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The Science of Substance Use: Trauma and Addiction

Updated: Nov 14

There is a strong connection between childhood trauma and addiction, which is why preventative trauma-informed interventions are crucial in treating addiction.

Substance use, close up of a person smoking a cigarette

As a trauma-informed change specialist, I have seen firsthand the powerful relationship between childhood trauma and harmful behavior, including addiction.

Trauma comes in many forms, including physical, sexual, and emotional use, as well as neglect and household dysfunction. Structural and systemic factors—such as racism, homophobia, misogyny, or ablism—only increase a person's likelihood of trauma.

When not properly addressed or supported, adverse experiences can have long-lasting effects on an individual's mental and physical health, including an increased risk of substance use and addiction.

Trauma and Addiction

Several studies have shown a strong association between childhood trauma and negative outcomes as adults. In the landmark study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente (1), researchers found a "strong graded relationship between the breadth of exposure to use or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults."

In other words, when children endure greater trauma during their youth, they are more likely to experience risk factors that include smoking, alcoholism, drug use, severe obesity, and STDs.

ACEs contribute to trauma in childhood, which leads to developmental delays, which contributes to risky behaviors and maladaptive coping mechanisms, which cause public health problems such as disease, disability, and addiction, which contribute to early death.

Illustration of the ACEs trajectory as a pyramid, from birth (the base of the pyramid) to death (the top of the pyramid), with five sections in order. 1. Adverse childhood experiences 2. Social, emotional, and cognitive impairment 3. Adoption of health-risk behaviors 4. Disease, disability and social problems 5. Early death
Photo from Relationship of childhood use and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study in American Journal of Preventive Medicine.

The problem with current systems is that we intervene during the "disease, disability, and social problems" stage rather than during childhood.

By focusing on supporting high-risk children and families, early interventions can have significant impacts.

Key Takeaways: What You Should Know About Trauma

Trauma is pervasive. An estimated 64% of US adults self-report at least one adverse childhood experience (2), and—as the Kaiser CDC study pointed out—these numbers are likely conservative due to a narrow definition of ACEs that excludes other traumatic experiences and participants' tendency to not view their experiences as traumatic.

Trauma is costly. The CDC estimates that the economic burden of ACEs-related health consequences costs an estimated $748 billion annually across Bermuda, Canada, and the United States.

Trauma is preventable. Trauma happens when we experience overwhelming stress and cannot resolve it. With the proper supportive relationships, connections, and outlets to express emotion, people who have experienced extreme stress can cope with their trauma and build resilience rather than falling victim to the negative outcomes associated with ACEs.

Breaking the Cycle of Trauma and Substance Use

Researchers at Rutgers University believe that "alcohol addiction is about 50 percent heritable, while addiction to other drugs is as much as 70 percent heritable." (3) Like addiction, trauma exists in a cycle, passed down through generations, and that cycle can be broken.

Trauma-informed care has been proven to improve treatment outcomes and reduce relapse rates among individuals with co-occurring trauma and addiction.(4) SAMHSA defines trauma-informed care as recognizing the widespread impact of trauma, understanding how trauma affects individuals, and responding in a way that avoids re-traumatization.

The link between childhood trauma and addiction is strong. Trauma can have long-lasting effects on an individual's mental and physical health, increasing the risk of substance use and addiction. However, trauma-informed interventions—in both childhood and adulthood—can help break the cycle of trauma and addiction, improving treatment outcomes and reducing relapse rates.


  1. Felitti, V. J., et al. 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, 1998.

  2. CDC Injury Center. Fast Facts: Preventing Adverse Childhood Experiences. Centers for Disease Control and Prevention, 2023.

  3. Smith, Andrew. Rutgers Researchers Delve Deep Into the Genetics of Addiction. Rutgers Today, 2022.

  4. SAMHSA's Trauma and Justice Strategic Initiative. SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. 2014.

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