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Trauma and Substance Abuse: Facts, Treatment, and Recovery Options for Women

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Research suggests that there is a strong correlation between trauma and substance abuse in women. This article will explore the nature of trauma, it’s relationship to drug and alcohol abuse, and the latest treatment options.

It is estimated that about 50% of all people will experience at least one significant traumatic event during their lifetimes. Trauma can come in many forms, including terrorism, war, natural disasters, a house fire, a car accident, and many more. In addition, there are several forms of trauma that are more common for women, including rape, domestic violence, and loss of a pregnancy.

trauma and substance abuse in women
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The effects of trauma can be profound, with 8% of trauma survivors developing some level of post-traumatic stress disorder (PTSD). Those diagnosed with PTSD often experience nightmares, intense fear and anxiety, anger, shame, isolation, insomnia, suicidal ideation, and difficulty maintaining intimate relationships. This can be exacerbated if the individuals also develop or already experience depression or anxiety.

One often-overlooked symptom of trauma in women is the development of a substance use disorder.

Trauma and Substance Abuse: The Facts

According to the National Institute on Drug Abuse (NIDA), nearly 80% of women who seek treatment for substance use report experience at least one instance of sexual or physical assault. In addition, 72% reported being emotionally abused Several studies have also indicated that experiencing trauma dramatically increases the risk of developing a substance use disorder in the future (Felitti et al., 1998; Messina & Grella,.)

Often, women who have experienced trauma begin abusing drugs they obtained during treatment for anxiety, depression, PTSD, or physical pain. This is especially true in cases of women who use benzodiazepines and opioids. In other cases, some women may turn to illicit drugs as a way to self-medicate from physical and emotional pain following a traumatic experience. Finally, some women experience abuse, and in particular sexual abuse, while under the influence of drugs or alcohol.

If you’d like to see a quick overview of the relationship between trauma and substance abuse, watch the following video.

Trauma and Addiction: How PTSD and Substance Abuse are Connected

A New Paradigm: Trauma-Informed Care for Substance Abuse Treatment 

Most substance abuse treatment protocols were developed to address drug addiction in men. Historically, these treatment protocols were single-focused and addressed only substance abuse.

However, it has recently become clear that those same treatment protocols may be ineffective when used for women unless treatment also addresses the reality that many women who abuse drugs or alcohol have experienced sexual or physical abuse and violence.

Trauma-informed care has many facets. In addition to acknowledging the impact of traumatic experiences on women, it is also important that substance use treatment protocols and programs that do not trigger trauma reactions or cause re-traumatization. This involves ensuring that programs that provide rehab for women are safe places where women will not face additional sexual, physical, or emotional abuse or threats of abuse.

Those involved in substance use treatment, including doctors, therapists, and group leaders need to be trained in trauma-informed care. The coping strategies of women who have experienced trauma may be different from those typically seen in substance abuse treatment programs designed for men. It is important that counselors and staff understand trauma reactions and coping strategies and help support women in coping with their trauma and managing their symptoms.

Three-Stage Model for Trauma Recovery & Treatment

Psychiatrist Judith Herman developed a three-stage model for trauma recovery that is well-adapted for use in substance use treatment protocols for women. In stage one, safety, a woman’s primary need is to find safety. Due to the trauma they have experienced, they often do not feel safe in their homes, their communities, or even in their own bodies. They may also not feel safe around their counselors and treatment providers

Treatment facilities must be safe places free from all types of abuse. In addition, it is important to ensure that boundaries between consumers and staff, as well as peers, are clear and respected.

Finally, in stage one, treatment providers must make sure that all safety concerns are addressed. For example, if the woman is a victim of domestic violence, before she can begin to recover from substance abuse, she must receive help to address the domestic violence concerns. 

In stage two, Remembrance and Mourning, women can begin working through the emotions and realities of their trauma experience in addition to addressing their substance abuse. At this stage, group counseling is often effective due to the support received by others that have experienced similar situations.

In stage two, women should also receive support and care to help prevent relapse; at this stage they are better able to realize the scope of loss and trauma in their lives and need to develop healthy coping strategies. 

Stage three, Reconnection, takes place during ongoing recovery from substance abuse. During this stage, recovery focuses on maintaining sobriety and rebuilding lives. Women should be supported in developing healthy relationships, securing employment or working on job skills, and engaging in recreational and community activities that help them feel a sense of purpose and value.


Above all, it is important to remember that without taking a holistic approach to trauma and substance abuse treatment that addresses a woman’s history of trauma and abuse, it is difficult for drug addiction treatment to be successful.

However, when women are given safe and supportive environments in which to heal from traumatic pasts, they are often able to recover from their drug or alcohol addiction. Trauma and substance abuse go hand-in-hand, but the right treatment can maximize the chances for a full recovery.

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Trauma and Substance Abuse in Women
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Reviewed for accuracy by Randy Withers, MA, NCC, LCMHC, LCAS.

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