Not What’s Wrong With You, but What Happened to You: The Link Between Childhood Trauma and Addiction

There is one question that changed the way we work. Instead of asking “What’s wrong with you?” or “Why do you use?”, we ask “What happened to you?” Often the answer takes weeks to arrive, because some things have never been said out loud. But when it does, their substance use starts to make sense.

This is more than a hunch. For more than 25 years, research has shown that what a person lived through as a child is closely linked to their relationship with alcohol and other drugs. In this article, we explain some of the most important studies on the subject in plain language. Our goal is to help families better understand what may lie behind a loved one’s substance use, and to let them know there is treatment that addresses both the addiction and the wound.

What are adverse childhood experiences?

Researchers use the term adverse childhood experiences to describe painful or threatening situations a person lived through before age 18. The studies we reviewed included three broad groups (Dube et al., 2003):

• Abuse: emotional, physical, or sexual.
• Neglect: emotional or physical, such as not receiving basic care, protection, or affection.
• Serious problems at home: living with someone who had problems with alcohol or drugs, or with a mental illness; witnessing violence against one’s mother; parental separation or divorce; or having a family member in prison.

Many of these experiences are more common than we tend to think, and they rarely happen alone: someone who lived through one often lived through others (Felitti et al., 1998).

What the research shows

The Adverse Childhood Experiences Study

The best-known study on this topic was carried out in the United States with more than 17,000 adults attending routine medical checkups. In its first analysis, published in 1998, researchers reviewed the responses of about 9,500 people and compared them with their health in adulthood (Felitti et al., 1998). What they found was striking:

• More than half of the participants had lived through at least one adverse experience in childhood.
• The more adverse experiences a person had lived through, the more health problems they had as adults. The researchers described this as a “graded” relationship: each experience added risk.
• Those who had lived through four or more were several times more likely to experience alcoholism, drug use, and depression than those who had lived through none. The same pattern appeared for heart, lung, and liver disease.

Adverse experiences and drug use

Using data from the same study, another team looked specifically at illicit drug use in more than 8,600 adults (Dube et al., 2003). These were their main findings:

• Each additional adverse experience made it 2 to 4 times more likely that a person would start using drugs at an early age (before age 14).
• People who had lived through five or more adverse experiences were 7 to 10 times more likely to report drug problems, addiction, or injection drug use than those who had lived through none.
• The authors estimated that these experiences could account for between one-half and two-thirds of serious drug problems in the population studied.
• The pattern held for people born across nearly eight decades, regardless of which drugs were popular at the time. For the authors, this suggests that drug use may often be a way of coping with the pain those experiences left behind.

Why trauma can lead to substance use

Trauma leaves the body on alert. It can show up as nightmares, being easily startled, memories that intrude without warning, difficulty feeling safe or, on the contrary, a sense of being disconnected from everything. Substances temporarily switch off that alarm.

Harvard psychiatrist Edward Khantzian proposed the self-medication hypothesis decades ago. His central idea is that many people do not seek pleasure in drugs, but relief from suffering they cannot put into words (Khantzian, 1997). The idea has two parts:

• Substances relieve emotional distress. It is not a weakness of character: the person found something that, at first, helped them bear what they were feeling.
• The substance a person chooses is not always random. People tend to prefer whatever best soothes what hurts most: someone who lives with a lot of rage may look for something that calms them; someone who feels empty, something that energizes them.

From this perspective, the key question is not “Why do they use?” but “What hurts?” (Khantzian, 1997).

The problem is that the relief is short-lived and the cost is high. Substance use also exposes people to new risks and violence, increases shame and isolation, and worsens the very symptoms it was meant to soothe. And so the cycle reinforces itself.

An important clarification: your story is not your destiny

Talking about trauma does not mean that every person with an addiction has lived through something like this, or that anyone who had adverse experiences will develop an addiction. The studies speak of risk, not destiny: many people with very difficult histories never develop a problem with substances.

Nor is it about blaming anyone or using the past as an excuse. Understanding where substance use comes from does not remove responsibility for recovery; it helps a person take it on with more compassion and less shame.

What this means for treatment

For years it was believed that people had to stop using first and only then talk about their trauma. Today, the evidence supports working on both at the same time.

A Cochrane review that pooled 14 studies with more than 1,500 people living with both post-traumatic stress disorder (PTSD) and a substance use disorder found the following (Roberts et al., 2016):

• Individual trauma-focused therapies, combined with treatment for substance use, reduced PTSD symptoms more than usual treatment, and the improvement held months later.
• Their effect on substance use was more limited, suggesting that addiction needs its own treatment and does not simply disappear when trauma is addressed.
• More people dropped out of trauma-focused therapies than of usual treatment. The authors concluded that these therapies should be offered with care, with good support, and at a pace the person can sustain.

Programs such as Seeking Safety, created by psychologist Lisa Najavits, were designed precisely to address both at the same time (Najavits, 2002). The core principle of Seeking Safety is safety: before exploring what happened, the person learns to protect themselves in the present, with topics such as asking for help, setting boundaries, and managing triggers. It does not require people to share the details of what they went through.

That said, pace matters. Opening up painful memories without tools to manage what they stir up can trigger a relapse. That is why we first work on feeling safe, and then on what happened.

Signs that trauma may be present

None of these signs, on its own, means that a person has lived through trauma. But if you notice several in your loved one, especially alongside substance use, it is worth mentioning them to a specialist:

• Has frequent nightmares or trouble sleeping.
• Startles easily or seems to be always on guard.
• Reacts with anger or fear that seems out of proportion.
• Disconnects, “checks out,” or seems to feel nothing.
• Uses more around certain dates, situations, or people.
• Finds it hard to trust others or feel safe, even at home.

What these studies teach us

Based on this research, here are some practical ideas for families:

1. Change the question. The question “Why don’t they stop if they can see the damage?” sometimes has an answer in a story the family does not know. Asking “What happened to them?” replaces reproach with understanding.
2. Don’t pressure them to tell you what they went through. Forcing someone to talk before they are ready can harm them; the place for that is therapy.
3. Read their reactions differently. If your loved one startles, shuts down, or overreacts, it may be the trauma talking, not defiance toward you.
4. Help build a sense of safety. Predictable routines, a calm tone, and clear agreements help more than yelling or threats.
5. If the trauma happened within the family, everyone will likely need support. This is not about blame, but about recognizing that the wounds, and the recovery, are shared.
6. Look for treatment that addresses both. Ask whether the program screens for trauma and how it treats it.

No one chooses their story

No one chooses what they lived through as a child. But it is possible to stop carrying it alone. If you saw yourself, or someone you love, in this article, asking for help is the first step toward healing.

At Lumenia we support people with substance use problems and their families, bringing together science and the experience of those of us who have already walked the path of recovery. If you have questions, message us on WhatsApp at +52 81 1805 4988.

If you need immediate guidance in Mexico, you can also call Mexico’s Línea de la Vida, a free helpline available 24 hours a day, at 800 911 2000. If your loved one’s life, or anyone else’s, is in immediate danger, call 911.

References

Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences Study. Pediatrics, 111(3), 564–572. https://doi.org/10.1542/peds.111.3.564

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550

Najavits, L. M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. Guilford Press. https://www.guilford.com/books/Seeking-Safety/Lisa-Najavits/9781572306394

Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2016). Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder. Cochrane Database of Systematic Reviews, 2016(4), CD010204. https://doi.org/10.1002/14651858.CD010204.pub2

This article is a plain-language summary and adaptation of the research cited. All credit for the research belongs to its authors. The translation, selection of content, and practical recommendations are by Lumenia.