Addressing Racial Trauma in the Treatment of Substance Use Disorders

Abstract

* Abbreviations: ACE — : adverse childhood experience SUD — : substance use disorder Recognition that trauma is a key contributor to the development of substance use disorders (SUDs) has been critical to developing effective clinical approaches for this patient population. Understanding the substantial increase in risk for SUDs conferred by a history of early traumatic experiences allows the health care community to shift the standard clinical frame from “What is wrong with you?” to “What has happened to you?” This framing promotes an attitude of compassion and understanding, which underlies effective treatment approaches to all individuals with SUDs. Not all groups, however, experience trauma the same way; and because of these differences, which often fall along racial lines, the precise nature of the relationship between trauma and SUDs also differs. Although Felitti and co-workers’1 original conceptualization of the relationship between adverse childhood experiences (ACEs) and increased risk of SUDs, mental illness, and physical illness was based on data from a largely white, employed, and insured population, these relationships have also been demonstrated in an urban Black population.2 However, the concept of ACEs itself, as well as widely used instruments to measure exposure to ACEs, does not incorporate the impact of racial trauma (ie, stress caused by interpersonal or systemic racism that may cause emotional and physical health problems).3 How ongoing racial trauma informs the development of SUDs and may limit the effectiveness … Address correspondence to Miriam Komaromy, MD, Grayken Center for Addiction Medicine, 801 Massachusetts Ave, Room 1039, Boston, MA, 02118. E-mail: miriam.komaromy{at}bmc.org

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