TRAUMA AND ADDICTION Keith Loring, MD
“Every human has a true authentic self. Trauma is the disconnection from it and healing is the reconnection with it” – Gabor Maté, MD
As Carl Jung said, “Until you make the unconscious conscious, it will direct your life and you will call it fate.” Deep within each of us is our center, our authentic self, the essential part of us that is perfectly whole and unbroken, that holds all the wisdom, energy and intuition necessary to heal our earliest and deepest wounds to restore wholeness throughout our system and to create a life of awareness, connection and joy. Addiction is a response to trauma, specifically early childhood trauma. In order to understand addiction, we need to understand the nature of trauma and its impact on human development. Seen through this lens, fully trauma informed, we are able to see those suffering addiction for what happened to them rather than what’s wrong with them. When we address what happened rather than what’s “wrong,” we see our patients for their possibility, not as victims. We are then able to offer solutions rather than solace. We meet them where they are, not where we think they should be. We become collaborators in their healing process, and we stop the fool’s errand of trying to fix them. That’s their job, not ours. For most of the 25 years I practiced emergency medicine, I saw addiction as an unsolvable problem to be mitigated, or at best, be managed. Patients suffering addiction were often the most difficult. They were manipulative drug-seekers, or they were intoxicated, combative disruptors of the emergency department, who got in the way of taking care of those who were truly suffering. I became adept at catching drug-seekers early in their game and finding the most efficient ways of detoxing intoxicated patients and discharging them as soon as possible in order to minimize their impact on the operations of the ED. In essence, I was loaded to the brim with compassion and understanding – NOT! Not for my patients and not for myself. What I wasn’t willing to see in them, I was unwilling to see in myself— my own suffering. About 15 years into my emergency medicine career, while holding leadership positions in two local emergency departments and their hospital medical staffs, at the San Francisco Emergency Physician’s Association and the (then) San FranWWW.SFMMS.ORG
cisco Medical Society, and as a regional medical director for a large multi-contract emergency medicine partnership, my primary coping mechanism—an insatiable appetite for the circuit party scene— collided in spectacular fashion with the rest of my life. I was addicted to taking on those many roles and responsibilities in a desperate attempt to prove my self-worth. And I had become addicted to the dance parties and the drugs that fueled them as the only way to cope with the overwhelming and ever-growing pain on the inside. That was the darkest and most transformational period in my life. My inner narcissist mounted a valiant effort to save face but failed. With him no longer in the lead, I got my life back, and began to recover my true self. Along the way, I have become well acquainted with the nature of human trauma, the colorful ways in which it is expressed, and the possibility that exists in every one of us, to move through and past our trauma, to discover that within our deepest suffering lies our greatest source of wisdom and compassion.
Coping with the Trauma Within Trauma is not what happens to us, it is what happens on the inside as a result of what happens. The inner experience is the key. Trauma is anything that changes us in a way that makes our future responses to the world more limited, that causes a constriction. It interferes with our natural process of growth and development. We come out of trauma more limited than when we go in—limited self-awareness, limited flexibility in our future responses, limited capacity to self-regulate. We become disconnected from our body and our self. We are more likely to override our gut feelings, which are essential for survival. We are less able to stay in the present moment. As infants and children, our inner experience is highly dependent on how well we are seen, heard and held by our adult caregivers. The difference between becoming traumatized and building resiliency depends entirely on the adult caregiving continued on page 16
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