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PTSD & Addiction (Part II)

She’s a late stage alcoholic. Her prognosis would traditionally be seen as exceedingly poor. She sees herself as broken and fairly hopeless, yet there is resilience in her. Upon hitting bottom she keeps getting back up. She’s willing to go to any lengths to get better. Her heart may be broken, but she has a lot of guts.

I ask a lot of stupid questions. I ask why she keeps getting drunk.

I’ve never heard it put more succinctly. She looks me in the eye and says, “Every time I get sober I remember. Every time I remember I get drunk.”

She was a military nurse and what she witnessed was beyond any horror I can imagine.

For a long time she tried to forget. Then she reasoned that it was pointless to talk about the past because she couldn’t change it. Years later she accepted that talking was necessary because the line between past and present kept getting blurred.

When you relive the past it’s never over. Flashbacks are nightmares with your eyes open. But unlike bad dreams, they’re real. The very nature of trauma is that what we survived is never really over.

She interviews me coldly but fairly. “I’ve tried to talk to people like you before. It seems to me that you people are afraid to hear about what happened to me but you don’t admit you’re scared. Instead you babble some shit about being in the moment and appreciating today. Are you afraid?”

I explain that I’m not. She studies my face for a long time. Her face softens. I meet her gaze and simply say, “You can’t hurt me.”

She’s been invalidated and shut down, but underneath it all she’s afraid that just hearing her story will leave me a mess. That’s common in my experience as a clinician specializing in trauma and addiction recovery. Those who have suffered the most tend to be beyond sensitive. They’re fearful of hurting others. This perspective often leaves them feeling like they have to protect those they care about by distancing themselves.

Normally I urge people to get sober and stable before they even think of doing trauma work. There are exceptions to the rule and she is one. She’s been trying to get sober through multiple wars historically and countless battles in her mind.

Her story starts long before going into a war zone. Like many nurses, she grew up taking care of an alcoholic parent and she learned early on that drinking is what one does to deal with feelings. This was reinforced years later while in active service. Alcohol is not simply a part of military culture. It’s all but mandated. To not drink is to raise suspicion.

She’s trying to tell me her whole story in a single session and I explain that simply isn’t possible. She decides to just give me the highlights. She’s studying my face as she lists them off, but her voice and body language are as though she’s reading off a grocery list.

Over the coming weeks she fills in the stories and sometimes she’s completely present and often she’s only physically in my office. We discuss grounding strategies – using her five senses to reconnect to the here and now. We explore what she felt then and how she can express it now. There are limits to what words can do. Trauma often leaves us holding rage and rage doesn’t fit neatly into words.

Every trauma is uniquely experienced. Two similar people can go through the same event and be affected in radically different ways. The devil is usually in the details – the sensory input that is so vividly recalled. Sounds and smells are usually the worst. We talk about pleasant sounds and smells she can use when the memories won’t go away.

We discuss dealing with triggers and why so many of them simply can’t be anticipated or avoided. I encourage her to consider that the more grief and anger she empties, the less remains to be triggered. She sees this but struggles with the anger piece. We devote some time to breaking glass. This allows her to be destructive without being self destructive.

She reaches a place where she has more good days than bad. Her progress continues but its slow going. She hasn’t drank. What worked for her was to simply accept that if alcohol has always been part of the problem that it can never be part of the solution. She doesn’t need it anymore because while she cannot forget, she’s far more able to live with what she remembers.

Trauma recovery is more art than science. It’s about having the willingness to bear witness and to help create a path out of Hell. The best clinicians understand this. They also have the humility to understand that we’re only a small piece of the puzzle. What folks who have survived unspeakable acts need far more than a good therapist is the love and support of friends, family, and fellow survivors.

Please reach out to those you love who are struggling. We’re losing not only a heartbreaking number of active and retired military personnel every day, but also countless others impacted but a myriad of other forces that result in Post Traumatic Stress.

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