Trauma and Substance Abuse: How Social Workers Can Help

A social worker leads a group therapy session.

Experiencing a traumatic event can impact a person’s life tremendously. Domestic violence or child abuse can bring on years of mental anguish, social anxiety or physical pain. Unfortunately, untreated trauma can lead to unhealthy behaviors, including substance misuse. People with trauma experiences often turn to drugs or alcohol as temporary coping mechanisms or self-treatment for symptoms such as shame, fear, flashbacks and poor sleep.

Social workers are tasked with helping individuals struggling with mental health issues, physical ailments, aging and a variety of inequities. Social workers empower individuals to overcome difficulties and improve their quality of life. In the case of substance abuse and trauma, social workers help patients make connections between their histories of trauma and current substance misuse.

Trauma’s Connection to Substance Abuse

Traumatic events come in many forms, ranging from family mistreatment, extreme poverty and community violence to car accidents, natural disasters and military combat. Trauma may be something experienced frequently for years, only once or even indirectly, such as witnessing a deadly event.

When trauma goes untreated, individuals may have a weakened sense of self and may turn to substance misuse and other negative behaviors to temporarily mask feelings stemming from traumatic experiences. About three-fourths of people in substance abuse treatment programs report abusive and traumatic histories, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). In turn, individuals who misuse substances are at a greater risk of experiencing traumatic events.

How Trauma Affects Individuals

How a person reacts to trauma depends on their genetic predisposition, physical health and mental well-being prior to the incident and whether they have support from family, friends, therapists or counselors in overcoming trauma. Other factors, such as age and gender, can also impact how long trauma affects a victim. For instance, studies have found that women tend to have longer-lasting symptoms from trauma than men, according to “Trauma and the Body: A Sensorimotor Approach to Psychotherapy.” One person might develop post-traumatic stress disorder (PTSD), which means their symptoms hinder daily functioning, while others may experience depression, anxiety, flashbacks, violent thoughts, social isolation or dissociation.

Trauma Can Lead to Substance Abuse

People who have experienced trauma have an increased risk of engaging in substance abuse and other self-harming behaviors, according to Behavioral Medicine. These behaviors often serve as negative coping mechanisms to deal with a traumatic past. For example, individuals may be self-medicating with alcohol or drugs to avoid PTSD or depression symptoms, such as emotional pain, poor sleep and terror. Social workers work with individuals who have experienced trauma to develop positive coping behaviors — such as exercise, mindfulness meditation, problem solving and seeking support — they can turn to instead.

If people experienced trauma during childhood, they are at a much higher risk for developing various types of addictions. According to the Adverse Childhood Experiences study, a child with four or more adverse childhood experiences — such as abuse, neglect, loss of a parent or domestic violence — is five times more likely to become an alcoholic. In addition, nearly two-thirds of IV drug users report childhood abuse and traumatic events, according to the Centers for Disease Control and Prevention (CDC).

Individuals diagnosed with PTSD are three times more likely to abuse substances, and veterans with PTSD are especially at risk, according to American Addiction Centers. Some substance abuse issues among veterans stem from the prescription of opioids for chronic pain related to combat injuries, according to Substance Abuse and Rehabilitation. Prescription opioids are highly addictive and can lead to use of illegal substances and overdose deaths, and prescribing opioids to veterans with PTSD or other mental health conditions increases the risk of abuse. A number of veterans receiving opioids for pain are also prescribed benzodiazepines for anxiety, insomnia and alcohol withdrawal, causing increased risk of overdose death, according to the Department of Veterans Affairs.

Likewise, those with substance use disorder are more likely to experience traumatic events, which can create a cycle of trauma and abuse. When trauma and substance abuse are present, other physical and mental ailments — such as heart disease, chronic pain, mood disorders and anxiety disorders — often exist.

Substance use only masks patient symptoms temporarily and can ultimately be harmful to concentration, productivity, restful sleep and the ability to cope with traumatic memories. It can also produce anxiety, irritability, depression and other physical and mental symptoms, according to the International Society for Traumatic Stress Studies. Furthermore, once an individual becomes physically addicted to a substance they begin to rely on it less for its masking effects and more to avoid the negative effects of withdrawal.

What Social Workers Can Do to Help

Social workers are often on the front lines of trauma treatment, helping to guide clients through stages of grief, stress and anger so that they can avoid future problems. In many cases, however, those undergoing trauma don’t receive needed services at the time of the event, and they struggle to cope with the impact for years.

When these coping behaviors lead to drug addiction and other self-harming actions, social workers can help motivate an individual to reduce or stop their substance use, as well as find ways to reduce the harm associated with substance use. Social workers also focus on treating the underlying trauma that is triggering the behaviors in addition to addressing the side effects of trauma. This requires carefully screening for histories of trauma and substance misuse in the many settings where social workers work and interact with clients.

Social workers help to establish treatment plans that may involve patient education, professional counseling and medical treatment. They coordinate care and make sure clients receive all of the services they need.

Practicing Trauma-Informed Care

To create meaningful change for those suffering from the impact of traumatic events, social workers must practice trauma-informed care (TIC). In the TIC model, social workers view present behaviors as side effects of past trauma — not as problems needing to be fixed.

Communication and Empathy: Social workers aim to prevent future traumatic events through systematic screening and treatment methods. When working with any new client, they must conduct thorough conversations, with sensitivity, to make connections between past incidents and current behaviors and help their client develop positive coping skills. Social workers also seek to understand the prevalence of trauma in society and the coping mechanisms that manifest in those overcoming trauma.

Establishing Strong Relationships: Forming meaningful bonds with clients is essential to halting cycles of substance abuse and trauma. Respecting clients for their individual traits, social workers seek to restore self-empowerment and help clients establish safe environments. A social worker practicing trauma-informed care is highly sensitive to vulnerabilities and triggers during client assessments, interventions and case management meetings.

Improving Access to Treatment Resources

Social workers are responsible for making sure that clients have access to social services, which includes helping them understand what resources are available and how to navigate social service systems. Conducting thorough intake and screening processes is essential to identifying clients suffering from substance abuse with underlying trauma so that social workers can develop the best case management plan for each person.

Access to Therapy and Support: Licensed clinical social workers (LCSWs) can provide direct psychotherapy, conduct group therapy sessions and diagnose underlying mental health disorders. Social workers might refer patients to an outpatient or inpatient rehabilitation facility or to a psychiatrist for medication. They might also work with individuals to develop relapse prevention plans and facilitate access to improved housing, education, nutritional resources or peer recovery groups.

Client Advocacy: Advocating for a client requires strong interpersonal skills and compassion. Social workers may need to speak on behalf of clients while communicating with medical and mental health care providers or government program administrators. They might also serve in an administrative role at an addiction treatment center, working to ensure that those struggling with trauma and substance abuse have equal access to care. Others might serve as community liaisons, educating members of the public on trauma and addiction and how they can help victims overcome inequalities.

Learn More About Earning a Social Work Degree

People with substance abuse problems are more likely to have experienced trauma. To make a difference for those struggling with trauma and substance abuse, social workers need a strong education in providing evidence-based, trauma-informed care. If you’re interested in pursuing a career in social work, visit Virginia Commonwealth University’s website and look into the school’s highly ranked Online Master of Social Work program.