Trauma and Addiction: Ending the Cycle of Pain Through Emotional Literacyby Tian Dayton, Ph.D., Tian Dayton
For the past decade, author Tian Dayton has been researching trauma and addiction, and how psychodrama (or sociometry group psychotherapy) can be used in their treatment. Since trauma responses are stored in the body, a method of therapy that engages the body through role play can be more effective in accessing the full complement of trauma-related memories.
This latest book identifies the interconnection of trauma and addictive behavior, and shows why they can become an unending cycle. Emotional and psychological pain so often lead to self-medicating, which leads to more pain, and inevitably more self-medicating, and so on--ad infinitum. This groundbreaking book offers readers effective ways to work through their traumas in order to heal their addictions and their predilection toward what clinicians call self-medicating (the abuse of substances [alcohol, drugs, food], activities [work, sex, gambling, etc.] and/or possessions [money, material things].) Readers caught up in the endless cycle of trauma and addiction will permanently transform their lives by reading this book.
Therapists treating patients for whom no other avenue of therapy has proved effective will find that this book offers practical, lasting solutions. Case studies and examples of this behavioral phenomenon will illustrate the connection, helping readers understand its dynamics, recognize their own situations and realize that they are not alone in experiencing this syndrome. The author deftly combines the longstanding trauma theories of Van der Kolk, Herman, Bowlby, Krystal and others with her own experiential methods using psychodrama, sociometry and group therapy in the treatment of addiction and posttraumatic stress disorder. While designed to be useful to therapists, this book will also be accessible to trade readers. It includes comprehensive references, as well as a complete index.
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THE ORIGINS OF TRAUMA
He that conceals his grief finds no remedy for it.
Trauma, by its very nature, renders a person emotionally illiterate. What happens feels out of the norm, hard to pin down, elusive and strange, so we don't integrate it into our context of normal living. The brain, like any good computer, categorizes information by type. For example, traumas such as the school shootings in Littleton, Colorado, or a devastating hurricane or being raped are not part of our daily routines, so we don't have well-developed mental categories for organizing our impressions of them. They seem unreal, out of the ordinary, and they need to be talked through to make them feel real. Talking about trauma, going over what happened, contextualizes it so we can integrate it. Also, if we do not process trauma, the result can be serious and ongoing life complications such as depression, anxiety, sleep disturbances, anger, feelings of betrayal, and trouble trusting and cornecting in relationships. Such are the symptoms that, when unresolved, lead people to seek pleasure or self-medicate with alcohol, drugs, food, sex, spending and other addictions.
Because of the unpredictable, uncontrollable and traumatic nature of substance abuse and addiction, people who are chemically dependent, or those in an addict's family system such as spouses, children and siblings, usually experience some form of psychological damage. Family members as well as many addicts present disorders that extend across a range of clinical syndromes, such as anxiety disorders, reactive and endogenous depression, psychosomatic symptoms, psychotic episodes, eating disorders and substance abuse, as well as developmental deficits, distortions in self-image, confused inner world with disorganized internal dynamics, and co-dependence.
Chronic tension, confusion and unpredictable behavior, as well as physical and sexual abuse, are typical of addictive environments and create trauma symptoms. Individuals in addictive systems behave in ways consistent with the behaviors of victims of other psychological traumas. For example, trauma victims often develop "learned helplessness'-a condition in which they lose the capacity to appreciate the connection between their actions and their ability to influence their lives (Seligman 1975) as do individuals in addictive systems.
"Persons are traumatized when they face uncontrollable life events and are helpless to affect the outcome of those events." (Lindemann 1944). Many people suffer deep emotional and psychological pain and are systematically traumatized from living with addicts. After repeated failures and disappointments while trying to gain some semblance of control, feelings of fear, frustration, shame, inadequacy, guilt, resentment, self-pity and anger mount, as do rigid defense systems. A person who is abused or traumatized may develop dysfunctional defensive strategies or behaviors designed to ward off emotional and psychological pain. These might include self-medicating with chemicals (drugs or alcohol) as well as behavioral addictions that affect their brain chemistry by bingeing, purging or withholding food, or engaging in activities such as excessive work or high-risk behaviors such as risky sex or gambling. These behaviors affect the pleasure centers of the brain, enhancing "feel-good" chemicals and minimizing pain. This means of handling trauma leads to the disease of addiction.
Scientific research, mainly in neurobiology, has produced significant studies of Post-Traumatic Stress Disorder (PTSD). The findings through brain imaging demonstrate that trauma can affect the body and brain much more than had previously been understood (Van der Kolk 1996). Traumatic memories are stored not only in the mind but throughout the body as what scientists call cellular memory. Psychodrama. because it is a role-playing method that includes the use of normal movement, provides a natural and immediate access to those memories. Long before the scientific research had yielded these conclusions, J. L. Moreno was developing his psychodramatic method, one of the earliest methods of body psychotherapy. Moreno taught that the body remembers what the mind forgets (J. Moreno 1964).
Based on observations of role-play, Moreno saw the importance of involving the body in remembering. He hypothesized two types of memory: content (mind) and action Goody). Content memory is stored as thoughts, recollections, feelings and facts. Action memory is stored in the brain but also in the musculature as tension, holding, tingling, warmth, incipient movement, and the like. The best route to recapturing action memory, according to Zerka Moreno, his wife and co-developer of the field of psychodrama, is through expressive methods that use the whole person (mind and body) in action. When we act out rather than talk out situations from our lives, the recollection of memories occurs more completely. The action itself stimulates memory, much in the same way an old song or a familiar smell is followed by a flood of associations.
"People have been aware of a close association between trauma and somatization since the dawn of contemporary psychiatry" (Van der Kollt 1996). The link between mind and body (psyche and soma) is again supported by the current research of neuroscientist Candace Pert (Pert 1998): "intelligence is located not only in the brain, but in cells that are distributed throughout the body... The memory of the trauma is stored by changes at the level of the neuropeptide receptor... This is taking place bodywide.
At any given time, ten percent of the drinkers in the United States will become alcoholics, those addicted to the drug of alcohol (Johnson Institute 1980). It is estimated that seven out of ten people in the United States are in some way affected by addiction. Children of alcoholic parents are conservatively estimated at twenty-two million people (Deutsch 1982). The significant characteristics of the diseases of alcoholism or chemical addiction are that it is primary (one of the most serious types of disorders a person can have), progressive (it Bets worse over time), chronic (it doesn't go away by itself) and fatal (it leads to death). The Johnson Institute describes four stages from alcohol and drug use to alcohol and drug dependence:
- The Initial drug experience (pre-symptomatic phase)-may be experimental, socially motivated and provide relief from tension. A person learns that the use of the substance can change a mood and through experience develops a relationship with the substance.
- The Onset phase comes when the drug use switches from recreational to medicinal with a beginning preoccupation with a drug of choice. The individual seeks a mood shift. This stage may be accompanied by "blackouts," or periods of time where the addict has no memory of what he or she said or did.
- The next phase, Harmful Dependence, is characterized by excessive use and loss of control when engaged in the use of drugs or alcohol. It is accompanied by a progressive deterioration of selfimage, acute phases of self-destructive behavior, and distorted emotional and psychological attitudes.
- In the Chronic phase that follows, a person needs to use just to feel normal. Because the illness is progressive, this phase often results in death.
Addictions have been subject to multiple understandings over the last hundred years, moving from being seen as a moral failure to being diagnosed as a disease to pharmacologically mediated brain dysfunctions (Gray 1999). The National Institute on Drug Abuse recently cited between fifty and seventy risk factors for drug abuse that are found in the addict's community, that is, within the individual's peer cluster, within the individual's family and within the individual. The largest risk factor for drug abuse is an untreated childhood mental disorder (Gray 1999) (including PTSD). Two other major reasons people take drugs are to awaken a "feel good" sensation (sensation-seeking) or to feel better (self-medication) (Lesher 1999).
Years of brain studies on addiction by the National Institute on Drug Abuse suggest a common and worrisome biological thread to all addictions: Drug use changes the brain. "Most recently the action of all drugs of abuse has been traced to the action of dopaminergic neurons in the mid-brain" (Gray 1999). Recent knowledge that many areas of the brain other than the base are affected by drug use has caused researchers to explore those other areas and has also inspired new behavioral studies to determine why those areas of the brain might be triggered (Schultz, Dayan, Peter, Montague and Read 1997).
In addition to the interpersonal and intrapersonal costs of addiction, there is a high burden financially on addicts as well as on society. As of 1995, the cost of substance abuse to society was about 276 billion dollars, and the cost of drug abuse and addiction itself was about 110 billion dollars (Lesher 1999). These costs include lost productivity, crime leading to incarceration, and mental illness. Actually, it is cheaper to treat addiction than to let it go.
The cost to public support systems, productivity in the workplace, and family cohesion from addiction is such that it tears at the infrastructure of society itself. It is one of the most serious health problems in America today.
We have a human need to confess and to share our feelings. There are examples throughout cultures of the various types of confessionùranging from dream sharing in African tribes to confession rituals in North and South American tribal cultures, as well as confession in the church and a preponderance of support groups in our culture.
According to James Pennebaker, author of Opening Up and researcher on the physical effects of withholding versus expression of emotion, inhibition has three serious effects on us physically. Inhibition is physical work: when people actively inhibit their thoughts, feelings and behavior, they have to exert significant effort to restrain and hold back feeling. In the case of emotional inhibition, the work is constant. Inhibition affects short-term biological changes and long-term health. In the short term, inhibiting feelings results in immediate physical changes such as increased perspiration, which can be measured through methods such as lie detector tests. "Over time, the work of inhibition serves as a cumulative stresser on the body, increasing the probability of illness and other stressrelated physical and psychological problems. Active inhibition can be viewed as one of many general stressors that affect the mind and body. Obviously, the harder one must work at inhibiting, the greater the stress on the body" (Pennebaker).
When we inhibit parts of our thinking and feeling, we are not able to think through significant events in our lives. Hence, we are prevented from understanding and then integrating that understanding into the larger context of our life pattern. "By not talking about an inhibited event, for example, we usually do not translate the event into language. This prevents us from understanding and assimilating the event. Consequently, significant experiences that are inhibited are likely to surface in the forms of ruminations, dreams and associated thought disturbances" (Pennebaker).
Pennebaker has also found that, "Confrontation reduces the effects of inhibition," reversing the detrimental physiological problems that result from inhibition. When we make a lifestyle of openly confronting painful feelings and we "resolve the trauma, there will be a lowering of the overall stress on the body." Confrontation "forces a rethinking of events. Confronting a trauma helps people understand and, ultimately, assimilate the event. By talking or writing about previously inhibited experiences, people translate the event into language. Once it is language-based, they can better understand the experience and ultimately put it behind them" (Pennebaker). This is a crucial part of developing the emotional literacy necessary for recovery.
Pennebaker's research was done with a research team which examined the progress of people who lost spouses by suicide or suddenly through accidental deathùthat is, recent traumasùas well as childhood trauma such as sexual abuse that occurred early in life. He found that childhood traumas affect overall health more than traumas that occurred within the last three years, due to the cumulative stress on the body through long-term inhibition of feelings. When traumas are not resolved, they are not converted into language, thought about and integrated into our overall pattern of thinking, feeling and behaving.
The obvious result of this, as I have observed over years of clinical experience, is that clients arrive at therapy, say in their mid-thirties, feeling as if their lives are puzzles with significant pieces missing. They may have trouble settling on a life's direction. They may be experiencing problems in intimate relationships, or the thought of a long-term committed relationship overwhelms them.
Intimate relationships trigger unresolved pain from the past. Early childhood traumas such as sexual abuse, physical abuse, divorceùor seemingly lesser traumas such as being ignored or misunderstood by those whom we most wish to understand us and are dependent upon for our sense of healthy connectednessùlie dormant within us if our coping style has been inhibition rather than confrontation and disclosure. Then the pain gets triggered without the understanding and self-awareness that we would have, had we gradually and over time resolved our feelings related to the trauma. The result of this is often a projection of early pain into the current relationship. That is, we see the trigger event or our current intimacy as the problem in and of itself. All too often it follows that our idea of the solution or way out of the pain is to dump or exit the relationship.
The deep excavating work of therapy is to make conscious these early wounds and convert them into words so that they can be felt and understoodùto use the skills of emotional literacy. Only then can we place them in their proper perspective, give them a context (where, when and how), and integrate them back into ourselves with understanding as to what happened and what meaning we made out of it that we currently live by.
(c)2000. All rights reserved. Reprinted from Trauma and Addiction by Tian Dayton. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442.
Meet the Author
TIAN DAYTON, Ph.D., T.E.P., is a therapist in private practice in New York City. In addition to her doctoral degree in clinical psychology, she also holds a master's degree in educational psychology. A fellow of the American Society for Group Psychotherapy and Psychodrama and a faculty member of the Drama Therapy Department at New York University, Dayton presents psychodrama workshops and training nationally. She is also a practioner of psychodrama, sociometry and group therapy. In her own practice, she continually witnesses sociometry group therapy and psychodrama working most effectively in resolving issues of PTSD, reducing relapse and allowing addicts, adult children of alcoholics (ACOAs), and spouses an arena in which to confront their issues and work through them toward successful healing.
She is the author of Heartwounds, The Soul's Companion, The Quiet Voice of the Soul, The Drama Within, Keeping Love Alive, Daily Affirmations for Forgiving and Moving On, and Daily Affirmations for Parents.
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