Post-traumatic stress disorder (PTSD) and addiction often have one mother – trauma. Studies show that 60-70 percent of people who have psychoactive substance abuse (SUD) have an early trauma in their experience. And people who have PTSD, especially complicated or complex, often abuse. Moreover, addiction can be not only due to SUD, but also in the form of overeating, anorexia, shopaholicism, gambling, promiscuity. You can also add to this group people who have borderline personality disorder, since for many people addiction is accompanied by borderline personality disorder.
The reality is more complicated than the theory of addiction. But we have to remember that in both PTSD and addiction, there are two things we need to consider.
1. Uniqueness of the experience
2. Universality. For each case, there is a theory, classification, knowledge that helps us build a therapy plan. The main goal of the therapy plan is to inspire hope in the client. Hope and faith allow the client to move on, to continue acting.
That is, when we treat a person's experience as unique, if we get rid of the blinders of theories, and do not squeeze the person into a Procrustean bed, we will strengthen the contact. At the same time, knowledge of the theory will help us withstand and manage the situation.
First of all, as in PTSD, so in addictions we need knowledge of neurobiology. This is the basis, the foundation of therapy. Secondly, we need knowledge of splitting. In both addictions and trauma, a person seems to distinguish between two people: a sober person and a drunk person (or one who really wants to use); a traumatized person and the person he used to be before the trauma.
And thirdly, a person who has subsequently overcome trauma or addiction will learn to set goals and achieve them. That is, every successful psychotherapy for addiction and trauma ends with coaching. That is where big dreams, goals, and realistic plans for the future begin to emerge, and it is very important to learn how to bring them to life.
Let's start by looking at how the neurobiology of PTSD and addiction are similar. This is a big topic, and in this article we will describe it very briefly and simply, but in a way that is understandable.
We should consider the following factors:
1) Suppression of the functioning of the prefrontal cortex. As we know, with PTSD and addictions, cognitive function decreases, and this is normal. If we are talking about an addicted person, then the first year, accompanied by obsessive syndrome and addictive depression, we will not be able to conduct in-depth psychotherapy, because we need to wait for the restoration of cognitive function. The only exception may be with gambling and shopaholics, because this is not a chemical addiction. As for PTSD, in this case we also must take into account the decrease in cognitive function. A person is as if stuck in an event. Post-traumatic stress disorder occurs when all protective biological reactions to danger are activated in a person. This reaction is non-specific; a survival reaction. These reactions are recorded: dissociation, alienation, panic attack. A person may be frightened by his natural reactions, and fear for his reactions often reinforces the stress reaction. It is important for the brain to remember what helped a person survive, what situations were dangerous.
2) Both PTSD and addiction should take into account the decline in the dopamine system. This is characterized by the fact that the person is bored, weary and feels emptiness. This condition is called anhedonia, when there is a lack of positive emotions. Dopamine is responsible for motivation and inspiration.
At the same time, there is a decrease in the serotonin system, when a person feels alienated from the world, feels that he cannot build relationships, that he is not in contact with others. When the serotonin system is reduced, a person has less control over impulses. Serotonin allows us to feel meaning, love, closeness.
3) The third system that suffers is the endorphin system. A person feels constant dysphoria, everything is wrong, everything is not the same, he is dissatisfied with himself and others, he cannot bring something to the end. Endorphins help to get pleasure, enjoyment from life.
That is, our emotions are controlled by neurotransmitters, and, as is known, psychoactive substances change consciousness and neuroadaptation occurs. That is, receptors are reduced due to chemicals, as a result, pleasure decreases. As a result, the dose of surfactant increases, therefore, dependence increases.
Depression is not only the presence of negative emotions. It is both andegonia (boredom, emptiness, not wanting anything), it also can cause alienation (lack of relationships, lack of trust and closeness), as well as dysphoria (a dissatisfied person, lack of joy and happiness).
In other words, a person uses to get high, forget about pain, experience some positive emotions, that is, to be “happy”. If they stop using, neurobiology will work, and the person will have to go through addictive depression. As for PTSD, in order to get out of dissociation and stop flashbacks, the person will have to face their pain. And if the dopamine system can recover on its own over time, the endorphin system and serotonin system can be restored through quality psychotherapy, because meanings and relationships are not built by themselves.
As for splitting, it differs structurally in addicted people and in those who have PTSD, but it is present in both cases. So it is important for us to work with the healthy part of the person, with his strengths. If this is an addicted person, we turn to the normative self, we ignore the dependent self. We work with ambivalence and support healthy motivation. It is important to remember that we do not motivate the client with bad consequences, we do not confront the dependent self in any way, we simply ignore it in the first stages of therapy. But we turn to the forgotten reasons, “What does this substance give me? What needs do I satisfy?”, and we learn to distinguish between our emotions and needs and satisfy them in another, healthier way. Thus, the Addictive part feels that we are interested in it, and the most important insights are made by the client himself, concerning why did he start using it, or what is he running away from, or what does he want to get? But the therapist provides a lot of information and explains how neurobiology works, what attraction is, how the brain and neurohumoral system work.
Regarding the splitting of PTSD, we turn to the Hero and restore power to the person. We do not support the position of the victim, we do not provide him to the pity. We turn to the part that managed, endured, preserved itself. We confront powerlessness and avoid disabling the client.
Shame and guilt are two emotions that a person with PTSD gets rid of through dissociation, and a person with addiction gets rid of when they use. The mistake is to rescue the client. The mistake is to be too empathetic to the client. The mistake is to focus on the traumatic event or to paint the negative consequences of the abuse. The mistake is to rush into therapy.
The therapist must be very patient and attentive. It is important to reflect on the client with PTSD and addiction:
1) what the client has already done correctly,
2) his thinking abilities and correct assessments,
3) enhancing the client's self-efficacy by nurturing their ability to act, think, and build their strengths,
4) it is very important to strengthen your own decision to do something for yourself.
So when we work with addictions, we need to be honest with our clients. Sobriety will not bring joy at first, it will be bad for a while, but sobriety is the basis of a normal life, and later a happy and fulfilled life. This also applies to PTSD. It is important to warn the person about the knowledge of neurobiology, and that in the process of therapy there may be a deterioration at first, and this is part of the therapy. Gradually we go into depression and sadness in order to reach a new level of understanding of meanings and happiness.
The therapist must remember that the main task of therapy is to gain the client's trust. Only then do the techniques and methods of psychotherapy work. But the therapist's personality itself, his self-confidence, empathy, sensitivity, calmness, moderation and wisdom are the medicine in therapy. Trust is built in contact, so the therapist's special task is to be in contact, to be attentive to what the client says. Trust in another person appears where they are listened to. Therefore, if a difficult client comes to you, with trauma and addiction, just listen to him. Where there is a feeling that you are understood, trust appears. The technique is very simple: give the client space, ask open questions, reflect the client's strength and common sense and summarize. But how much wisdom and knowledge is in this, which accumulates over the years and experience.