Physical or Psychological Trauma Often Triggers Addiction

Pain specialist Corey Waller, MD, MS, FACEP, discusses FDA-mandated education during the Ruth Fox Course Thursday.

Pain specialist Corey Waller, MD, MS, FACEP, discusses FDA-mandated education during the Ruth Fox Course Thursday.

Because physical and psychological traumatic injury often leads to addiction, it was fitting that this year’s Ruth Fox Course for Physicians thoroughly covered “Trauma and Addiction.” Leading experts addressed the waterfront of issues Thursday from post-traumatic stress disorder (PTSD) to traumatic brain injury (TBI) and how those experiences relate to addiction and other psychiatric comorbidities.

“We decided to explore trauma and addiction from several different angles, especially given the number of military service personnel returning from Iraq and Afghanistan who have had traumatic injuries from a physical and psychological source,” said Margaret Jarvis, MD, Course Chair.

In fact, the course included a presentation devoted to trauma and addiction in the military.

“A lot of trauma in military service involved people’s experiences with the improvised explosive devices (IEDs) that can cause either minor head trauma or much more severe head trauma,” said John Tanner, DO, Course Vice Chair. “Other events can cause PTSD as well, such as sexual trauma, so we also wove different aspects of those issues into the course.”

The Ruth Fox Course for Physicians provided key information, resources and tools that can be used to treat individuals with addiction and trauma issues, Dr. Jarvis said. Some medications and psychotherapy techniques have proven useful in treating nightmares, a common outcome of traumatic events.

Sexual abuse trauma in adolescents frequently leads to addiction in these youths.

“When you are treating adolescents, it’s important to remember the brain changes that are going on at the time make it difficult to employ some of the techniques that work better in adults,” Dr. Jarvis said. “Adolescents often don’t have the capacity always to think beyond the next couple of minutes.”

The development of personality features, particularly borderline and histrionic, are often “part and parcel of trauma in childhood,” she said. Issues with mood and anxiety also have origins in childhood trauma.

In treating trauma, physicians have focused more on physical disabilities, such as the weakness in an arm or leg or paralysis, but didn’t really scrutinize the emotional changes that occur after TBI, Dr. Tanner said.

“It has long been known that trauma of all forms from emotional, sexual, physical and head injury is highly linked to the development of addiction,” he said. “But we have not always fully understood why people who have had various trauma develop addictions.”

Dr. Jarvis commended Dr. Tanner on his presentation about neuropsychiatric imaging in addiction, TBI and other behavioral disorders. “If we can look at a scan and identify a problem that causes specific behaviors, it makes things easier to study, identify and get a handle on,” she said.

Dr. Tanner noted that neuroimaging science has advanced considerably in recent years to quantify behavioral medicine. Magnetic spectroscopy uncovers the presence of chemicals in specific regions of the brain, and those chemicals can reveal what has happened post-injury.

“By doing this imaging, we can actually attach some prognostic indicators to what happens after someone experiences trauma,” he said. “We know that certain disease states, such as severe depression and addiction, can result in the deterioration of certain brain structures.”

Specific drugs increase or decrease specific chemicals in certain structures of the brain, and each drug has some visual signature regarding its impact on the brain, Dr. Tanner said. If a patient with an addiction is not responding to traditional treatment, many times neuroimaging will provide unexpected answers.

“We hope addiction medicine specialists left the Ruth Fox Course feeling that they have a more comprehensive understanding of how trauma can play a part in addictive disease,” Dr. Jarvis said.

Dr. Tanner said that he hoped audience members walked away with better resources to evaluate and appropriately treat patients. “All trauma, whether it is physical or emotional, can be a factor either to aggravate or trigger addictions or mental health problems,” he said. “These people, through no fault of their own, have experienced this trauma and are now vulnerable to develop all kinds of problems.”