Trauma is the only gateway drug
Oftentimes, research proves something that a lot of us already know to be true. And what you may not know is there is about a 17 year gap between new evidence proven through research and a change in the delivery of medical care as a result of that evidence. In 2003 a group of researchers published a paper showing that ACEs (Adverse Childhood Experiences) are strongly correlated with substance use disorder, and that:
“Compared with people with 0 ACEs, people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use.” (Dube, et al, 2003)
Addiction medicine is slowly catching up to the idea that substance use disorder has both genetic and environmental risk factors which include intergenerational and childhood trauma, but stigma and all the isms continue to drive the treatment, marginalization, and criminalization of people who use drugs despite scientific evidence of substance use not being a moral failing being readily available for 20 years.
Almost all of the messages that we receive about substances and the people who use them blame the drug user. From “gateway drugs” ie, ‘bad choices’, to selfishness, to moral failing, the onus falls on us. As a person with an ACE score of 8, (that’s a high score, btw) when I look back over the course of the early years of my life I feel as though I didn’t even have a chance - IV drug use was pretty much written into my life’s outcome by my childhood experiences. Yes, this is a reductive statement; I absolutely admit that. But, the protective measures and support weren’t there to prevent this outcome. So, to blame me and other people who use drugs for our substance use disorder is also reductive, and misguided.
Just as the responsibility of our use is put upon people who use drugs by our society, so is our healing. People who live with substance use disorder are marginalized, criminalized, blamed for a large percentage of societal problems, and left alone to figure out how to navigate living with a disease that wasn’t our fault in the first place. There is finally a consensus in the medical field that substance use disorder is a disease, yet we are still largely dismissed and discarded when seeking support from our communities and from medical professionals.
See: American Public Health Association Policy statement on Harm Reduction
Before my substance use disorder went into remission, I asked for medical help multiple times. From being prescribed medication to alleviate my withdrawal symptoms that almost killed me to being told by a doctor at age 19 that I didn’t have it in me to kick my habit and that I should just give in to being a “lifer”, my experiences were far from trauma informed. Until, after a couple years of searching, I found the right provider. He trusted me, collaborated with me by giving me agency over my treatment plan, and offered me a very unfamiliar glimmer of hope. And it worked.
This doctor’s approach was rooted in the harm reduction framework, and between the care that I received from him and access to syringe exchange services, I made it out alive and relatively healthy. It is important to note that this was during a different era - one where suboxone wasn’t yet available, and one that preceded our current emergency with the drug supply being contaminated with fentanyl and xylazine. There has always been an urgency to show up for people who use drugs, but the stakes are even higher now.
I want this to be an informative piece of writing, but it is also a call to action: Do not leave people who use drugs out of your definition of trauma informed care. I am talking to all care workers, all medical professionals, all community members, all family members; everyone!!
If trauma is the only gateway drug, what are we doing to create a world that cares for people who experience trauma? *I must mention that to be alive in this capitalist colonial patriarchal white supremacist delusion (Darch, 2022) means that having a beating heart equals living with trauma. Trauma isn’t a “them” problem, it’s an us problem.
How do we move forward from here? I have a few suggestions.
Interrupt stigma in real time. Question your own assumptions first. Living in a society that continuously stigmatizes people who use drugs means that it’s almost impossible not to internalize that stigma. When you notice a judgmental thought, ask yourself questions - Where did this idea come from? What does it mean, exactly? Why am I feeling this way? Is there a different perspective that I can learn from? Is there someone in my life (including myself) that this thought would cause harm to?
Question the assumptions of those you interact with. Ask the above questions of your community, colleagues, and loved ones when you hear stigmatizing rhetoric in conversation. Come from a place of curiosity, meet people where they are, and help bring new perspectives. Share information about trauma being a risk factor for substance use, and engage in dialogue around encompassing substance use disorders and people who use drugs into trauma informed care.
Seek out more learning opportunities and center the voices of people with lived experience.
Learn about the history of the war on drugs and the continued harm that comes from it.
Get involved with local harm reduction organizations. Lift them up, donate to them, volunteer, and use them as resources.
Get loud: Call your local representatives and request that more harm reduction services be made available in your community. Ask that funding go toward harm reduction programming.
Love people who use drugs out loud. We won’t make change in an echo chamber, and staying quiet in spaces with differing opinions just continues to further stigma. Let people know why this is important to you.
Ask your medical providers what services they have available for people who use drugs and request that they include harm reduction strategies.
Carry naloxone. Get trained in using narcan, and carry it with you.
Please share your thoughts, ideas, experiences, and feedback in the comments section. We are in this together.
Nickie Tilsner (she/her) is a harm reductionist first and foremost, Registered Nurse currently in Primary Care leadership, birthworker for 22 years, doula trainer, Co-Executive Director and Co-Founder of Cornerstone Birthwork Training, as well as a parent, partner, and pet parent.
Capstone US: Advanced Full Spectrum Birthwork Training where you can lean into learning about harm reduction and how to weave it into your practice (among other things) began YESTERDAY April 23, 2023, AND you can still JOIN! Registration closes 4/30/23.