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 (https://villakalima.com/the-villa/) and outpatient (https://villakalima.com/intensive-outpatient-program-for-women/) 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 (https://www.tandfonline.com/doi/abs/10.3109/10826089509055829).
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 (https://traumatized.com/library/judith-herman-complex-post-traumatic-stress-disorder/) in the 1990s in her trailblazing book, Trauma and Recovery (https://archive.org/details/traumarecovery00herm_0). While not classed as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (https://psychcentral.com/disorders/dsm-iv-diagnostic-codes) 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 (https://drdansiegel.com/). The framework is called “the window of tolerance” (https://www.betweensessions.com/wp-content/uploads/2022/10/Understanding-the-Window-of-Tolerance_101422_ad.pdf).
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 (https://www.polyvagalinstitute.org/whatispolyvagaltheory) 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 (https://psycnet.apa.org/record/2017-42390-001)) 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 (https://villakalima.com/).