How Trauma is Linked to Addiction and Mental Health

March 13th, 2023

By P. Casey Arrillaga, LCSW, LCDC

How Is Trauma Linked to Addiction and Mental Health?

There is an undeniable connection between trauma, addiction, and other mental health issues, yet the nature and depth of that connection is still poorly understood by many people. This is in part due to lack of information, but also perhaps because not everyone understands the nature of trauma itself and how pervasive it can be.

The Nature of Trauma

Trauma can come in many forms, some very obvious and others more subtle. Some trauma researchers call the most obvious traumatic events “big T” events, and smaller, less obvious events “little t” events. For example, a horrible car crash in which someone you love dies in front of you would be an obviously traumatic event No one would be surprised that you would have a long-term trauma reaction, although they might not know exactly what to expect that reaction to be and how long it might go on. On the other hand, the less-obvious traumas can be small, often repeated events that erode a person’s sense of safety in the world, most destructively by chipping away at their sense of who they are. Such repeated small hurts are the “little t” traumas. Examples include ongoing bullying or being repeatedly told your needs don’t matter. These events aren’t called “little” because they don’t have much effect. They are called "little” because they fly under that radar. In fact, sometimes the traumatic effect is exacerbated by those around them saying, “That’s no big deal. You’re being too sensitive.” This can reinforce the negative self-talk that is the real culprit in making the event traumatic.

In his book, “The Body Keeps the Score”, well-known trauma researcher Bessel van der Kolk makes the point that it is our reactions and the way we talk to ourselves afterward that create and perpetuate the trauma. For instance, if we grow up being neglected, we may start telling themselves that this is happening because we aren’t good enough. Because people like to be right, we will then look for anything that confirms our beliefs and discount anything that goes against them. Thus, anything that seems to confirm our belief that we aren’t good enough will be given special attention, and then over time we will take for granted that such things are our lot in life because of our imagined flaws. 

To make things worse, people often perpetuate their traumas by unconsciously seeking out situations that remind them of the trauma, or out-and-out replay it. This may be because we find such things familiar even if we don’t like them, or it may be in an effort to “get it right this time.” Some people may do this because the negative beliefs about themselves imply that they deserve no better. Regardless of the reason, replaying the old scenes and dynamics results in people retraumatizing themselves, and further spiraling downward into feeling less and less worthy and thus less and less safe.

How this impacts addiction and other mental health conditions

Research shows strong links between traumatic events and addiction. Trauma is so prevalent in people with addictions, that many therapists who work in the field consider addiction to be a response to trauma. While it would be impossible to verify that everyone with an addiction was only in this position because they suffered trauma first, it is safe to say that most of the people in treatment have been through trauma. It even seems reasonable to hypothesize that it is the addition of trauma that may make the difference between someone who might recover from their addiction without needing treatment and someone who will recover no other way.

People in addiction treatment often reveal traumas they have never addressed sufficiently or at all. Some discover traumatic memories that had been obscured by subconscious protective mechanisms or years of addiction. Even if someone had no trauma from childhood, there are many traumatic events that happen in the course of addiction, including some that are harder to recognize, such as loss of self-esteem over and over, or the trauma that comes from hurting loved ones.

In similar ways, trauma has been shown to exacerbate almost any other mental health condition. The more traumatic the event and the earlier in life it happens, the more profound the effect tends to be. For instance, people who have experienced trauma as children are more likely to suffer from depression, anxiety, ADHD, and are more vulnerable to less common conditions such as bipolar and schizophrenia. Just as with addiction, this can become a self-perpetuating cycle, as both “big T” and “little t” traumas are more likely to occur to someone who struggles with mental health, thus creating greater risk and worse outcomes.

What can be done?

First and foremost, if you or a loved one has experienced trauma, seek help. This may start with telling someone who seems safe, but our most trusted people do not always have the skills to help heal beyond holding the space or lending an accepting ear. As helpful a start as these things can be, there is no substitute for professional help by a therapist who is trained and experienced in healing trauma. There are variety of proven techniques practiced by experienced professionals, such as CBT, EMDR, and IFS. While the many acronyms may seem like alphabet soup at first, there are plenty of good articles written on each, and a therapist can help explain the techniques they use in terms that are easy to understand. If the addiction or mental health issue is causing serious problems, the healing is best done in a treatment center where there is 24-hour support available and there are many others who are also healing. This type of environment becomes part of the process within itself, giving support and encouragement so that inner freedom and outward success can be found.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”. His books, podcast, videos, etc. can be found at

Sign up for our FREE Family & Friends Course

Created specifically for those who have loved ones that struggle with addiction.