Past trauma sometimes plays a part in the emergence of substance dependency. The definitions of “trauma” and “stress” are evolving. However, for the purposes of this blog, I will derive their meanings from the familiar term “post-traumatic stress disorder”. This term implies that trauma is a sudden, usually unexpected, catastrophic event which (in predisposed individuals) will lead to chronic, recurring (and destructive) stress. While EXPECTED adversity MAY be beneficial in SOME cases, the traumatic event in susceptible individuals may lead to chronic, debilitating, “bad” stress which is a disorder. The inciting traumatic event may be the classic wartime “shell shock” or it may be verbal/physical/sexual abuse going as far back as childhood and carrying with it that element of repeatedly experienced unpredictability. There are many more examples of traumatic events.
At this point, a brief explanation of the term “substance misuse” is necessary; this term may be preferable to the alternative “substance abuse,” since the alcoholic/addict is (literally speaking) not abusing the substance: it is the substance which is abusing the alcoholic/addict!
In the context described above, substance misuse (the destructive self-administration of non-prescribed drugs or alcohol or inappropriately prescribed medications) represents a maladaptive coping strategy used to combat post-traumatic chronic stress. At first, it appears to be a rapid, predictable, reliable and attractive “solution” but it soon degenerates into tolerance, dependency, emotional blunting and the exclusion of all other activities.
Ironically, substance misuse can be traumatic in itself (motor vehicle accidents, emergency hospitalizations, near-death experiences and overdoses), thus setting up a vicious cycle of trauma, chronic stress, and further substance misuse!
Health care professionals working in the ER are frequently exposed to traumatic events and are constantly grappling with the challenges of appropriately acknowledging death and their own limited powers to forestall it. Health care professionals often have great difficulty in communicating their feelings with each other or indeed with anyone. This can greatly exacerbate the destructive effects of traumatic events, especially in those predisposed to substance misuse.
I recently heard an ER physician on the radio recommend that attending health care workers observe a collective moment of silence and offer a few shared thoughtful words for any patient dying in the ER. This simple measure can greatly alleviate the suppressed negative feelings and emotions experienced by health care professionals when confronted with death. I feel that this is a good first step in the right direction. The idea here is to lessen the impact of traumatic events.
Substance misuse, on the other hand, is a “quick fix” response to emotional pain. It is poor decision-making, brought about by chronic, debilitating “dis-ease”, the extreme uneasiness in the face of adversity that impairs our judgement. The real solution – connection with others – takes time, takes work, persistence and practice, and has a more gradual beneficial effect. These may be viewed as initial disadvantages, since they demand an effort on our part. However, the pay-off is a durable and far more effective Recovery. The alternative, the “quick fix,” leads to substance dependency and death.
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