Trauma Theory

Of the contemporary psychodynamic theories described above, the theories proposed by Wurmser (1978, 1985) and Khantzian (1985) lends support to the role of trauma in the etiology of addictions. It should come as no surprise that victims of sexual assault, child and adolescent physical and sexual abuse (Cavaiola & Schiff, 1988;Wilsnack.Vogeltanz, Klassen, & Harris, 1997; Briere & Elliot, 2003; Spatz-Widom, Marmorstein, & Raskin-White, 2006; Lee, Lyvers, & Edwards, 2008; Asberg & Renk, 2013;Tonmyr & Shields, 2017;) combat trauma (Brady, 2001) and perhaps to a lesser extent, those victimized by natural disasters (e.g. floods, earthquakes, hurricanes) are all more likely to experience co-occurring substance use disorders along with PTSD. In keeping with the self-medication hypothesis, many individuals describe how alcohol or other substances will help them to cope with PTSD symptoms (e.g. anxiety, apprehensions, depression and difficulty turning off intrusive thoughts that makes it hard to fall asleep). It is important for addictions counselors to keep in mind that clients may not disclose traumatic experiences in the early stages of counseling. It is imperative that a trusting therapeutic bond be established in order for a client to feel confident that he or she can make such disclosures. Counselors also need to consider that often traumatic memories may be repressed and may not surface for months or years following the traumatic event. That brings us to the role of defense mechanisms.

Learning Opportunity 2.2 — The Power of the Unconscious

Pair off with someone in the class. Now each of you take a sheet of paper and at the top write the words, “alcoholic” and “addict." Now under those words list any and all words that come to mind in response to those words. What you’re doing is a psychoanalytic technique called “free association.” Now exchange your list with your partner. Do you notice any negative or pejorative words that might reflect an unconscious bias towards individuals with substance use disorders? Read the article referenced below which will give you an idea of how negative or pejorative labels often creep into our vocabulary when we’re discussing substance use disorders:

Broyles, L.M, Binswanger, I.A., Jenkins, J.A., Finnell, D.S., Faseru, B., Cavaiola, A.. Pugatch, M., & Gordon, AJ. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response. Substance Abuse, 35(3), 217-221.

Defense Mechanisms and Addiction Theory

Try to recall a particularly embarrassing or humiliating experience. Most people find that it’s difficult to recall these memories and there’s a tendency to want to push that memory out of our conscious awareness and think of something more pleasant. According to Anna Freud, the daughter of Sigmund Freud, this would be known as a suppression, and it’s one of the many ego defense mechanisms that Anna described in her renowned text entitled The ego and mechanisms of defense first published in 1936. As described earlier, defense mechanisms are ways for the ego to cope with difficult or painful emotions. For example, while the defense mechanism, suppression is thought to describe when we try to consciously push a painful memory out of awareness, there’s another defense mechanism, repression, which occurs unconsciously or outside of one’s awareness. This may occur following a particularly traumatic event, like a car accident or sexual assault, in which the person is unable to recall particular memories of the event. A client of mine (AAC) once described having been in a horrible car accident as a child, however, all he could to recollect of the accident was being med-evac’d by helicopter to the nearest hospital trauma center. In this example, the car accident itself had been totally repressed, leaving my client with no memories of the car accident.

Table 2.1 Defense Mechanisms

Table 2.1 provides a list of defense mechanisms and how they may be experienced. As indicated earlier, everyone uses defense mechanisms at one time or another; when someone is over-reliant on defense mechanisms, however, or when they distort reality, defense mechanisms become problematic or pathological. Such would be the case when a person with an SUD over-relies on denial in order to convince him or herself that their heroin use is not really a problem and, if anything, helps them to cope with life.

Another common defense mechanism counselors often find expressed by people with SUDs is rationalization. Here someone basically distorts reality and comes up with an alternative, rational explanation for why a particular event or behavior has occurred. For example, if a person were to get fired from their job for coming into work under the influence, they may rationalize that they were unjustly accused or that they were one of the top employees in their department.

Or they may conclude “I really didn’t like that job anyway” or “I was really over-qualified for the job” as a means of avoiding the harsh reality that he or she was just fired from their job.

Interestingly, when Vernon Johnson had created the Intervention technique by which people with SUD could be confronted in a loving way, he concluded that there were specific reasons why Interventions could be helpful in getting someone to accept treatment. In the traditional intervention procedure, family members and significant others are encouraged to come up with two or three instances whereby their loved one’s alcohol or drug use had caused them worry or concern. Johnson felt this was important because often people with SUD were unable to recall these instances or, if remembered, he or she would recall the event in a distorted way. Vernon Johnson said these, often horrific incidents, were not recalled because of (1) blackouts (similar to amnesia, not to be confused with passing out), (2) repression (see definition of this defense mechanism in Table 2.1) and (3) euphoric recall (i.e. the tendency to recall only the pleasurable parts of the drinking or substance use incident). What Johnson is describing are memory distortions created by ego defense mechanisms. No one likes to recall painful memories, so they are either distorted, suppressed or totally repressed from memory.