How Trauma Leads to Addiction and Substance Use—and What Helps People Heal

Let’s start by redefining addiction. According to the American Society of Addiction Medicine (ASAM), addiction is a chronic brain disorder. That means it changes how your brain works—not because you’re weak or broken, but because your brain has adapted to intense stress and trauma in ways that are meant to protect you, even if they hurt you in the long run.
Yes, genetics can play a role in addiction. If addiction runs in your family, you may be more prone to it. But genes aren’t destiny. Environmental stressors—like poverty, instability, peer pressure, and especially trauma—are often the tipping points.

One of the most powerful tools we have for understanding the link between trauma and addiction is the Adverse Childhood Experiences (ACE) study. It looks at how early experiences of abuse, neglect, and household dysfunction—like having a parent with mental illness or substance use issues—can affect health later in life.

The higher your ACE score, the more likely you are to struggle with mental health issues, chronic illnesses, and yes, substance use. Trauma shapes our brain development, our coping mechanisms, and how safe we feel in the world.

Trauma-informed care is a strengths-based approach to treatment that recognizes the widespread impact of trauma and assumes it may be present—even if a person hasn’t explicitly disclosed it. This approach helps us look beyond behavior to understand the “why” behind it.

Trauma-informed care helps us see that using drugs or alcohol might have been the only “life jacket” someone had to keep from drowning.

Instead of asking “What’s wrong with you?” we ask, “What happened to you?”

It’s not about diagnosing PTSD in everyone with trauma. Not every individual who experiences trauma will develop symptoms like flashbacks or hypervigilance. But those who do often turn to substances as a way to cope, numb, or escape. Trauma-informed care helps us see that using drugs or alcohol might have been the only “life jacket” someone had to keep from drowning.

Here’s what happens in the brain: repeated or chronic trauma over-stimulates the amygdala—the part of the brain responsible for our fight-or-flight response. When this system is always on, it creates a state of constant anxiety, fear, and hypervigilance. Substances often help quiet that inner alarm system—at least temporarily.

But here’s the catch: when someone stops using, those trauma symptoms often roar back stronger than ever. Nightmares, flashbacks, irritability—they all come flooding in. That’s why treating addiction without treating trauma is like patching a leak without fixing the pipe.

If we want real healing, we have to treat both conditions at the same time. That means:

• Re-establishing safety: For many people, especially those who’ve lived through trauma, safety doesn’t just mean physical safety—it means emotional and internal safety too. Creating a warm, welcoming, nonjudgmental environment is essential.
• Identifying triggers: Both internal (feelings, body sensations) and external (places, people, situations) triggers can lead to relapse. Teaching people to recognize and respond to these is key.
• Using evidence-based trauma therapies: Modalities like EMDR (Eye Movement Desensitization and Reprocessing), Brainspotting, and Internal Family Systems (IFS) can help process trauma safely and effectively.
• Offering coping skills: People need tools to replace substance use. Mindfulness, yoga, peer support, medication, and therapy are all part of a holistic treatment plan.
• Moving at the right pace: Trauma recovery isn’t one-size-fits-all. We never force someone to open up before they’re ready. In fact, asking too much too soon can do more harm than good.

Telling someone with a trauma history to “just stop using” can feel like asking them to give up the only thing that has kept them afloat. Let’s think about it from their perspective.

Lisa Ferentz, in her book Letting Go of Self-Destructive Behaviors, uses a powerful metaphor: she describes how professionals often stand safely on the deck of a cruise ship, calling down to someone floating in the ocean surrounded by sharks, urging them to give up the only life jacket they’ve had—because it’s “not good for them.” But from the floating person’s perspective, that life jacket—whether it’s drugs, alcohol, or another form of coping—has kept them alive. Instead of demanding they let go of it, we need to offer safer, more effective alternatives. That metaphor really stuck with me because it reminds us that healing doesn’t happen through judgment, but through compassion, safety, and support.

Addiction is complex. Trauma is complex. But with compassion, the right tools, and a willingness to look beyond behavior to the pain underneath, healing is possible.

If you or someone you love is struggling with substance use, know this: there is hope. And you don’t have to go through it alone.