoga, reiki, acupuncture, ecotherapy…and more!

The purpose of a holistic approach to trauma healing is to integrate. Integrative practitioners take interventions from many healing systems and use them sensitively. At Villa Kali Ma, we aim to adapt mindsets and models to serve the live unfolding healing process, rather than to expect any woman to fit into a pre-existing protocol.

Integrating Mindfulness, Movement, and Meaning

Trauma affects the body in a specific way: it restricts movement. Not only the big, expressive, playful movement we see children and animals, but also the natural fluid flow of aliveness that all bodies have. Even in stillness, bodies are movement, according to Somatic Therapist Manuela Mischke-Reeds, author of Trauma-Sensitive Movement: 96 Somatic Techniques to Support Nervous System Regulation and Embodied Transformation in Therapy. Trauma forces movement into rigid, repetitive conditions, that create pain and hold emotion back from resolution.

Trauma also affects the meaning that we make of our experiences in the now. This happens as we are forced to carry extreme beliefs, which are false conclusions about the self and the world. The meaning trauma compels us towards is distorted, overgeneralized, and self-centered. We believe not only that the world isn’t safe, that bad things can happen at any time, but also that we ourselves, in our worthlessness or inadequacy, are to blame for what happened.

What trauma does to our cognition and to our body is reflected in our attention. Rather than being able to flow our attention freely and organically, our attention gets burdened, stuck, and dysfunctional. We lose capacity to be openly mindful, receptive, exploratory. With our attention hijacked by strategies meant to protect us from re-experiencing unresolved trauma, the benefits of the alpha brainwave flow state are unavailable to us.

The path of healing holistically from trauma removes trauma’s blockages and burdens. Trauma healing takes constraints away, permitting us to slip back into free-flowing movement, meaning, and mindfulness. Rather than efforting, we come to rely on what naturally and organically emerges from our aliveness. Holistic trauma healing approaches all work with how attention, movement, and meaning can be restored back to health.

Evidence-Based Practices for Mind-Body Healing

At Villa Kali Ma, we use many evidence-based practices to help women find recovery.

The key clinical modalities we use are generally considered to be gold-standard approaches for healing trauma and addiction. Evidence-based modalities we offer include:

Individual, family, and group psychotherapy

Dialectical Behavior Therapy (DBT)

Cognitive Behavior Therapy (CBT)

Experiential therapies (Expressive Arts Therapy, Equine Therapy, and Ecotherapy) Acceptance and Commitment Therapy (ACT)

Motivational Interviewing (MI)

Internal Family Systems Therapy (IFS)

Eye Movement Desensitization and Reprocessing (EMDR)

12 Step

and more!

In addition to those clinical approaches, we use holistic treatment approaches, some of which stand out in the literature as being especially supported by evidence.

The ancient Indian healing system of yoga is widely acknowledged and accepted as having an important role to play in clinical applications at this point. Randomized control trials and other formal studies have helped remaining skeptics over the hump.

The practices and principles of yoga inform all of our programs. We love yoga, not only as a form of exercise, but for its salubrious effects on the nervous system and its natural enhancement of mindfulness. Yoga alone is an admirably comprehensive path to wholeness.

In addition to yoga, we incorporate mindfulness-based approaches into all of our offerings. In particular, we love Kristin Neff and her Mindfulness and Self Compassion program. Mindfulness-based approaches have benefited from a fair number of formalized studies, which we appreciate for the extra scientific verification of what we experience in ourselves and in our clients.

Explore Holistic Trauma Treatment at Villa Kali Ma

Villa Kali Ma has a dedicated residential trauma treatment program, the Retreat, for those women among us who need trauma treatment primarily. Our residential addiction treatment program, the Villa, helps women who also have substance use disorders recover from their trauma holistically. We offer holistic treatment in our intensive outpatient treatment program, as well.

The essence of holistic trauma recovery is a focus on wholeness. When wholeness is recognized to underlie all symptoms, no matter how severe, distorted or destructive those symptoms seem to be, we get much further. When trauma-generated burdens, beliefs, and behaviors are given the opportunity to resolve out of the body, mind, emotions, and energetic field, women bounce back into a natural state of wholeness on their own.

Are you curious to find out if this could be true for you, too? We believe that it could be. Whatever you decide, and whatever your journey back to wholeness,  we wish you the very best! You can do it!

At Villa Kali Ma, we work with women recovering from trauma, mental illness, and addiction. These three forms of suffering often go together. When a woman has trauma, she experiences mental and physical health symptoms stemming from that trauma. It is also very likely that she has at least a few addictive or compulsive behaviors.

We can also frame this equation the other way around. When a woman has a substance use disorder, she has mental health symptoms too. And almost always, she has underlying trauma.

Villa Kali Ma’s holistic residential and outpatient programs address these three topics together, because they aren’t easily teased apart. Compassionate understanding of how trauma, mental illness and substance abuse work together is required to gently unravel the complex ways they can interact.

For women who struggle with substance abuse, it can make all the difference in the world for our self-esteem to realize that addiction makes sense in the context of a traumatized body, mind, and spirit. In this article, we’ll look a little closer into the connection between trauma and addiction, so that those of us dealing with addiction can loosen up, and let go of any remaining judgment about the topic. Addiction isn’t a moral issue, it’s a neurobiological one.

Understanding the Link Between Trauma and Addiction

The link between trauma and addiction is especially strong among women, with the majority of women entering substance abuse treatment reporting a history of significant trauma.

Some of the trauma that women with addiction report is clearly generated by a single, overwhelmingly distressing event, like a car crash or sexual assault. For many women, however, the trauma is much older, subtler, and more deeply rooted, reaching all the way back to childhood.

Today, there are several definitions of trauma that go beyond the well-known clinical diagnosis of Post-Traumatic Stress Disorder (PTSD). It behooves us to know about them. We may not recognize our own trauma if we only know about PTSD. Correctly, we may think that PTSD is generally developed in response to one big event that changes a person’s life.

What women may not know enough about is complex trauma, which was first introduced by Judith Herman in the 1990s in her trailblazing book, Trauma and Recovery. While not classed as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders at this time, Herman found evidence in her work for an equally prevalent syndrome now known as complex post-traumatic stress disorder (C-PTSD).

Like PTSD, C-PTSD generates symptoms of severe anxiety (due to hyperarousal, or feeling always on guard), as well as intrusive thoughts and memories. It can also create depressive patterns and habits of disconnecting from feelings. C-PTSD is responsible for difficulty with soothing and regulating emotion, struggles in interpersonal relationships, and low self-esteem. Like PTSD, C-PTSD is paired with strategies for avoiding people, places, and scenarios that trigger unresolved trauma to re-surface. C-PTSD is an underlying cause for substance addiction, eating disorders, and self-harm.

Why Trauma Often Leads to Substance Abuse

Why do PTSD and C-PTSD tend to lead to substance abuse? One explanation can be found in a basic understanding of the nervous system, and what prolonged exposure to threat does to the nervous system.

Trauma disturbs the nervous system deeply. To understand how, we look at a model of nervous system arousal states pioneered by psychiatrist Dr. Dan J. Siegel. The framework is called “the window of tolerance”.

The window of tolerance refers to a level of nervous system arousal (or wakefulness). When our nervous system is operating within the window of tolerance (not too activated, not too sleepy) life feels good to us. We are pleasantly alert and energized, but not frazzled, agitated or stressed. At the same time, we are pleasantly relaxed, but not numbed out, shut down, or fog-brained.

It’s normal to move in and out of higher or lower states of arousal throughout the day. Sometimes we have more energy and other times we are more relaxed. What happens for people with trauma, though, is that, through repeated exposure to danger, our nervous systems get stuck in extreme states of activation, outside the window of tolerance on both ends of the spectrum.

On the upper end, we are cued by threats in the environment into hyperarousal, or the fight-flight nervous system response. Hyperarousal is a very uncomfortable state. It feels like agitation, aggravation, panic, and distress. Anxiety, fear, dread, and irritability are all signs that we are in hyperarousal.

When our bodies believe it will save our lives, external threats may also prompt us to go into hypoarousal. Hypoarousal is what Dr. Stephen Porges calls “dorsal vagal collapse”. In hypoarousal we may shut down, space out, or go numb. Chronic depression, among other symptoms, is sometimes a signal that chronic hypoarousal helped us survive in the past.

Hypoarousal is also the eventual result of being in hyperarousal for too long. The body “crashes”, bypassing the window of tolerance, all the way down to collapse. The body shuts us down, to create an opportunity to rest and recharge which is still life-protective.

What do you think might happen to a woman whose life circumstances repeatedly cued her nervous system into states of hyperarousal and/or hypoarousal, again and again, over many years? What beliefs, emotions, and action tendencies (to use Dr. Carol Dweck’s BEATS) might she develop, that match a nervous system that only operates in danger mode?

If you thought, she might turn to substances to get some relief…bingo! Women whose nervous systems were trained, through no fault of their own, to overproduce feelings of distress even in non-dangerous situations, have a problem to solve. If they don’t know better, or no other kind of help is available, they often find their way to substances.

Substances are addictive because of the way they affect the nervous system: to relax, soothe, or enliven it, and to bring much-needed sensations of pleasure, safety, and ease. Substances – at least in the beginning – loan us a window of tolerance.

Identifying and Treating Co-Occurring Disorders

Many women who meet diagnostic criteria for a substance use disorder (SUD) also qualify for a mental health diagnosis. For example, a woman can have cocaine addiction and major depression at the same time. A woman can be an alcoholic and also have anxiety.

The interplay between trauma, co-occurring mental health disorders, and addiction is complicated. Trauma, addiction, and other mental health diagnoses share symptoms like anxiety, depression, obsessive thinking and compulsive behaviors. That’s why it’s important to treat all of these conditions in parallel, and to hold all possible hypotheses about what will help a particular woman with an open mind.

In general, our staff feel it is wise to take all levels and layers of a woman’s being into account. We try on different lenses when finding the best course of treatment for each woman. At Villa Kali Ma, we embrace a range of viewpoints, including (but not limited to) a scientific, neurobiological understanding of symptoms. We understand that identifying and treating co-occurring disorders can also involve cognitive, behavioral, relational, somatic, and spiritual ways of understanding a woman’s suffering. All of this depends on who a woman is and how she experiences herself. We are all much, much more than our symptoms.

Broadly speaking, it is helpful to work with a hypothesis of a mental health diagnosis, such as bipolar disorder, borderline personality disorder, or major depression, even though such diagnoses are sometimes considered controversial in the field. The benefit of using such terms as a trail map for understanding a woman’s experience is that diagnostic categories can be correlated to best practices for treatment.

When we discover during initial assessment that a woman resonates with the diagnostic criteria associated with a particular co-occurring disorder, that gives us some idea of what course of treatment may be especially effective for her. Knowing what has helped other women who experience life in similar ways never hurts.

Trauma-Informed Addiction Care at Villa Kali Ma

At Villa Kali Ma, we have believed for a long time in the power of addressing trauma and co-occurring mental health disorders alongside addiction. From our own experiences, clinical insight, and observations in the field of addiction and trauma treatment, we see the power of this trifold approach.

In our holistic inpatient and outpatient programs for women struggling with addiction, we offer a differentiated, highly customized path through treatment. Each woman receives what really benefits her as a unique and irreplaceable person.

With all that we know about the ways that trauma, addiction, and mental health affect women in predictable ways, we also know that each woman’s recovery is special. Like nurses in a maternity ward, we never get tired of the miracle of new life! In our case, the newborn we hold precious is a recovering woman, taking her first breaths in the light of a new, safer, friendlier world.

If you’re wondering about the connection between your own trauma and substance use, we invite you to check out our suite of holistic recovery programs for women.

Signs of unresolved trauma can be tricky to recognize. Many of us live with trauma for years without a clue that life could be any different. For women with a trauma background, we may know that our past was “bad”, but we may not see how thoroughly our environment shaped us.

Trauma affects everything about us, from our work lives, relationships, and conscious emotional experiences, right down to the unconscious operations of our brains and bodies. Trauma molds how we process sense stimuli like sights and sounds, and how we store and recall memories. Trauma explains most of our tendencies: how we make eye contact, move our bodies, and hold ourselves upright.

Trauma is like the proverbial water to the fish. Until we have the opportunity to experience life on land, we won’t even have a word for “water”. The good news is that when we start to heal trauma at the root, we can experience widespread transformation in our lives.

The fact that trauma is so pervasive in its wounding effects is exactly why, when we heal it, we experience a beautiful change that flows into every part of us. In this post, we’ll look closer at some of the ways that unresolved trauma might be showing up.

How Unresolved Trauma Manifests in Everyday Life

Many people have heard by now that trauma has symptoms like flashbacks, nightmares, and severe anxiety. What we may not have heard about are the ways that complex trauma, the kind that begins in childhood or even in the womb, gets woven into our very personalities.

For people who grew up in distressing circumstances, trauma is baked into our beliefs, emotions, and behavioral tendencies. We take it to be part of our identity. Years later, as adults, we may say, “I am insecure”, or “I am a procrastinator” or “I overeat” without really understanding why. We don’t know where these sides of us came from, nor what purpose they serve. It is likely that our inner world is soaked with shame.

People with complex trauma often blame ourselves for our supposed (or real) deficiencies. We do this even though every other traumatized woman in the world has the same symptoms, and the same shame about those symptoms. As Dr. Janina Fisher says in her work on shame and trauma, we wouldn’t be surprised to learn that people with the same flu experience the same symptoms, would we?

It’s important to call things by their right name, and to recognize the true origin of personality traits and behavioral styles, when they actually come from trauma. For any woman with a substance use disorder, for example, you need to know that you have used substances for a good reason. The substance was a way to meet the demands of life…. in the context of a traumatized nervous system.

Here are some other very common, everyday ways that trauma shows up in women’s lives.

Perfectionism

Perfectionism means more than having a high standard. If you have a perfectionist side to your personality, you may feel severe emotional distress when you don’t meet your standard. If you associate achieving or striving for perfection with feeling safe and secure, to the point where it makes you anxious to be seen when you’re being imperfect, you may have a trauma-generated perfectionist part (to use the language of the Internal Family Systems model).

Harsh Inner Critic

Hand in hand with the perfectionist Part, the Inner Critic is another common trauma-generated Part. Almost everyone can relate the description of a voice inside our heads that criticizes us. If you have an exceptionally mean inner critic, who berates you, shames you, and calls you names, you may have an over-empowered inner critic. Over-empowered inner critics are a legacy of trauma.

A Need for Control

Another common Part found in women with trauma is a high need for control. Being controlling may be considered a bad thing (by those affected by our behavior), but the attempt to make our environments more predictable stems from bad experiences with uncertainty in the past. If you have a very hard time letting go of outcomes and “seeing what happens”, this can be a sign of a controlling Part, another trauma-generated personality facet.

People Pleasing, Boundary Struggles, and Conflict Avoidance

Do you absolutely hate it when people are mad at you? Do you struggle to set boundaries (or even know what your boundaries are?) If you avoid conflict and boundary setting because you can’t stand feeling angry or having others be angry at you, you may have developed a submission-oriented Part. This Part typically feels it is her job to make sure you make others happy, no matter what. The “collapse and submit part”, Dr. Janina Fisher explains, represents a survival strategy. It was developed in environments where our maintaining our attachment bonds required us to give up our power.

The Psychology of Trauma: What Happens Beneath the Surface

Trauma begins with a basic premise – that we must “do or die”. In other words, something is required on our end – an action must be taken, to ensure that we make it.

To a certain extent, that’s true of all life, and there’s nothing wrong with developing agency. “Working for a living” – expending physical effort to stay alive – is part of being human the moment we leave the womb, as Dr. Daniel J. Siegel explains in his work on personality development. But in trauma-generating environments, we learn that we have to do extreme, almost impossible things to get our life needs met.

When you remember that as mammals, we will not make it to adulthood unless the adults take care of us, the extremity of our survival adaptations makes a little more sense. As babies we needed a lot from our caregivers: not only physical care but also emotional connection. Caregivers must provide relationally-attuned attention that helps us feel “safe, seen, and soothed” for secure attachment to take root. We all adapted to available attachment conditions in ways that optimized our survival. Women who have trauma had to develop very extreme creative solutions to make it work.

There are many ways a child may take on an extreme burden. She may suppress and hide her needs and emotions, or take the role of parenting her parents. She may perform heroically in school to bring pride to the family, or clown around to make her parents smile. She may have to play nurse or try to control a parent’s drinking. Girls frequently develop strategies based on playing small, acting out, or hurting themselves.

All of these learned behaviors become habits. Double binds turn into permanent compartmentalization. The mental and nervous-system gymnastics we go through to stay safe and attached become personality traits later on. The greater the level of polarization and paradox inside our own psychology, the greater demands our environment must have asked of us.

Everyday Signs You Might Be Living with Unhealed Trauma 

In the Internal Family Systems Therapy model, we look at polarizations between Parts of our personality that have opposing strategies. If a Part of you thinks you should stop drinking, and another Part drives you to drink, that’s a classic polarization between parts. Here are some other examples of polarities that sometimes arise in women who survived trauma-generating childhoods.

Work hard, Party Hard

Many women work to the brink of burnout (and beyond!), driving themselves into the ground trying to follow a strategy of finding relational safety through high performance. If I only achieve perfection, then I will at last be loved, is the logic of this Part.

In response to this, another Part, whose job it is to take away the feelings of exhaustion and anger at the requirement to meet this part’s demands, is likely to kick in with some way of numbing out. For women with substance addiction, this can be the typical “party hard” part. There are other ways to numb out and check out, including behavioral addictions like eating disorders, self-harm, compulsive shopping, and more.

Procrastination and Perfection

Procrastination is an avoidance strategy. It is frequently polarized with perfectionism. When we have extremely high standards and it makes us anxious not to meet those standards, we can develop a pattern of avoiding or delaying projects and daily tasks. We postpone because we don’t want to get sucked into horrible feelings associated with not meeting our standards of perfection. This polarity can keep us paralyzed, unable to move forward.

“Shameless” and Ashamed

Some women experience a polarization between an acting out Part, and another Part that feels deeply ashamed of that behavior. For example, a woman may act out sexually, by cheating on her partner. The survival benefit of that behavior is explained by the short term sensations created by the behavior: a sexual “high”, juicy romance or fantasy. The sensations created by acting out are used by a traumatized nervous system to soothe and distract from pain. Another Part of this woman’s personality then holds the shame, guilt, and regret about this behavior. Because these Parts are locked into a polarization, the end result is inner turmoil.

How Villa Kali Ma Helps Women Heal from Emotional Trauma

Villa Kali Ma is a unique treatment provider. We take a holistic approach to healing women, combining the best approaches from all relevant fields. For women who have trauma, we created a dedicated facility, the Retreat. The Retreat is a licensed residential trauma treatment center.

The Retreat is an in-patient setting providing cutting-edge trauma-treatment modalities like brainspotting and ketamine assisted psychotherapy. We also help women through the most tried and true trauma healing approaches like somatic therapy, Internal Family Systems Therapy, and Eye Movement Desensitization and Reprocessing – powerhouse modalities for restoring feelings of capacity, reprocessing traumatic memory, and bringing back joy.

If you’re ready to look deeper into the ways that trauma, mental illness, and addiction can be healed with compassion, we invite you to check out our many programs for women.

In recent decades, more focus has been given to differences between men and women when it comes to substance use disorders. Several gender differences have been observed, in each phase of addiction and recovery.

In terms of raw numbers, more men than women use substances – men are about twice as likely to consume drugs and alcohol as women are.  (The exception to this is prescription painkillers and tranquilizers, where studies suggest women are on equal footing with men). The women who do use drugs and alcohol, a number which is on the rise, are more vulnerable to developing problems stemming from those substances, and to struggle throughout the recovery process.

Women move more quickly through the stages of addiction, from initial exposure to a substance to dependence upon it. It takes less of a substance to affect a woman’s physiology, and health impacts are more severe. Women are more sensitive to cravings, experience more vivid mental emotional suffering during withdrawals, and are more prone to relapse.

Although the topic merits a lot more research, one consideration is the role of women’s hormones. As every woman knows, our hormonal systems are complex, such that we experience several hormonal shifts every month. These variations notoriously affect our mood, thoughts, and physical sensations.

It is perhaps no surprise that the hormonal aspect of the female experience interfaces with the topic of addiction. In this blog, we’ll look closer at what is currently known about women’s hormones and addiction.

Understanding hormones and their functions 

Hormones are tiny molecules that travel throughout the systems of the body, serving as chemical messengers. Chemical messengers are substances that communicate commands to activate or inhibit a body part or system.

Hormones are produced by glands, and are part of our endocrine system. They are released into the bloodstream and carried to organs and tissues, where they act upon those organs and tissues to excite or dampen them.

Hormones are responsible for balancing the body’s many systems, including metabolism. They are critical for restoring homeostasis, keeping body systems regulated and in check. Hormones also circulate in the brain, where they are intimately involved in triggering and modulating the stress response.

How do hormones impact addiction? 

Stress is connected to the release of a hormone called cortisol, which generates the uncomfortable feelings of stress, dread and agitation we feel when the body perceives a danger or threat to our survival or belonging to the herd.

High levels of cortisol over a sustained period of time is what leads to chronic stress. Too much cortisol in the body is linked to vulnerability to addiction, and also describes what happens to the body after traumatization.

Serotonin and dopamine are two other hormones which are involved in regulating mood and behavior. Adrenalin, oxytocin (the “love hormone”) and endorphin (the body’s natural painkiller) are hormones, too. Each of these hormones has a job which can be temporarily boosted or reduced through using drugs, alcohol, and prescriptions.

People who fall into the trap of addiction do so because these powerful systems of mood regulation, pain modulation, and reward become dysregulated through the introduction of chemicals which are foreign to the body. The dazzlingly complex operation of hormones in creating the human experience is still only slightly understood, but it has been established that hormones are affected, hijacked and depleted by substance abuse.

Which certain hormone phases are connected with addiction? 

The primary female sex hormones are progesterone and estrogen. These two hormones are important throughout the entire life cycle of women, affecting puberty, menstruation, PMS, pregnancy, menopause, and elderhood.

During reproductive years, estrogen is high during the first two weeks of a woman’s menstrual cycle. In this phase, women are more likely to experience feelings of happiness, positive mood, and to experience less cortisol and adrenalin, two hormones linked to the discomfort of stress and trauma.

Progesterone appears once ovulation occurs. Progesterone is linked to the area of the brain that is responsible for triggering a sense of alarm when perceiving danger, and is believed to be the cause of the moodiness associated with PMS. Progesterone is connected to higher levels of cortisol, which explains why women feel irritable and sensitive to stressors, as well as to triggers of traumatic memory during this phase.

Women who have a predisposition to higher levels of cortisol to begin with, such as happens with trauma, are likely to seek some sort of modulating substance during these two weeks of the cycle, whether it be eating fatty, high calorie foods or turning to drugs and alcohol. Women who are in recovery are more prone to relapse during these two weeks.

The operations of these hormones and the ways that they interact with other hormones like serotonin, dopamine, cortisol, oxytocin, and endorphins is incredibly intricate, subtle, and complex. It is important not to oversimplify, nor to imagine that any of these hormones operates out of a context of supreme interdependence.

It is safe to acknowledge, however, that during phases of the cycle when we experience higher amounts of progesterone, as during PMS, we are more likely to experience the feelings of unease and unhappiness which underly self-medicating behaviors.

What is estrogen’s link to substance abuse?

Estrogen is linked to sensitivity to pleasure. The interactions between addictive substances and estrogen may be such that women’s response to addictive substances is especially powerful during this stage, as one study on the effects of stimulants like cocaine in women has indicated. This suggests that women who have high estrogen levels may be more likely to become addicted to substances, as well as to form a powerful association between getting high and this stage of the menstrual cycle.

How does progesterone lower drug seeking behaviors?

When progesterone levels fall, estrogen becomes the dominant hormone, which may make women more sensitive to the effects of drugs and alcohol. During progesterone-dominant phases, women experience less sensitivity and responsiveness to the same chemical substance.

What are key hormones involved in substance use disorders?

Several hormones have an important role in the body when it comes to substance abuse and recovery. Awareness of these hormones and their relevance to addiction may inform the way that we approach treatment.

Cortisol

Released by the adrenal glands in response to a perception (or memory) of danger or threat, cortisol is often called “the stress hormone”. Cortisol prepares the body to act swiftly, as may be needed to run away from, fight off, or freeze to mitigate the effects of harm.

Cortisol is intended by nature to be a short-term, emergency solution, and it works by spiking blood sugar levels to fill the body with energy, momentarily suppressing the restorative, digestive, and immune systems. The condition of chronically high cortisol levels is also present in people with trauma and people who have high levels of stress as a daily experience.

People who experience chronically high levels of cortisol are at risk to develop substance use disorders. Elevated cortisol levels also increase the risk of relapse once in recovery.

Serotonin

Serotonin is a neurotransmitter influencing mood, sleep, and appetite. Serotonin levels are believed to explain the presence of mood disturbances like depression and anxiety. Drugs and alcohol change the level of available serotonin in the body. This impact on serotonin levels explains why people who are used to chronic mood disturbances tend to turn to drugs and alcohol to try to change serotonin levels. It also explains why, after drugs and alcohol have depleted serotonin levels, people will experience depression and anxiety symptoms.

Dopamine

Dopamine is the neurotransmitter connected to the brain’s reward circuit. Dopamine is released when we are behaving in ways that led to social or physiological rewards in the past. Dopamine feels pleasurable, and it is meant to reinforce behaviors that are good for the physiology’s health and longer term survival. Drugs and alcohol are believed to hijack the reward system, releasing dopamine artificially, even though we are not behaving in life-affirming ways.

Endorphins

Endorphins are produced naturally in the body when we experience pain. Endorphins interact with the brain’s opiate receptors, lessening pain and creating feelings of euphoria. Endorphins are meant to be released only in occasional cases of injury and pain. Opioids and other addictive substances were designed to bind to the same receptors in the brain, to induce euphoria and numbing. They are highly addictive due to the combination of painkilling and euphoria-boosting. Problematically, using substances reduces the body’s ability to produce endorphins naturally.

Norepinephrine

Essential for alertness and focus, norepinephrine is a hormone and neurotransmitter involved in the body’s high arousal system, or fight-flight. Stimulants like cocaine affect norepinephrine levels, temporarily boosting energy and concentration, while also triggering anxiety and leading to severe dependence.

GABA (Gamma-Aminobutyric Acid)

GABA is a neurotransmitter that inhibits nervous system activity, creating feelings of calm and relaxation. It works as a brake, dampening the effects of other hormones and helping the body to move into parasympathetic, or restoration and digestion states. Substances like tranquilizers and alcohol enhance GABA’s effects, initially creating feelings of well-being, and eventually leading to greater feelings of anxiety and cravings to use.

Gender differences in hormonal impact

The differences between men and women due to hormones have implications for treatment. Women can experience greater success in recovery from addiction when armed with the awareness of how their hormones influence mood, motivation, stress, and sensitivity. By tracking their hormonal cycles in tandem with substance abuse treatment, women can be prepared for phases of the month which represent different challenges, and take proactive steps to protect themselves from fluctuations in mood and urges to act destructively.

Hormonal changes across life stages

Fluctuating hormone levels affect women’s responsiveness to substances and vulnerability to relapse. Understanding how hormones feature in different stages of a woman’s life can be helpful for supporting recovery.  Here is an overview of how stages of life imply different hormonal considerations.

Adolescence

During adolescence, girls experience extreme fluctuations in sex hormones, making them more susceptible to risk-taking behaviors such as experimentation with drugs and alcohol. They are also more sensitive to the effects of alcohol and drugs. Exposure to drugs and alcohol during adolescence is highly correlated to long-term problems with neurotransmitter functioning, and vulnerability to addiction.

Pregnancy

During pregnancy, women experience a wash of hormones that can affect urges to use substances. Estrogen and progesterone changes impact stress and mood levels. Using substances during pregnancy can harm mother and fetus significantly.

Menopause

The decrease in estrogen associated with menopause may be experienced as depression, anxiety, and rapid fluctuation between moods. Women who have a history of using substances to cope with their unpleasant sensations and emotions are at a greater risk of relapse during this phase of life.

The role of stress and coping mechanisms

The role of stress is extremely important in addiction. When the stress system is activated, cortisol levels increase and positive feeling hormones and neurotransmitters are inhibited.

When experiencing chronic stress, the body is exposed to toxic levels of cortisol, which has negative health effects, leading to disease. When cortisol is present in the bloodstream, it is experienced subjectively as unease, dread, and agitation. When the nervous system is permanently dysregulated, a person can’t easily reduce cortisol back to normal levels naturally.

Being in a state of frequent cortisol activation, as happens when we grew up in an environment of many survival threats, leads women to self-medicating behaviors. These behaviors occur out of desperation to get a break from over-activation of sensations of dread, fear, and lack of safety.

During recovery, it is important to understand the role of stress, and to find coping mechanisms that heal chronic hyperarousal, such as tools from somatic therapy, yoga, nutrition, and mindfulness based therapies.

Integrating Hormonal Considerations into Treatment Plans

When working with women to recover from substances, hormonal considerations can be incorporated into treatment plans. Hormone levels may be tested, menstrual cycle tracking included as a part of teaching self-care and stress management practices, and stage of life considered in terms of hormonal impacts for women.

Impact of Hormones on Substance Use Disorders

In gender specific addiction treatment, such as that offered by Villa Kali Ma, the role of hormones in creating lasting peace and feelings of wellbeing in recovery can be safely explored. The impacts of hormonal phases and fluctuations can be  acknowledged and incorporated into healing work, to support women to understand their experiences and needs more compassionately. Each woman is unique and deserves to be met where she is at, hormonally as well as in every other way.

Substance Abuse among women is on the rise. Here are some statistics reflecting information gathered in the most recent national surveys and studies.

Substance Abuse Statistics for Women 

The following statistics are from the National Center for Drug Abuse Statistics and from the National Institute on Alcohol Abuse and Alcoholism.

• An estimated 12 million women in the United States qualify for Alcohol Use Disorder, about 8% of all women in America
• 17% of women have used drugs in the past year
• 5% of women abuse opioids
• 2% of women use heroin
• 4% of women abuse prescription pain killers; 9 million women have a prescription opioid abuse problem
• 4 million women abuse Hydrocodone
• 4 million women abuse Oxycodone
• 125,000 women abuse Fentanyl
• 5% of women use cocaine
• 4% of women use methamphetamines
• 6% of women misuse prescription stimulants
• 5% of women use marijuana
• 0% of women abuse prescription tranquilizers
• 5% of women abuse prescription sedatives
• 20% of people in drug treatment are women

Substance Abuse Differences between Men and Women

There are gender differences among men and women with substance use disorders. According to statistics gathered in large-scale studies comparing the genders, men are around twice as likely as women to abuse substances, except in the case of prescription narcotics (opioid medications) and tranquilizers, where the numbers are more equal.

Though men are more likely than women to abuse substances, women who do abuse substances are more likely than men to develop tolerance, become dependent, and develop an addiction. Women are also more likely to have adverse health effects from using substances, such as liver damage and psychological problems like depression and anxiety. Women progress more quickly than men from initial exposure to a substance to needing substance abuse treatment, a phenomenon called telescoping.

When women enter treatment, they present in worse condition than men, in spite of having used a smaller amount of the substance, for a shorter period of time. Women who use substances are more likely than men who use substances to have additional psychological, behavioral, medical, and social problems alongside their substance use disorder, and to qualify for a diagnosis of PTSD.

Hormonal differences between men and women are currently believed to have a role in women’s greater sensitivity to substances, as well as their greater vulnerability to relapse. Ovarian steroid hormones (estrogen and progesterone) and sex differences in how GABA-A and DHEA are processed may have an influence on drug related behavior. During phases of the menstrual cycle when progesterone is low and estrogen is higher, women are more sensitive to the effects of substances. They are also more likely to experience vulnerability to cravings, negative emotions, and impulsive behavior which can interfere with progress towards sobriety.

Relapse vulnerability may also be explained in part by sex differences in neuroendocrine adaptations to stress. Women are more likely than men to have what’s called hypothalamic-pituitary-adreonocortical (HPA) dysregulation, which means that women experience greater emotional intensity at lower levels of arousal of the stress system. This means women subjectively experience the triggered state more vividly than men with a comparable substance use history.

The role of co-occurring disorders is also important to consider. Women are significantly more likely than men to have a lifelong diagnosis of a mood or anxiety disorder than men. Women who use substances are also significantly more likely to have a co-occurring eating disorder, such as bulimia. Finally, the link between post-traumatic stress disorders and substance abuse in women is critical to acknowledge, with the majority of women who enter treatment qualifying for PTSD or complex PTSD.

Alcohol

Alcohol is the most commonly abused substance in the United States. In the past, cultural norms that inhibited women from drinking alcohol meant that women were less likely to become addicted to alcohol than men. The gap between the genders when it comes to alcohol abuse has lessened over time, and the number of women presenting with a need for treatment for their alcohol use is ever on the rise.

Particularly troublesome is the fact that women are more likely to develop dependence on alcohol than men, while consuming lower levels of alcohol. Women progress through the phases of alcohol addiction more swiftly, and are more vulnerable to relapse once sober.

Health impacts of alcohol abuse are also stronger on women, with women more likely to manifest disease and tissue damage. Among people diagnosed with alcohol use disorder, women have a higher death rate, due to suicide, alcohol-related accidents, stroke, and liver disease.

Women are more likely than men to struggle with co-occurring conditions that complicate recovery, such as trauma and mental health disorders. Women are less likely than men to seek treatment, and to face gender specific barriers in treatment, such as financial problems and childcare issues.

Benzodiazepines

Alcohol use may have been socially unacceptable, but women have always been prone to becoming addicted to prescription depressants with similar effects to alcohol, such as tranquilizers and sedatives prescribed by their doctors to treat “nervous disorders”.

Contemporary prescription depressants, like the benzodiazepine class of drugs (Xanax and Klonopin, for example), continue to be popular drugs of abuse among women, often leading to severe dependency with multiple health impacts.

This situation may be owed in part to the ways that trauma is misunderstood and the ways that gender affects expressions of distress externally; women are more likely than men to be diagnosed with an anxiety disorder, and consequently to be prescribed addictive pharmaceuticals as a way to reign in symptoms of chronic nervous system hyperarousal.

Opioids

Opioids are a serious problem for both genders. However, women are generally more sensitive to pain, and more likely to be diagnosed with a chronic pain related syndrome, which can lead to a prescription for opioid pharmaceuticals, introducing the addictive substance to the more substance-sensitive and habit-forming female body.

Given the same exposure levels, women are faster to develop tolerance, dependence, and to spiral into addiction. Nevertheless, men are more likely to die from an opioid overdose than women, though recent death tolls indicate that female death by opioid overdose is rising by faster numbers than male opioid deaths. Women are less likely to inject an opioid intravenously, such as heroin or fentanyl. However, if they do, they are more likely to overdose.

Marijuana

Marijuana is the most popular illicit substance in the United States, with almost 100 million Americans self-reporting that they have tried it – about 40% of the population at the time of the 2003 National Study on Drug Use and Health. Women are less likely than men to use marijuana daily, and begin using marijuana at a later age, on average. Marijuana use may be linked, for some women, to stages of the menstrual cycle, particularly for women who have severe PMS or a diagnosis of Premenstrual Dysphoric Disorder.

The effects of marijuana may also be different for men and women. Women are more likely to move faster through the stages of addiction, developing dependency after a shorter period of use than a male using the same amount. Adverse impacts on memory and attention have been observed to affect women more strongly than men, as well.

Stimulants: Cocaine and Meth

The interactions between hormones and the effects of stimulants may explain why women are more sensitive to cocaine’s effects, including its addictiveness, than men. There is a link between estrogen and sensitivity to stimulants according to one study on cocaine, which may reinforce the addiction cycle in women.

As with other classes of addictive substances, women are generally less likely than men to try stimulants. If they do experiment with stimulants, however, including prescription stimulants like Ritalin, women tend to progress through the stages of addiction more quickly than men.

Women experience greater effects and stronger dependence from lower levels of the substance, as well as worse health impacts. Women struggle more with mood dysregulation, cravings, and relapse once sober.

Ecstasy

MDMA, or Ecstasy, is a stimulant and hallucinogen. Some findings suggest that women experience more euphoria under the influence of ecstasy, stronger hallucinations, and more depression following ecstasy use, than men do.

Prescription Drugs

There are three categories of prescription drugs which represent a serious risk of addiction: benzodiazepines, opioids, and stimulants.

The benzodiazepine class of drugs (tranquilizers and sedatives, such as Xanax and Klonopin), is a common source of addiction among women.

Prescription opioids are also a widespread problem. Although men and women suffer in equal numbers, it’s important to recognize that medications like OxyContin have been widely diagnosed to women due to their greater sensitivity to pain and their greater likelihood of being diagnosed with chronic pain.

Prescription stimulants like Ritalin and Adderal, commonly used to manage symptoms of ADHD, are also prone to abuse and addiction. While women are still less likely than men to be diagnosed with ADHD, more and more women are being diagnosed as criteria are expanded to include less obviously disruptive symptoms of the disorder.

If prescribed a stimulant for their ADHD, or if experimenting recreationally with ADHD medications, women are more likely to have an addictive response to it, more likely to move from use to abuse, and on to dependence.

Why are women in recovery more susceptible to cravings and relapse?

Once women enter treatment and begin a life in recovery, they are more prone to experience intense cravings and to succumb to relapse than men. This difference is owed to a few factors, including fluctuations in hormones that mean women experience changes in mood and levels of stress each month, as well as throughout different life stages and transitions.

Estrogen, as a hormone linked to feelings of pleasure and well-being, is linked to women’s greater sensitivity to habit forming experiences of euphoria. Progesterone, on the flip side, is linked to greater feelings of stress, irritability, and depressed mood. The complicated dance between female hormones and the other key neurotransmitters responsible for mood, motivation, reward, pain, and stress, create a greater overall risk, due to more vivid cravings and stronger urges to self-medicate for emotional reasons.

Beyond hormonal considerations, women are more likely to suffer from co-occurring mental health disorders and traumatization than men. This means that upon achieving a measure of basic sobriety and stability, more women than men have the immediate and challenging task of facing a pre-existing condition of chronic painful emotions and states.

The high incidence of sexual trauma history among women who use substances also explains the challenges many women face once they stop using substances. They must quickly stabilize new behaviors and coping tools that really work to reduce the severe distress of trauma symptoms, or they will find themselves turning to substances again to modulate their intense experiences as before.

Overcome Substance Abuse in Women

Everything about addiction is different for women, and recovery is different too. Women report different reasons for using drugs and alcohol in the first place. Women have different pre-existing conditions, from the basics of biology to the many vulnerabilities inherent to being female in our society. What drives a woman to latch on to certain substances as a strategy for coping with chronically disturbed emotions, can be quite opposite from the reasons the man next to her reaches for the same tool. Once in recovery, the intense, ever-changing emotional waters that women are immersed in by nature, affect and inform their experiences of recovery. Our more emotional and relationship-oriented connection styles, once healed, become vast resources for profound transformation.

For all of these reasons, and more, we believe in our hearts that supporting women in gender specific treatment environments is the key to healing womankind from the triple burdens of addiction, mental illness, and trauma. Our many programs for women reflect the value we place on women’s experiences, and how much we want to do to help women to flourish in this world, for the benefit of all.