The Good and the Bad of Trauma Theory in Addiction
Why the Life Process Program doesn’t focus on trauma—it doesn’t work!
Trauma theory has come to dominate addiction practice. It is commonplace to hear assertions that all addiction is due to trauma, or the converse—no one can escape the trauma in their lives. Both of these statements are not true, as I will illustrate with case examples from the popular press.
- Trauma does focus on life experience. First, the good thing about trauma theory. It doesn’t assume that people inherit problems genetically. In the case of mental disorders, including addiction, it is now clear that we cannot trace emotional problems, addiction, and alcoholism to specific genes, or even combinations of genes. One proof of this is that most people overcome their addictive problems with maturity, age, and responsibility—an impossibility if these problems were anchored in people’s DNA. Trauma theory correctly notes that people’s life experiences are the source of such problems. On the other hand, the kinds of traumatic life events detailed in the ten-item ACE (adverse childhood experience) scale are not usually specific events, but rather long-term, ongoing experiences during childhood. ACE items, answered with a simple “yes” or “no,” are typically stated this way: “Did you often or very often feel that. . . . No one in your family loved you or thought you were important or special?” (item 4) or “Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you?” (item 2). Even those things that could be characterized as individual events often exist throughout childhood, such as “Were your parents ever separated or divorced?” (item 6) or “Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?” (item 8).
- Trauma theory is considered as irresistible as genetics. When trauma is thought of as an ineradicable experience, one permanently imbedded in, or that damages, the brain, it become a lifetime disease meme much like the idea that addiction is caused by genes. And, yet, we see in study after study that most people outgrow their addictions. Of course, the problem with thinking that your addiction is permanently imbedded in your brain is that this makes you less likely to be able to overcome it. Instead, as Maia Szalavitz makes clear, “Healing a broken heart is difficult and often involves relapses into obsessive behavior, but it’s not brain damage.” The Life Process Program is geared towards understanding your problems, and to recognize the pathways out of them are within your grasp. Here is how J.D. Vance, the author of Hillbilly Elegy, about his Appalachian childhood among dysfunctional relatives, a broken home, and much mental illness and addiction, still managed to find his way home by idolizing President Obama:
The president’s example offered something no other public figure could: hope. I wanted so desperately to have what he had — a happy marriage and beautiful, thriving children. But I thought that those things belonged to people unlike me, to those who came from money and intact nuclear families. For the rest of us, past was destiny. Yet here was the president of the United States, a man whose history looked something like mine but whose future contained something I wanted. His life stood in stark contrast to my greatest fear.
Vance got a good education and formed his own stable family. But one thing that helped him along the way was to find—as he describes in this article—a role model, in this case President Barack Obama. But others were involved in his escape from potential trauma: “There were many personal heroes in my life: aunts and uncles, a protective sister, a father who re-entered my life at the right time.” We need such role models. Fortunately, they are all around us.
- Trauma theory ignores the world people live in. Vance grew up amidst impoverished and ruined lives. Consider item 5 in ACE: 5. Did you often feel that . . .You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?” Here is one description of life in an area like this: McDowell County, West Virginia, and its impact on inhabitants:
Towns are hollowed out as people flee, and communities are scarred by family dissolution, prescription drug abuse and a high rate of imprisonment. . . .”He had another seizure the other night,” Ms. Bolden, 50, said of her son, John McCall. John got caught up in the dark undertow of drugs that defines life for so many here in McDowell County, almost died of an overdose in 2007, and now lives on disability payments. His brother, Donald, recently released from prison, is unemployed and essentially homeless.
Poverty and social isolation are hard burdens to overcome. But they are not lifetime diseases. They cannot, and should not, be totally eradicated from our minds. But the don’t have to—they don’t—dictate our futures, so long as people can escape these oppressive worlds.
- Hopefulness is the most important curative factor in recovery. Vance idolizes the former first family. And, indeed, Michelle Obama’s greatest contribution to the American psyche was her insistent emphasis on HOPE, which is the greatest curative factor of all, including for addiction. Hopelessness, on the other hand, is the greatest burden to recovery. Thus, LPP is a hopeful program. Ken Anderson reviewed the literature of negative childhood events. He found that overemphasizing their determinative role in people’s lives reduced people’s success at recovery. Should people with a substance use disorder seek out an underlying trauma or a repressed memory as the cause? The answer to this is an unqualified no! If you find a therapist who promises to cure your addiction by recovering repressed memories of childhood trauma, run—do not walk—the other way. Instead, as one of our coaches, Dolores Cloward, made clear:
Let me start by saying that you absolutely can quit drinking vodka (et al.) if that’s your goal and it’s causing you problems. Support and information can help, but bottom-line, your own determination and effort are the things that will make the difference, as with most (all?) endeavors in life.
There is no magic to wanting to stop a behavior that’s hurting you. Dr. Peele and the Life Process Program approach emphasize creating a full life and tapping into your own strengths and resources to better do that. That involves some focused work on where things stand, what you feel your current resource/skill level is now and what you might want to work on, and finding and maintaining the motivation to do the things you want to, including stopping using/drinking, and taking action. There is no program in the world that is going to just “work,” without thought and effort on your part.
What about the worst trauma—post traumatic stress. As Ken Anderson’s post makes clear, most negative events in our lives don’t really qualify us for post-traumatic stress disorder (PTSD), and it is harmful to think that they do. But there are situations that do qualify for a PTSD diagnosis, like war theaters—although, even there, most people’s resilience carries them through. And what helps people with PTSD? As Anderson’s article makes clear, the best therapies for PTSD emphasize hope (that is, expectations that people can improve) and skill training—which is exactly what LPP provides.
If you believe that you have PTSD, you should of course seek medical advice. Good therapies for PTSD, as discussed by Schnyder et al. (2015), are time-limited (often eight to 16 sessions), conducted with guidance of a therapy manual, and delivered by therapists specially trained in the specific technique. Good PTSD therapies help to reduce unhelpful strategies such as rumination, hypervigilance for threat, thought-suppression, and excessive precautions. Finally, good PTSD therapists will only give you treatment for PTSD only if there is a genuine diagnosis.
But if you are one of the 94% of people with a substance use disorder who do not have PTSD, you should not seek out treatment for PTSD, even if you—like most people—have suffered some trauma in your past.
One other major factor that determines successful emergence from even the worst trauma is supportive relationships and communities—towards which LPP also directs client. Here is what Sebastian Junger, a writer who covered the war in Afghanistan who himself experienced PTSD, found to be most effective in both the scientific and anthropological research: “Because PTSD is a natural response to danger, it’s almost unavoidable in the short term and mostly self-correcting in the long term. Only about 20 percent of people exposed to trauma react with long-term (chronic) PTSD.”
But what creates the best possible environment for cure is not a therapy, as Junger identifies, but the communities to which people return, and become a part:
In other words, the problem doesn’t seem to be trauma on the battlefield so much as re-entry into society. Anthropological research from around the world shows that recovery from war is heavily influenced by the society one returns to, and there are societies that make that process relatively easy.
It is those societies that allow people to mend their psychological wounds that do the best for those who experience trauma. We are not such a society: but “the spirit of community healing and empowerment that forms the basis of these ceremonies (in healing societies) is certainly one that might be converted to a secular modern society.”
And, so, think of LPP as your recovery society (along with nondisease recovery groups we recommend, such as SMART Recovery). We want to help you to create a world of recovery where your chance for wellness is both our goal, and our—and hopefully your—expectation.