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Hayley: Hello! This is your host, Hayley; welcome to Straight Talk With The Doc.
Dr. Bhatt: I’m good Hayley, how are you doing?
Hayley: I’m doing good too, thank you. Dr. Bhatt, you’ve worked with many people who have dealt with a mental health disorder (some disorders being more common than others), and certain disorders can be brought on by traumatic events.
In America, 70% of adults have experienced some type of traumatic event at least once in their lives. Some recover just fine, some need a little help to recover, and others have long-lasting effects. I want to talk about that today, and I also want to go over the link between trauma and addiction.
But first I want to talk about what defines a traumatic experience. Dr. Bhatt, what qualifies as a traumatic experience — and are there different types of trauma?
Dr. Bhatt: That’s a good question, and I think many people hear the word trauma now and often they can confuse it with a more qualified diagnostic mental illness like post-traumatic stress disorder (they often can equate one to another). So I’m glad you’re asking that, because yes: you need a traumatic event to have post-traumatic stress disorder, but not all traumas lead to post-traumatic stress disorder.
What types of traumas exist? Well, first of all, trauma is defined as something that somebody experiences that leads to a physical, psychological, emotional consequence that is enduring or temporary. It causes distress, and there’s different types of trauma that can occur. People who have a loss or death in the family, experience some sort of violence or assault, or have medical illnesses can be traumatized.
We see people in the military when they go off to war and combat; many of our veterans have been exposed to a lot of very traumatic experiences just due to the violence that they experience being in the military.
There’s other things that we experience that can be traumatic, such as natural disasters, separation from people, bullying; bullying can be very traumatic, and even neglect can be traumatic.
So there are multiple different types or classifications or instances that can be traumatic for an individual and lead to psychological, emotional, or physical distress that could ultimately lead to the development of the actual mental illness of PTSD.
Hayley: Does it matter when the trauma happens in someone’s life? Is it different when it happens to a child versus an adult?
Dr. Bhatt: The difference is how the experience has been appreciated: how your cognition is, what your resiliency is like at the time, and how different parts of your brain communicate and relate to one another and interpret that experience.
Cognition has a lot to do with it (the more we are aware of something); there are other underlying risk factors that could or could not be present: the presence or absence of associated mental illnesses may increase our risk or decrease our resilience.
When you talk about a time frame or age, I believe if you’re not cognitively intact or if you haven’t developed a level of cognition — sometimes maybe just your lack of awareness if you’re very early in childhood where you’re not aware and you cannot recall those memories — maybe you’re a little bit more immune to the presence of something that you can’t appreciate cognitively.
When we get older, we’re cognitively intact; then we can record and remember and be aware of that experience — it becomes more vivid to us. Again, I think if we have vulnerabilities there, whether they be mental or physical, they can increase our risk for that trauma being more profound to the individual.
Hayley: So it’s not as much the age, but it’s more the level of resilience.
Dr. Bhatt: Yeah, I think it goes hand in hand; it’s compounding, it’s together, it’s collective.
If we have childhood trauma it can have more of an enduring effect because it’s happening during our development, and it’s happening during periods where we might not have gained certain resiliencies or coping or experiences; we’re often dependent on other people as our caregivers.
Childhood experiences, childhood traumatic events can have lifelong enduring effects. I don’t want to negate age or minimize it in this conversation at all, childhood traumas are a huge component for people developing long-lasting effects, but also, at the same time, many children are resilient — I gave you that example of our ability to recall certain things and how we cannot just recall a memory, but the memory being cemented in our brain in the first place.
It’s all related.
Hayley: One study I saw was of adolescents who are receiving treatment for substance abuse, and it found that 70% of them had a history of trauma exposure. Why does childhood trauma lead to substance abuse?
Dr. Bhatt: Childhood trauma can lead to substance abuse because trauma is related to the development of mental illness, depression, and anxiety; mental illness is often related to substance use disorders.
It’s all connected.
Does it have to occur? No. But does it increase your risk? Yes. Many times, when we first start to use substances, we’re doing it to experiment or to fit in.
But after time, depending on the effect that alcohol or drugs have, they could be used as a coping mechanism. If there’s something that you’re trying to escape from: a negative emotion, a physical pain, some sort of memory that is — of course — negatively affecting somebody, by using a drug it helps us escape or blunt the pain. That can reinforce our continued use.
So, if we do have more traumatic experiences and negative psychological consequences, then we go and chase or use drugs or alcohol as a mechanism to cope; that increases our chance of developing a substance use disorder.
Hayley: What can people do to help? How can you stop someone who had a traumatic childhood experience from using substances to cope?
Dr. Bhatt: First of all, we have to address the traumatic experience in the first place. We’re under the assumption here that the child has not developed a substance use disorder or is not using drugs. Proper treatment to address that traumatic experience is first and foremost.
If somebody has developed some sort of depression or anxiety — or many different types of psychological effects that can happen depending on the type of trauma, neglect, physical abuse, or sexual abuse — therapies can address the symptoms that are consequences of that offending trauma.
If we address the consequences of any traumatic event, we can minimize the usage of drugs to cope with that because we’re giving a proper therapeutic intervention. That’s really the best way to help prevent subsequent substance use: getting proper treatment and proper therapies and having trauma acknowledged.
Validation should happen without embellishment or regurgitation; I do believe traumas are often inadvertently over-processed and, unfortunately, projected by others. Especially with children, because children might be coping with trauma, dealing with it, but the subjective appraisal of the caregiver might be more “Hey, something had to have happened” — and they’re projecting their own sentiment and their own appreciation of the event (sometimes they’re digging more than they should.)
Some studies after 9/11 have shown how debriefings sometimes have had negative consequences for people who have had traumatic events happen to them. The short answer is: make sure we address it without complicating it, and that will minimize further risk that substance use occurs due to that traumatic event.
Hayley: At the start of the episode, you mentioned post-traumatic stress disorder. Can you quickly explain: What is PTSD? Where’s that line between “just” trauma and PTSD?
Dr. Bhatt: Trauma is the event (or the subjective appraisal of that event) and how we deal with it emotionally and how we respond to that.
But PTSD is an actual cluster or diagnostic criteria symptomatology that is altogether a mental illness. It usually occurs when somebody is exposed to a life-threatening or perceived life-threatening event, so there has to be that initial criteria: that a person has witnessed, perceived — or even through a loved one or somebody close to them indirectly — had exposure to some sort of event that they perceived as seriously life-threatening to them.
It could be sexual, it could be physical, it could be a natural disaster, but it has to be of significant magnitude. It has to have that initial stressor.
But, beyond that which is the trauma, then they have a second set of criteria where they have this persistent re-experiencing, these intrusive symptoms where they have nightmares or flashbacks and they have a lot of distress, things that will remind them of that event — and with it, because of those things, they avoid anything that might remind them of any thoughts or feelings that will occur due to those triggers; that leads to that fourth set of criteria that their mood gets altered, they can’t recall certain things, they have negative depressed affect, they often feel isolated (depressive types of symptoms will occur).
The last major one is that they have to have this increased irritability or hypervigilance or hyper-reactive state. And I bring this all up together as these sets of criteria because, altogether, lasting over a period of a month in response to that significant distress or trauma, and functionally having all of these impairments, that’s where you have this post-traumatic stress disorder. So that distinguishes it from one traumatic event and the experienced response that could be limited, versus the PTSD which is a combination of all of these things that I just went over.
Hayley: Okay, that makes sense. I feel like most people think of PTSD as being in military service members, which is true; I read that as many as 500,000 service members who have served over the last 13 years have been diagnosed with PTSD. But what other populations often also develop PTSD?
Dr. Bhatt: We see PTSD often in victims of sexual abuse. Numbers are high; it’s unfortunate for women or anybody who has been exposed to sexual violence or battery. It just happens to occur more often in women, but that’s one population.
We see people who have been exposed to psychological traumas, torment, prisoners, bullying; these things can cause people to suffer from PTSD. Often, first responders — we see police officers, EMS, frontline workers in emergency rooms — they see things that most of us don’t see.
We see people that are in significant states of not just bodily injury, but that whole perception of how that bodily injury occurred paints this mental picture that really can be traumatizing.
People who have experienced a natural disaster, people who have been in earthquakes or hurricanes or have had significant displacement due to that or an effect of that — there’s many different populations who can get it besides the military, but we do often see it, again, in those people who I just mentioned. The bottom line is everybody needs to have it addressed and have it be taken care of and the proper treatment provided to them.
Hayley: Do people with PTSD often struggle with addiction, and, if so, how common is that?
Dr. Bhatt: We do see it; there’s varying percentages with that. We do see trauma as an underlying major relational thing when it comes to substance use disorders in general.
There are some studies that say that the significant major portion of people who suffer with substance use have some sort of traumatic history that’s unresolved and still unprocessed within them, and that has led to an increased risk factor for them developing a substance use disorder.
With PTSD, we often see very high numbers — often through studies through the VA — we do see many people who have PTSD who do suffer with alcohol or other substance use disorders.
The numbers are high, they’re higher than the general population for sure, and it’s like any other co-occurring mental illness. For the most part, when it’s there, the risk factors are up. So, we do see this in higher amounts, but trauma in and of itself — it’s a huge percentage when it comes to people who suffer with substance use disorders.
Hayley: So that’s something that you want to identify when somebody comes in for treatment for an addiction?
Dr. Bhatt: Yeah, definitely. One thing is that first part of addiction is, and it’s not just trauma in this case, but once we get them through the initial phases of getting them off the substances (which could be through detoxification) so they’re properly medically taken off — once the drugs are removed, then the symptoms that are festering or the underlying medical or mental health conditions that were maybe the triggers or were unresolved, they start to finally show up, and it’s unmasked then.
Again, it could be neglect, it doesn’t have to be physical, it could be many different ways people perceive something that’s traumatic. I think the key point here is that these are processed, and these are resolved, and they’re brought to a more adaptive stage in that person’s life, so that cognition or that memory is handled in a better way. It could in and of itself tie into that substance use, and that really is the key to recovery.
Hayley: Dr. Bhatt, is there anything else on this topic that you want to discuss or that you think people should know?
Dr. Bhatt: The key is, if somebody’s experienced something traumatic — even if it’s not as significant as a widespread natural disaster — on an individual basis, the key is to get the proper help and to get the proper treatment to make sure that they monitor that this is not correlating to any substance use disorders, or any other maladaptive substance abuse, or any other types of behaviors that are not of benefit and are not healthy.
There are treatments out there for those who end up developing some significant mental health disorder; the trauma doesn’t necessarily have to lead to PTSD, it could lead to an anxiety disorder or a major depressive disorder — or, again, post-traumatic stress disorder.
There are medications that are available, there are psychotherapies that are available, there are evidence-based therapies such as EMDR that are available, there are treatments that people need to be aware of: contacting a psychiatrist, a mental health provider, even speaking to your primary care physicians, getting into treatment if it’s led to substance use.
These are just the important things — things that you don’t have to suffer alone, or silently, or be ashamed or feel guilty over. A lot of times, people who are victims of trauma, they feel ashamed and guilty that they somehow were responsible for this — but they don’t have to. And to seek the treatment that they deserve, and the treatment is there, and treatment does work.
Hayley: I like what you said at the end there: that no, they’re not responsible for their trauma. I think that’s important to remember, so thank you for explaining all of that.
And for those listening who may have experienced a traumatic event and are having trouble coping, know that you’re not alone. You don’t have to turn to substances to try and ease the stress and the pain; there are professionals out there that can help.
You can learn more about trauma and addiction at addictioncenter.com, and you can also check out more podcast episodes there as well. Thank you for listening to this episode of Straight Talk With The Doc.
Dr. Ashish Bhatt
Throughout his career, Dr. Bhatt has been a leader in substance abuse treatment programs, including administrative and medical directorship positions for inpatient and outpatient programs, detox units, and inpatient residential dual-diagnosis facilities. He is a Board Certified Diplomate of the American Board of Psychiatry and Neurology in both Adult and Child and Adolescent Psychiatry, a Certified Medical Review Officer, and is Board Certified in Addiction Medicine. He has served as the Chief Medical Officer for regional and national behavioral health companies and worked to develop public and private substance abuse and dual diagnosis facilities.
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