Evaluating an Individual’s Treatment Needs
Addiction Among Victims of Trauma & Domestic Abuse
Trauma, abuse, and domestic violence can have a profoundly negative impact on an individual’s health and wellbeing. Survivors of trauma and abuse have higher rates of mental illness, relationship problems, occupational instability, and substance abuse than the general population. In the aftermath of a life-threatening experience, many suffer from a psychiatric illness called post-traumatic stress disorder, or PTSD. This debilitating condition can significantly detract from a person’s quality of life, placing the individual at risk of depression, suicidal behavior, and drug or alcohol abuse.
Not everyone who lives through a traumatic event or who witnesses a shocking incident will develop PTSD. However, those individuals who do have this disorder are affected at every level of their lives, from their physical and emotional health to their family relationships, occupational functioning, and day-to-day social interactions.
Trauma is defined as the result of exposure to shocking or dangerous events that threaten individuals’ safety or the safety of their loved ones. The most common sources of trauma include:
- Military combat
- Political persecution and torture
- Natural disasters
- Sexual assault
- Child abuse
- Motor vehicle accidents
Trauma and Violence in Childhood
PTSD is often associated with exposure to military combat, war, and terrorism. Statistics from the U.S. Department of Veterans Affairs (VA) prove that PTSD is far more common among veterans than in the population as a whole. The lifetime prevalence of this disorder among Vietnam veterans is nearly 31 percent for men and nearly 27 percent for women, for example, while the prevalence of PTSD among Gulf War veterans is over 10 percent. By comparison, the VA estimates that 6.8 percent of American adults have experienced PTSD at some point in their lives.
The experiences of war and combat can have a devastating effect on an individual’s psyche. However, the exposure to child abuse, spousal abuse, and personal loss or trauma can be equally devastating. Yet many of the survivors of abuse are reluctant to seek help, either because they fear reprisal from their abuser or because their self-esteem has been so badly damaged that they do not believe they deserve support.
Unfortunately, exposure to abuse and violence are far from uncommon. The National Survey of Children’s Exposure to Violence indicates that most children experience violence — either directly or indirectly — in their daily lives.
The repercussions of violence experienced in childhood linger through adulthood, carrying over into the personal lives of men and women. As adults, survivors of childhood trauma are more likely to become the victims of domestic abuse from a spouse or partner. They may suffer from flashbacks and memories that intrude on their daily lives, interfering with their jobs, relationships, and social activities. Without adequate treatment, they are likely to experience severe depression, suicidal thoughts, and substance abuse.
According to the survey, 60 percent of American children are exposed to violence in one or more of the following ways:
- By being physically or sexually abused
- By witnessing domestic abuse
- By learning about a violent act against a friend or family member
- By being threatened or bullied personally
- By having their family or school threatened
Effects of Childhood Trauma and Abuse
The consequences of abuse and trauma run deep, affecting the way individuals experience the world and copes with their environment. According to the National Center for Mental Health Promotion and Youth Violence Prevention, child abuse can manifest itself in children in the following ways:
- Developmental delays
- Behavioral problems
- Learning disabilities
- Social dysfunction
- Sleep disturbances
- Appetite loss
Children who are neglected or abused may have trouble learning, remembering, forming relationships with other children, or controlling their emotions. They may have difficulty eating or sleeping, which can interfere with healthy physical development. To cope with the pain and fear they experience at home, they may project these feelings onto other children in the form of bullying.
To cope with the pain and fear they experience at home, they may project these feelings onto other children in the form of bullying.
The ramifications of child abuse do not end in childhood. Unless the effects of trauma are addressed, children who survived abuse will often turn to drugs or alcohol as teenagers. They may engage in high-risk behaviors, such as binge drinking, intravenous drug use, or unsafe sex.
Violence in the Home
Domestic violence is one of the most common causes of personal trauma in the United States. Statistics from the National Coalition Against Domestic Violence (NCADV) suggest that Americans are more likely to be the victims of abuse or assault at home than they are on the streets or in the battlefield:
- Over 10 million adults, both male and female, are physically attacked by a spouse or partner in the US each year — or 20 individuals per minute.
- During their lifetime, 25 percent of men and 33 percent of women will be the victims of violence by an intimate partner.
- About 15 percent of all violent crimes in the US take place between intimate partners.
- Out of those who experience domestic violence, only 34 percent seek medical treatment.
It is troubling to note that only around a third of individuals who are abused at home seek medical attention for their injuries. These injuries may be psychological as well as physical, causing long-term damage to the victim’s self-esteem and sense of personal security. According to a report from Bureau of Justice Statistics, just over half (56 percent) of incidents of violence between partners or immediate family members were reported to the police. This reluctance to seek treatment and report violent crimes suggests that many victims are afraid that their attacker will seek revenge. Some may be afraid that their attacker will be legally punished or harmed, or that the household will lose the financial support of a provider.
Perhaps most disturbingly, many domestic violence victims feel ashamed to seek help, feeling that the attack was their fault. They may believe that they provoked the attacker’s anger or that they somehow caused the argument that resulted in abuse and injury. A literature review published in PLOS Medicine revealed that adults, especially women, who are the victims of violence by intimate partners have higher rates of depression and suicidal behavior than the general population. Conversely, the study found that women with depression and other forms of mental illness are more likely to be the victims of domestic violence, a finding that underlines the importance of preventive mental health treatment.
PTSD and Substance Abuse in Trauma Survivors
For the loved ones of a trauma survivor, it is important to realize that PTSD is not a “normal” response to abuse or violence. PTSD is a form of mental illness that occurs as a result of unresolved emotions related to a traumatic experience. Individuals who have PTSD usually experienced feelings of helplessness, powerlessness, or weakness at the time the incident occurred.
These feelings have lingered in the form of guilt, remorse, resentment, or anger, resulting in symptoms such as:
- Flashbacks, or disturbing memories that interfere with daily life
- Emotional outbursts
- Panic attacks
- Drug and alcohol abuse
The Anxiety and Depression Association of America estimates that 7.7 million American adults suffer from PTSD, and many of these individuals use drugs or alcohol to cope with their symptoms. People who have survived trauma and abuse often turn to chemical substances to suppress their emotional pain and anxiety. The National Center for PTSD, a division of the Department of Veterans Affairs, states that up to 75 percent of individuals who have experienced violent assaults or physical abuse have a problem with alcohol, and that over 30 percent of those who have been involved in traumatic accidents abuse alcohol.
Individuals who suffer from both PTSD and a substance use disorder are also at risk of the following serious health problems:
- Chronic pain
- Heart disease
- Liver disease
- Mood disorders
- Attention disorders
Treating PTSD and substance abuse requires an approach to therapy that integrates substance abuse services with mental healthcare. Unless a rehab program incorporates intensive therapy for PTSD and trauma resolution with its recovery services, the client is likely to drop out of treatment or relapse into substance abuse or mental illness after completing the program.
Challenges in Recovery
For many survivors of trauma and abuse, one of the greatest barriers to rehab is the belief that they don’t deserve help. The depression caused by abuse can result in a lack of motivation to seek help, low energy levels, and feelings of low self-worth, all of which can block access to treatment. An intervention by loved ones may be required to persuade the trauma survivor that he or she not only needs professional help but also deserves to receive that treatment. During the recovery process, abuse survivors may need additional motivation and encouragement from their treatment team.
Another challenge to recovery is the lack of specialized mental health and trauma recovery services in many mainstream rehab programs. Unless a substance abuse treatment program addresses the psychological and emotional ramifications of trauma, it is unlikely that these underlying issues will be fully resolved. Family members and partners must be actively engaged in the treatment process through education, counseling, and therapy, so they can be part of the individual’s support system and contribute to the recovery process.
Therapeutic Treatments for Trauma and Abuse
Exposure to trauma requires a specialized approach to treatment that acknowledges the individual’s pain, reinforces self-esteem, and provides coping strategies for managing the emotional repercussions of abuse. Therapeutic services for trauma and abuse survivors and their loved ones include:
- Trauma therapy:
A modality that focuses on resolving the emotions and feelings associated with violence or abuse. Trauma survivors may also benefit from bereavement therapy if they have lost a loved one as part of their past experience.
- Cognitive Behavior Therapy (CBT):
An approach to treatment that focuses on changing the negative thought patterns that can lead to destructive behavioral patterns. CBT has been used successfully in the treatment of depression and anxiety disorders as well as substance abuse and other compulsive behaviors.
- Motivational Interviewing:
A therapeutic approach based on the philosophy that the therapist and client are engaged in a collaborative effort to empower the client to change.
- Conflict resolution training:
A form of communication training that teaches clients and significant others how to express their feelings, solve disputes, and set boundaries in a respectful, nonconfrontational manner.
- Experiential therapies:
Based on the premise that coping skills can be learned through recreation and creative activity, these therapies help the client work through painful emotions and learn new life skills through hands-on experiences. Experiential therapies include art and music therapy, dance therapy, equine-assisted therapy, and fitness therapy.
Resolving the symptoms of PTSD and substance abuse can take time and patience, both on the part of clients and their loved ones. However, the work of rehab can produce life-changing benefits, especially if individuals can rely on support from friends and family.
- Adult Survivors of Child Abuse (ASCA): The ASCA sponsors self-help support groups on an international level for the adult survivors of childhood neglect, physical abuse, and sexual assault. Its website provides links to information about online support groups and face-to-face groups within communities.
- Domestic Violence and Child Advocacy Center: This organization sponsors programs to empower the survivors of child abuse, teen violence, and domestic violence to speak out about their experiences and seek help for their physical and emotional trauma. Its website offers educational materials and access to support resources in both English and Spanish.
- National Center for PTSD: Sponsored by the U.S. Department of Veterans Affairs, this website offers access to support resources, emergency services, and informational materials about post-traumatic stress disorder (PTSD). These useful resources are available for both veterans and non-military members and their families.
- National Coalition Against Domestic Violence (NCADV): The NCADV is a public service organization whose mission is to promote national awareness of the problem of domestic abuse, while providing support and education for its survivors and their loved ones.
- National Domestic Violence Hotline: This free national helpline offers confidential support, either through online chat or by telephone, 24 hours a day, 365 days a year. The website also includes extensive information and support resources for the victims of domestic violence and their friends and family members.
- National Resource Center for Mental Health Promotion & Youth Violence Prevention: This national organization is dedicated to offering resources, teaching materials, and support services to prevent violence among America’s youth and to promote the wellbeing of children and their families.