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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Complex Interactions

Women, Trauma, Addictions and Mental Health

Susan Armstrong, MEd, RCC

Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 34-35

Counsellors who work with survivors of violence are aware that many of their clients have issues of addiction and mental health. The relationship of trauma to addiction and mental health is complex and, to date, inadequately researched.

Research has documented that mentally ill people are highly vulnerable to violence. One study revealed that people with a mental illness are 2.5 times more likely to be a victim of crime,1 and another study documented that 81% of psychiatric inpatients had experienced serious physical and/or sexual assault.2 Other studies reveal that women, in particular, use alcohol and drugs as ways of managing trauma related symptoms.3

As a Stopping the Violence counsellor and as a therapist specializing in trauma, I found that many of my female clients with addictions or mental health diagnoses had significant histories of childhood abuse and neglect and experiences of assault in adulthood.

The following client stories show the complex interactions of trauma, mental health diagnoses and alcohol and drug use.


Sylvia* was a participant in a re-employment program for women. She was referred for counselling because she frequently zoned out in classes and was unable to remember much of what had occurred in the day. Sylvia had a long history of heroin addiction and was on methadone. The program facilitator wanted to know whether her attention difficulties were due to the methadone.

After establishing rapport with Sylvia, I conducted a dissociation assessment. This revealed that she experienced various forms of dissociation on a consistent basis.

When asked about her life, Sylvia related how she had become hooked on drugs during a relationship with a man involved in the drug trade. She had engaged in drug use and trade to keep herself safer with her abusive boyfriend: if Sylvia got high with him and complied with his demands that she traffic drugs, she was beaten less often. Sylvia eventually ended up on the streets. She went through drug treatment a number of times before managing to leave the streets and the city permanently and be placed on methadone.

In the years that Sylvia was in and out of drug treatment, no one had ever asked her about childhood experiences of assault and neglect. Nor had anyone adequately understood her level of terror regarding her ex-boyfriend and his association with a gang.

Sylvia’s story illustrates how drug use can be a survival strategy within abusive relationships. The drug use helps distance a survivor from feelings of terror.


Karen is a 20-year consumer of mental health services. She was referred to counselling at age 37 by her psychiatrist. Her psychiatrist was aware that Karen had a history of childhood sexual abuse, but this had been left unexplored. She had been treated solely with medications and/or electric shock therapy.

Karen remained in counselling for her childhood sexual abuse for years. She did recover her sense of safety and ultimately triumphed over her suicidal and self-harming behaviours.

Several years into her counselling process, I asked Karen what her psychiatric diagnosis was. Laughing, she asked me which one. She had had nine diagnoses over the years. Her psychiatrist was now considering post-traumatic stress disorder as a primary diagnosis.

Although Karen is mentally ill and remains on medication, her self-esteem and self-love are restored, she’s engaged in her community and she’s able to have trusting relationships. But I often wondered what Karen’s life could have been if her trauma history had been assessed and a referral to counselling made when she had her first psychiatric admission at 17.


Alita was referred for counselling by a public health nurse after having an episode of rage during a home visit. Alita had overcome a severe addiction to alcohol and had maintained sobriety for years. She was, however, a regular consumer of marijuana and felt great shame about her use.

Alita’s trauma history was profound. Her childhood was filled with severe neglect, assault and rape, and her adult life with serious physical and sexual assault and ongoing poverty and racism. As she worked through her trauma history—both historical and current—Alita’s isolation decreased, and her self-esteem and parenting improved.

Although Alita was able to reduce her marijuana usage, she was unsuccessful in abstaining completely. Attempts to do so resulted in immobilizing depression and rage—symptoms that were not successfully managed by antidepressants. It became clear that marijuana was medicating Alita against some of her strongest trauma-related feelings.

These three case examples of courageous, resilient survivors of trauma illustrate the complex intersection of trauma, addiction and mental health. It is important to assess whether an addicted or mentally ill woman has a trauma history. Assisting women to safely containing their trauma-based symptoms while slowly working through their experiences can truly transform lives.

* All names and some details have been changed to protect client confidentiality.

About the author

Susan works in Vancouver as a Program Manager for the BC Association of Specialized Victim Assistance and Counselling Programs. Previously she provided trauma counselling in Toronto and Vernon, BC.

  1. Hiday, V.A., Swartz, M., Swanson, J. et al. (1999). Criminal victimization of persons with severe mental illness. Psychiatric Services, 50(1), 62-68.

  2. Jacobson, A. & Richardson, B. (1987). Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry. American Journal of Psychiatry, 144(7), 908-913.

  3. Davis, R.E., Mill, J.E. & Roper, J.M. (1997). Trauma and addiction experiences of African American women. Western Journal of Nursing Research, 19(4), 442-460.


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