The Factor of Trauma + Some Good News
Scroll down some good news in treatment access. First, our weekly topic post.
Discussions about substance use often turn toward trauma as a precursor to dependence and addiction. Both research and accounts of lived experience support this connection: some people with trauma histories come to rely on substances to regulate emotions, connect with others, or feel safe. And for many people in recovery, addressing past trauma is critical to long-term stability and growth.
It is simplistic and dangerous, however, to say that addiction comes from trauma. In my experience as a clinician and advocate, here are some pitfalls in this line of thinking:
1) Some people have addictions but not trauma. Many of my patients deny a history of trauma. Of course, understandings of trauma may vary even after you discuss the definition. Sometimes a patient denies trauma and then recounts experiences that sound highly traumatic to me. But I will never argue this point, especially as some of my patients explicitly reject that trauma has any role in their substance use. It's as if they've been offered a "deal" for deservingness– "if you blame your trauma, you'll make a more sympathetic addict"– and they're refusing the deal. I don't blame them:
Rosalie Genova
2) Some people have trauma but not addictions. Especially if trauma seems framed as an "excuse" for substance-related harm– think drunk driving or violence while under the influence– affected others who have their own trauma may take exception. Composite example: "My sibling and I grew up under exactly the same traumatic conditions. Now I'm raising their kids because they can't stop getting into trouble, but no one asks how I'm doing." Conflict in movements, as in families, is inevitable. But we shouldn't invest too much in any conception of addiction that fosters comparison between different kinds of suffering.
3) Ongoing trauma has no place in the narrative. The idea that addiction is caused by trauma posits that trauma occurred in the past, then precipitated substance use that escalated to addiction. People in recovery, then, have the chance to heal their trauma as they stop looking to substances as a primary way to cope.
But trauma is not necessarily confined to the pre-substance use part of the story. People may experience trauma throughout their using careers, including in encounters with police or while incarcerated. Chemical withdrawal may be traumatic. Treatment can be traumatic, especially when it is forced. And even in long-term sobriety, life is not necessarily free of trauma. It is unrealistic to expect all of someone's activities and relationships to be calm and safe just because they no longer use substances. For some of my patients, that life would be too boring. And thank God for all the people in recovery doing street outreach and harm reduction work, which involves what some would call traumatic experiences like responding to overdose.
Trauma has a place in discussions about addiction. But it is not the cause. Trauma may be a feature of life before, during and after active addiction. And it is one of many possible challenges in a story that can only be told by one person.
Meanwhile, in Illinois: Good news for mental health and substance use treatment access
As I have mentioned, many "behavioral health" providers do not accept insurance at this point due to low reimbursement rates and other insurance company shenanigans. This creates an artificial scarcity of affordable treatment, leaving patients either to pay out of pocket or go without.
Thanks in part to my BFF from kindergarten, Rep. Lindsey LaPointe (D-Chicago), Illinois is about to become the fourth state to require a minimum insurance reimbursement rate for therapy services! No more offering half the market rate and then telling your members it's just too bad they can't find a provider in network! (The bill targets other insurance-related barriers as well– here's a news writeup, a basic overview and a more detailed summary. Guess who doesn't like it?)
As usual with legislation, there are compromises and exceptions, and there's plenty more work to be done. But this bill is a major accomplishment that we can hope to see replicated in more states. (Pending the demise of the private insurance system.) CONGRATULATIONS LINZ! 🥳 Mainers get it done!
This will be the last post for 2025. As always, thank you for reading, and see you next year!
