Trauma and substance use disorder often develop hand-in-hand. For many trauma survivors, substance use begins as a way to sleep through the night, quiet racing thoughts, or escape memories the body never had a chance to process. What starts as an attempt to manage overwhelming emotions or physiological distress can evolve into a cycle that reshapes the brain’s stress, reward, and decision-making systems. Without support, this cycle can disrupt relationships, emotional stability, and long-term wellbeing.

If this feels familiar, you’re not alone - what you’re experiencing is a nervous system trying its best to make it through something it never asked for.

If you or someone you know feels hopeless or is having thoughts of self-harm related to trauma or substance use, please seek help immediately. In the United States, you can call or text 988 to reach the Suicide and Crisis Lifeline or dial 911 for emergency assistance. Effective treatments exist, and recovery is possible.

Understanding Trauma and Addiction

Trauma is not just a memory, it is a physiological imprint that can shape the brain for decades. When overwhelming events occur without adequate support, the body and nervous system adapt to survive. These adaptations often take the form of chronic fight, flight, or freeze responses.⁶ What once helped someone survive an overwhelming threat can become a default state - shaping sleep, emotion regulation, relationship patterns, and vulnerability to substance use. These responses aren’t character flaws; they’re survival strategies that simply never got updated once the danger passed.

Research consistently shows strong associations between trauma exposure and substance use disorders, especially when trauma occurs early in life.³ Many individuals use substances to numb fear, cope with intrusive memories, or quiet a constantly activated stress response.

Below, we’ll explore how trauma changes the brain, why these changes influence addiction, and what approaches help people heal both.

How Trauma Rewires the Brain

The Brain’s Stress System

Trauma sensitizes the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress system. Dysregulated cortisol patterns and chronic hypervigilance become common, making it difficult to feel calm or grounded.⁷ This constant physiological activation raises the likelihood of cravings, as substances can temporarily soften the stress response. Many trauma survivors describe using substances not to “get high,” but to take the edge off chronic hyperarousal - making relapse more likely during stressful periods. It’s not about chasing a high; it’s about chasing a moment of peace in a body that rarely feels safe.

The Limbic System and Emotional Memory

The amygdala, responsible for detecting threats, becomes hyperreactive after trauma, while the hippocampus, which processes memory, may shrink or function less effectively.⁵ This leads to overwhelming emotional responses and a sense of being “hijacked” by fear or distress. These emotional surges may also be triggered by “body memories” - sensory cues such as smells, sounds, or physical sensations that unconsciously remind the body of past trauma. For many people, this isn’t something they can “think their way out of” - their body reacts before their mind has a chance to catch up.⁶

Impaired Executive Functioning

Trauma reduces activation in the prefrontal cortex (PFC), the part of the brain responsible for planning, decision-making, and impulse control.¹ When the PFC is offline, emotional regulation becomes harder, and the brain becomes more vulnerable to compulsive behaviors, including substance use.

Why These Changes Matter for Addiction

When someone is overwhelmed or on high alert, using substances can feel like quick relief. For a moment, the body calms down, emotions feel quieter, or there’s a sense of escape or connection.

Over time, the brain starts to link these experiences together:

Feeling bad (distress) → substance → feeling better (relief).

This cycle becomes deeply ingrained, not because someone is weak, but because the brain learns patterns meant to help them survive. Breaking this cycle is much harder without trauma-informed support.

Why Trauma Increases Vulnerability to Substance Use

Self-Medication and Emotional Escape

Many trauma survivors use substances to cope with intrusive memories, anxiety, shame, or chronic dysregulation. Trauma disrupts emotional literacy and regulation, leaving individuals oscillating between numbness and overwhelm. When you don’t have a safe place to put all that intensity, substances can feel like the only door out. Rebuilding the capacity to name, feel, and tolerate emotions is one of the most important tasks in trauma-informed addiction recovery.³

Attachment Wounds and Developmental Trauma

When safety, consistency, and emotional attunement are disrupted in childhood, the brain learns to prioritize survival over connection. This increases risk for both addiction and difficulty trusting others during recovery. Many survivors also develop “learned aloneness,” a belief that they must manage distress entirely on their own. This relational wound can make reaching out for help feel unsafe, increasing reliance on substances as the only reliable form of comfort. What looks like withdrawal or self-reliance is often a lifetime of learning that closeness comes with a cost.⁶

The Role of Shame

Trauma often leads to deep feelings of unworthiness or “brokenness.”

• Shame fuels avoidance.

• Avoidance fuels substance use.

• Substance use fuels more shame.

Shame is one of the most powerful nervous system activators we know - and one of the most misunderstood.

Why Standard Recovery Models Can Fall Short for Trauma Survivors

Traditional recovery models often emphasize insight, motivation, or compliance. But trauma survivors may struggle because:

• Threat responses overpower logical reasoning

• Internal triggers (sensations, flashbacks, loneliness) drive relapse more than external ones

• Rigid or punitive approaches may retraumatize

• Emotional dysregulation can be misinterpreted as resistance

  
  

Because of these factors, clients may appear “unmotivated” or “noncompliant” when they are actually dysregulated. Their nervous system is prioritizing survival over participation, and traditional models that emphasize willpower or cognitive insight may unintentionally overlook this. 

In trauma-informed care, we understand that people must first regulate (feel safe in their body), before they can relate (connect with another person), and only then can they reason (think clearly and learn new skills). In other words: calm the body, connect with someone safe, then work on the thinking part. When trauma isn’t addressed, relapse prevention often focuses only on the reasoning part - and misses the deeper drivers of cravings and urges.

Evidence-Based Treatments for Trauma and Addiction

Effective trauma treatment is rarely linear. Most evidence-based approaches follow a broad sequence: stabilizing, regulating, processing, and integrating.

Trauma-Informed CBT, DBT, and ACT

Trauma-informed cognitive and behavioral therapies help clients understand how trauma has shaped their thoughts, feelings, and behaviors. In trauma-focused CBT, clients learn to recognize and shift beliefs that maintain fear or avoidance.

Dialectical Behavior Therapy (DBT) adds essential skills in distress tolerance, emotion regulation, and interpersonal effectiveness, making it particularly helpful for individuals with intense emotions or trauma-related impulsivity.⁴

Acceptance and Commitment Therapy (ACT) helps clients build psychological flexibility, learning to relate differently to painful thoughts and sensations while taking action aligned with their values.

Together, these approaches strengthen cognitive understanding, enhance emotional regulation, and support behavior change in both trauma and addiction recovery. These therapies teach people how to work with their mind instead of feeling trapped inside it.

EMDR, CPT, and Prolonged Exposure

Trauma-processing therapies work directly with traumatic memories and their emotional and physiological impact. Eye Movement Desensitization and Reprocessing (EMDR) uses bilateral stimulation to help the brain integrate experiences that previously remained stuck.²

Cognitive Processing Therapy (CPT) targets “stuck points” - rigid trauma-related beliefs that interfere with recovery.

Prolonged Exposure (PE) gradually reduces avoidance and recalibrates the fear response system.

These therapies are most effective once clients have adequate stabilization and can safely engage in trauma processing.²

Experiential and Somatic Therapies

Somatic and experiential therapies work directly with the body, senses, and action systems - the places where trauma often lives.⁶ Somatic practices such as grounding, breathwork, and guided movement support nervous-system stabilization and increase tolerance for emotional intensity.

Experiential methods - including sociometry, guided enactments, values mapping, bilateral exercises, and sensory-based interventions - allow clients to practice new patterns of safety and connection in real time. These approaches also expand a client’s “role repertoire,” giving them opportunities to rehearse new relational and emotional responses in ways that reshape long-standing survival patterns. In experiential work, change isn’t just talked about - it’s practiced, felt, and lived.

When paired with modalities like CBT or DBT, experiential work enhances integration and long-term recovery.

Group Therapy

Group therapy offers connection, belonging, and mutual aid - core ingredients in healing relational trauma. Clients learn that they are not alone, experience corrective emotional interactions, and practice relational skills that counteract isolation and mistrust.

For individuals navigating substance use or recovery, group spaces also provide a powerful antidote to the shame, secrecy, and learned aloneness that often accompany addiction. Hearing others speak openly about their struggles normalizes the recovery process and reduces the burden of self-blame.

Group work also reduces shame, strengthens motivation, and offers a consistent experience of safety in community. It is often most effective when combined with individual therapy.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) uses FDA-approved medications to treat opioid and alcohol use disorders. MAT reduces cravings, stabilizes neurobiology, and lowers the risk of relapse and overdose, creating a safer foundation for trauma work.⁸

Medications such as buprenorphine, methadone, acamprosate, and naltrexone help clients regain stability so they can fully participate in therapy and long-term recovery.

As clients gain medical stability, they also begin developing emotional sobriety - the capacity to meet emotions with presence rather than avoidance - a concept well-established in trauma and addiction literature.²

The Brain’s Capacity to Heal: Neuroplasticity and Recovery

The brain is not static. Neuroplasticity allows the nervous system to reorganize in response to consistent, safe experiences. Over time, trauma-informed therapy, supportive relationships, and healthy routines strengthen the brain circuits responsible for regulation and resilience. Experiential repetition - practicing new emotional, relational, and somatic patterns - helps encode new neural pathways, replacing trauma-driven responses with a growing sense of safety and self-efficacy.⁶

Recovery becomes not just the absence of substances, but the presence of safety, identity, and connection. This is the part many people don’t realize: the brain can learn safety again.

Understanding Trauma, Addiction, and Hope

Trauma-related substance use is not a sign of failure - it is an adaptation to overwhelming pain. When individuals receive trauma-informed, evidence-based care, they can heal both the wound and the coping strategies built around it.

If you or someone you love is struggling with trauma or substance use:

• Call or text 988 in the U.S. for 24/7 crisis support

• Contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) for treatment referrals

• Connect with a licensed therapist or addiction specialist

  
  

Support is available, and healing is possible. Trauma may shape the beginning of the story, but with the right support, it does not have to define the ending.

References

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4. Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and PTSD in an urban civilian population. Depression and Anxiety, 27(12), 1077–1086.
   
   

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7. van der Kolk, B. A. (2014). The Body Keeps the Score. Viking.
   
   

8. Maglione, M. A., Raaen, L., Chen, C., Azhar, G. S., Nima, S., Shen, M., Maksabedian Hernández, E. J., Shanman, R. M., & Hempel, S. (2020). Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review. Rand Health Quarterly, 8(4), RR-2108.
   
   

9. Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—Tackling the opioid-overdose epidemic. New England Journal of Medicine, 370, 2063–2066.