Trauma, Shame & Addiction

We have all heard about the opioid epidemic. But what do we actually know? It’s an ongoing problem that has resisted various attempts at resolve—from the War on Drugs, recovery programs, and community outreach. Yet, the outcome for most is uncertain through obstacles, stigma, and adversity… are we missing something?

Donald Sansom, DO, explored this topic in a webinar titled “Trauma, Shame, and Addiction: How Did We Get Here… and How Do We Change?”. Sansom is the Associate Medical Director and Director of Addictions at Sierra Tucson in Arizona, which is a comprehensive treatment facility that offers a variety of programs for addiction and mental health recovery.

Sansom emphasized statistics for context, like alcohol being the most dangerous drug, ranking 3rd as a leading cause of preventable death in the United States. Additionally, over the past 20 years, the role of drugs in both accidental overdoses and suicides has nearly tripled.

There’s more. Every day in America, about 130 people die from an opioid overdose… that means approximately every 11 minutes another life is lost to this epidemic.

As a side note: take a minute to think about this. For each of the 130 people overdosing, they have parents, family, friends, interests, talents, feelings, purpose… it is much more than a life.

How did we get here?

Well, Einstein said, “We cannot solve our problems with the same thinking that created them.” In other words, we can’t use the same approaches, but expect different results.

The trend falls under society’s perception—the stigma of addiction. We forget about the human behind the substance use. Instead we blame the individual for the addiction, and we never ask about the why. (This is the very basis of REAL LIFE’s model, also)!

Thus, Sansom has proposed the lethal mental health triad—addiction, trauma, and shame. These factors overlap in more ways than one, and ultimately lead to a lethal outcome.

So, we’ve talked a bit about addiction. How does trauma and shame fit in?

Only recently have we been able to determine the long-term effects resulting from trauma. In the mid-1990s, a research study was conducted focusing on Adverse Childhood Experiences, or ACEs.

The study arose from Dr. Vincent Felitti, who treated obesity and discovered a link between present health problems being intensified as a result of trauma. Felitti then developed the ACEs questionnaire, which lists 10 types of traumatic events.

The results indicated a connection between early developmental trauma and the likelihood of problems later in life. For every ACE scored, the chance of experiencing additional problems as an adult increased, such as substance use, suicidality, mental illness, and obesity.

Sansom continues to his main point that, “Many, if not most, people dying from an overdose in this country are dying of trauma,” and that trauma is fueled by a lifetime of shame, causing secrecy and isolation.

Without going too far into it, most have at least heard of the “fight or flight” response, which is at the core of the lethal triad. The Autonomic Nervous System (ANS) controls this response with two separate systems: (1) the “fight or flight” response, known as the Sympathetic Nervous System, and (2) the “rest and digest” response, known as the Parasympathetic Nervous System.

Those who experience trauma can get stuck in “fight or flight,” causing the two systems to become unbalanced. This results in ANS dysfunction, which affects the entire body’s response to stress.

The triad is a cycle that must be broken.

And how do we change?

Well, Sansom simplifies it as: (1) shame reduction is trauma care, and vice versa; and (2) addiction and trauma would both benefit from the same treatment approach. This can be accomplished through promoting opportunities for accurate diagnoses, learning about trauma-informed care, using ACEs as a risk indicator, and taking a holistic approach to treatment.

As a budding social worker, I think it starts with realizing we are human. Any one of us could experience trauma, shame, and addiction… just as REAL LIFE happens. So, to be super cliché, treat others the way you would want to be treated.


~~ Alison Brown, VCU Social Work Student & REAL LIFE Intern