Managing Substance Use and Emotions in the Context of Trauma: A Case Study

The reciprocal interaction between substance use, trauma, and emotions is well documented. Trauma is associated with neuroendocrine and neurobiological dysfunction and the subsequent development of psychopathology in adults. Cumulative trauma triggers, aggravates, and increases the recurrence of psychiatric symptoms. Individuals suffering the psychiatric sequelae of cumulative trauma have a more complex clinical profile, ultimately resulting in worse treatment outcomes. Limited guidance exists in the form of treatment guidelines or clinical evidence on the management of substance use and emotions in the context of trauma. This article chronicles one patient's experience with cumulative trauma, depression, anxiety, and iatrogenic opioid dependence. The authors review the impact of trauma on brain function and discuss evidence and treatment strategies engaged in the management of this patient.