When working with individuals affected by substance use, one pattern shows up again and again: a history of trauma. Whether we’re talking about childhood abuse, neglect, domestic violence, homelessness, or other deeply distressing events, trauma is often at the root of problematic drinking or drug use.
Yet, all too often, trauma remains unspoken or misunderstood especially in frontline services under pressure to manage risk, reduce harm, and achieve outcomes.
At Reflect Training, we believe that understanding the relationship between trauma and substance use is essential for anyone working in health, housing, social care, or addiction services. This article explores how trauma shapes substance use, what trauma-informed care really means, and why staff training is critical for delivering compassionate, effective support.
Why Trauma and Substance Use Are Closely Linked
Many people who use drugs or alcohol problematically are not trying to “get high” they are trying to feel better, feel safer, or simply survive. Substances may be used to cope with overwhelming emotions, distressing memories, or a constant state of fear.
In this context, substance use is not random or irrational. It often represents an attempt to regulate pain when other supports are unavailable or unsafe.
What Is Trauma?
Trauma is not just what happens to someone it’s also how they experience it.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma is the lasting emotional response that often results from living through a distressing event. This could include one-off incidents like accidents or assaults, or long-term, repeated experiences like abuse, discrimination, or neglect.
Types of Trauma
There are many types of trauma, including:
- Acute trauma (a single event)
- Chronic trauma (repeated exposure, such as domestic abuse or bullying)
- Complex trauma (exposure to multiple traumatic events over time, especially in childhood)
- Intergenerational trauma (historical or cultural trauma passed down through generations)
Trauma affects the brain, the nervous system, relationships, and our ability to feel safe. It can lead to anxiety, depression, emotional dysregulation, and a deep sense of shame or worthlessness—all of which increase vulnerability to substance misuse.
Why Trauma and Substance Use Are Closely Linked
Many people who use drugs or alcohol problematically are not trying to “get high” they’re trying to feel better. They’re using substances as a way to cope, escape, or survive. In this context, addiction makes sense.
Common reasons people with trauma histories may use substances include:
- To numb emotional pain (e.g. dissociation or depression)
- To manage symptoms of PTSD (e.g. flashbacks or hypervigilance)
- To sleep or feel safe enough to rest
- To regulate emotions (e.g. anger, fear, shame)
- To fit in or feel less alone
- To feel in control of something
This is often referred to as self-medication. While it may work temporarily, over time, substance use can reinforce trauma symptoms, increase shame, and lead to dependency or health problems. It becomes a cycle that’s hard to break especially without support that understands the trauma underneath.
How Trauma Shapes Substance Use Behaviour
For many people with trauma histories, substances serve a specific purpose. They may provide temporary relief from emotional pain, reduce intrusive thoughts, or create a sense of control where none exists.
Self-Medication and Emotional Regulation
Common reasons people with trauma histories may use substances include:
- To numb emotional pain such as grief, shame, or despair
- To manage symptoms of PTSD, including flashbacks or hypervigilance
- To sleep or feel safe enough to rest
- To regulate intense emotions such as anger, fear, or panic
- To fit in socially or feel less alone
- To feel some control in an otherwise unpredictable world
This process is often referred to as self-medication. While substances may provide short-term relief, over time they tend to reinforce trauma symptoms, increase shame, and contribute to dependency or health problems. Without trauma-informed support, this cycle can become deeply entrenched.
How Trauma Affects the Brain and Stress Response
Trauma can have a lasting impact on the brain’s stress and reward systems. When someone experiences trauma, particularly repeatedly or at a young age, their nervous system may become locked into a state of heightened alert.
This can result in:
- increased sensitivity to stress and threat
- difficulty regulating emotions
- problems with impulse control
- reliance on external substances to calm or stimulate the nervous system
Alcohol and drugs may temporarily dampen stress responses or activate reward pathways, making them feel like effective coping tools. Over time, this neurological reinforcement increases the risk of ongoing substance use and dependency, particularly when trauma remains unaddressed.
The Impact of Childhood Trauma and Adverse Childhood Experiences (ACEs)
Research shows that Adverse Childhood Experiences (ACEs) have a powerful impact on later substance use. ACEs include experiences like:
- Physical, emotional, or sexual abuse
- Domestic violence
- Parental substance use or mental illness
- Divorce or loss of a parent
- Neglect or emotional abandonment
The original ACE study found that people with 4 or more ACEs are:
- 2–4 times more likely to use drugs or alcohol problematically
- 7 times more likely to become alcohol dependent
- 10 times more likely to inject drugs
Large-scale studies have shown that people with four or more ACEs are significantly more likely to experience problematic substance use in adulthood. Early trauma can place the brain in long-term “survival mode,” shaping coping strategies well into later life.
Without trauma-informed intervention, individuals may repeat harmful patterns especially if they have previously felt judged, dismissed, or stigmatised by services.
What Is Trauma-Informed Care and Why Does It Matter?
Trauma-informed care (TIC) is not a therapy it’s an approach. It means shifting from “What’s wrong with you?” to “What happened to you?”
A trauma-informed approach recognises the widespread impact of trauma and integrates this understanding into every aspect of service delivery.
Core Principles of Trauma-Informed Care
Trauma-informed care is built around:
- Creating safety (emotional, physical, and psychological)
- Building trust and transparency
- Supporting choice and empowerment
- Recognising triggers and avoiding re-traumatisation
- Promoting collaboration and respect
Trauma-Informed Practice in Substance Use Services
In substance use services, trauma-informed care involves:
- Understanding that relapse or disengagement may be trauma responses, not “non-compliance”
- Avoiding confrontational or punitive approaches
- Being aware of how our own tone, body language, or rules might feel unsafe to someone with trauma
- Making room for people’s stories, not just their risk assessments
Without a trauma-informed lens, we risk misinterpreting behaviour, reinforcing shame, and driving people further away from support.
Trauma-Informed Substance Use Support in the UK
In the UK, trauma-informed practice is increasingly recognised across health, housing, social care, safeguarding, and substance use services. It aligns with national priorities focused on reducing harm, improving engagement, and supporting long-term recovery.
Frontline services often work with people experiencing overlapping challenges, including trauma, substance use, mental ill-health, homelessness, and domestic abuse. Trauma-informed substance use support helps professionals respond to complexity with compassion, consistency, and safety, rather than reliance on sanctions or exclusion.
Real-World Examples: When Trauma Goes Unseen
At Reflect Training, we’ve worked with countless frontline teams who share stories like these:
- A woman with alcohol dependency is labelled “non-engaging” because she avoids group therapy. Later it’s revealed she was sexually abused in childhood and doesn’t feel safe around men.
- A man in temporary housing keeps relapsing. Staff assume he is not “motivated.” In reality, he’s experiencing flashbacks every night and drinks to sleep.
- A young person in supported accommodation is aggressive towards staff. But he grew up in care and associates authority figures with danger.
In each case, understanding the trauma behind the behaviour could lead to very different and more effective responses.
Why Trauma-Informed Training Is Essential for Staff
Frontline workers are often expected to manage high-risk situations without the training, time, or support they need to do it safely. When staff lack a trauma-informed understanding, they may:
- Misread behaviours as manipulative or resistant
- Escalate conflict unintentionally
- Burn out from constant stress and emotional exposure
- Feel helpless when standard interventions don’t work
Trauma-informed training gives staff the tools to:
- Recognise trauma responses in behaviour and communication
- Respond with empathy and clear boundaries
- Create safer, more inclusive environments
- Reduce re-traumatisation and promote engagement
- Reflect on their own triggers and stress responses
It also helps organisations shift culture from reactive to reflective, from punitive to supportive.
Building Trauma-Informed Practice with Reflect Training
At Reflect Training, we offer high-quality, practical, and compassionate trauma-informed training tailored for frontline teams in health, housing, social care, criminal justice, and substance use services.
Our most popular courses include:
- Trauma and Substance Use: Understanding the Link
Explore the neuroscience, behaviour patterns, and practical tools to support people with trauma histories and addiction. - Trauma-Informed Practice for Frontline Workers
Learn how to create psychologically safe spaces, communicate effectively, and avoid re-traumatising interactions. - Managing Conflict Where Trauma Is a Factor
Build confidence responding to distress and aggression in ways that de-escalate rather than punish. - Working with Domestic Abuse, Trauma and Substance Use
Understand the complex interplay of trauma, control, and substance use in abusive relationships.
All of our training is interactive, inclusive, and evidence based. We incorporate lived experience, case studies, and real-world strategies you can use straight away.
Book Training Today
If you want your team to better support people with complex needs, trauma-informed training is no longer optional it’s essential.
Whether you’re looking for a one-off workshop or a full training programme, Reflect Training can help you:
- Increase staff confidence
- Improve service outcomes
- Reduce burnout and turnover
- Deliver more compassionate, effective care
View our current trauma-informed training courses
Get in touch to book a training session or request a quote.
Email us at hello@reflect-training.co.uk
Call us on 01234 567890
Let’s work together to build services that see the person, not just the behaviour.
Final Thoughts
Trauma and substance use are deeply connected. For many people, using drugs or alcohol is a way to survive pain that has never been recognised or supported. When we understand this, we stop blaming, shaming, or labelling and start helping people to heal.
Trauma-informed training isn’t just about learning new skills. It’s about seeing things differently. If you’re ready to make that shift in your organisation, Reflect Training is here to support you every step of the way.
Frequently Asked Questions
What is the link between trauma and substance use?
Trauma and substance use are closely linked. Many people use substances as a way of coping with the emotional distress, anxiety, or intrusive memories associated with traumatic experiences. This is sometimes referred to as “self-medication,” where substances are used to manage overwhelming feelings rather than for recreation.
Does experiencing trauma increase the risk of substance misuse?
Yes. Research shows that people who have experienced trauma, particularly in childhood, are at a higher risk of developing substance use problems later in life. The risk increases with repeated or prolonged trauma, especially where there is little support or early intervention.
How does trauma affect the brain in relation to substance use?
Trauma can affect the brain’s stress and reward systems, making individuals more sensitive to stress and emotional triggers. Substances may temporarily reduce distress or numb emotional pain, reinforcing their use and increasing the risk of dependency over time.
What is meant by “trauma-informed” substance use support?
Trauma-informed support recognises that trauma may underlie substance use behaviours. It focuses on safety, trust, choice, collaboration, and empowerment, while avoiding practices that could re-traumatise individuals. The aim is to support recovery while addressing the root causes of distress.
Can substance use itself be traumatic?
Yes. Substance use can expose individuals to additional traumatic experiences, such as violence, exploitation, homelessness, or involvement with the criminal justice system. This can create a cycle where trauma and substance use reinforce each other.
Why do traditional substance use services sometimes struggle to help people with trauma?
Traditional approaches may focus only on reducing substance use without addressing underlying trauma. If trauma is not recognised, individuals may disengage from services, relapse more frequently, or feel misunderstood. Trauma-informed approaches help improve engagement and outcomes.
Is trauma-informed care relevant in the UK?
Yes. Trauma-informed practice is increasingly recognised across UK health, social care, safeguarding, and substance use services. It aligns with national guidance focused on reducing harm, improving engagement, and supporting recovery.
Can people recover from trauma-related substance use?
Yes. While trauma can increase the risk of substance use, recovery is possible. With the right support, including trauma-informed care, therapeutic intervention, and stable social support, people can reduce harm, build resilience, and improve their wellbeing.