The Role of Trauma and Stress in Co-occurring Disorders

Author of the Month

January 12, 2026 

Belinda Morey, Author

Tom O'Connor, Publisher

Author Belinda Morey, a member of our Editorial Advisory Board and a subject-matter expert in co-occurring disorders, is a living testament to the transformative power of understanding trauma in treating these conditions. Her journey from personal struggle to professional expertise is a beacon of hope, demonstrating that life can be messy and unpredictable yet still turn out better than expected. She started a blog because she was over the shame, the silence, and the sugarcoating around addiction and recovery. Her story serves as a testament to the fact that understanding trauma can lead to positive change and improved outcomes.

You can visit Belinda's website, Progress is Progress Mile or a Milimeter at https://progressisprogress.substack.com/

According to Belinda Morey 

Let's address the often-overlooked issue—the invisible elephant in the room that silently affects half our clients. At the same time, the rest of us pretend it's just a slightly larger emotional support animal. Recognizing and understanding this trauma is not just a key; it's our responsibility to provide adequate care.

As clinicians, it's not just our responsibility, but our duty to understand and address this issue. We are the frontline in the battle against co-occurring disorders, and we must equip ourselves with the knowledge and tools to tackle trauma in our practice effectively. 

Someone walks (or stumbles, or is dragged) into your office with a substance use disorder (SUD), maybe some depression or anxiety riding shotgun, and you're supposed to "treat" them. Perhaps you even have a few trauma-informed care posters on your wall—bonus points if they're laminated. But let's be honest: most of us are still playing catch-up when it comes to understanding the real role trauma and stress play in co-occurring disorders.

As a substance use counselor, a master's student in mental health, and a person in recovery, I urge you to shift your perspective. If you're not talking about trauma, you're not addressing the root of the problem. It's not just time for change, it's overdue, and we're ready for it. The time to act is now.

Trauma: Not Just the Obvious Stuff

It's easy to recognize trauma when it's loud and obvious. Car accidents, assaults, and clear-cut moments when someone says, "Yes, that was definitely traumatic." But what about the others—the slow, quiet drip of generational pain or the so-called "minor" neglect that happens in homes where love is conditional, and eye contact is rare?

Trauma isn't always headline-making. Sometimes it's a quiet footnote. It's the water people swim in so often that they don't even notice they're wet. For Native American communities—I work with many of them—trauma isn't just personal; it's rooted in history, culture, and systemic issues. It's the result of policies and practices that were meant (let's be honest) to erase you. And that echo doesn't disappear just because textbooks say it's over.

Generational Trauma: The Gift That Keeps on Giving

Let's discuss what's politely called 'intergenerational trauma.' This term refers to the transmission of trauma from one generation to the next. For Native American populations, this includes boarding schools, land theft, cultural erasure, and systemic oppression that would make Kafka blush. Recent research keeps revealing that historical trauma isn't just history—it's a living, breathing force that affects health outcomes today. 

*You might also like to read Belinda's article on intergenerational trauma.

A 2022 article in the Journal of Ethnicity in Substance Abuse found that historical trauma directly increases substance use disorders among Native American populations, and that culturally relevant, trauma-informed approaches are crucial for healing.

But here's the kicker: you can't see this trauma on an intake form. It doesn't appear on a DSM checklist. It shows up in the stories people tell about their grandparents, in the silences at family gatherings, in the way addiction sometimes feels less like a choice and more like a birthright.

Developmental Trauma: The Stuff You Don't Remember (But Your Nervous System Sure Does)

Now let's get even less comfortable. Developmental trauma—stuff that happens to us before we have words for it—can shape everything about how we relate to the world. Think chronic neglect, inconsistent caregiving, or that vague sense of "something was always off in my house." You may not remember it, but your amygdala does. I myself have had to look back at my own infancy and those extraordinary abandonment and attachment issues!

Recent research backs this up: a 2019 review in Current Psychiatry Reports found that the more adverse childhood experiences (ACEs) someone has, the greater their risk for substance use disorders—sometimes exponentially so. 

A 2020 study in Substance Use & Misuse further nails it down: ACEs are reliably predictive of both substance misuse and co-occurring mental health disorders.

Codependency: The Trauma That Disguises Itself as Love

If trauma is the invisible elephant, codependency is the emotional support animal with a fake service vest. Codependency is a behavioral condition in a relationship where one person enables another person's addiction, poor mental health, immaturity, irresponsibility, or underachievement. The field often jokes about 'codependency' as if it's just being a little too nice. But let's be honest: it's what happens when love and survival become entangled. When you grow up learning that your needs come second (or last, or never), you start building relationships that feel a lot like trauma reenactment. I spent about 30 years living in this one.

And once again, research has caught up: a 2017 article in Addictive Behaviors Reports found that codependency often stems from early relational trauma and is linked to a higher risk of both substance use and other mental health issues.

The Evidence: Trauma and Co-Occurring Disorders Walk into a Bar

• What does the research really say? Short answer: trauma and stress are the most reliable indicators of co-occurring SUDs and mental health disorders. Longer answer: It isn't easy, but it isn't complex.

• PTSD and SUDs: Studies from the past decade continue to show that people with trauma histories, especially PTSD, are much more likely to develop substance use disorders. Self-medication isn't just a theory; it's a survival tactic. A 2017 study in the European Journal of Psychotraumatology highlights how trauma—including childhood trauma—significantly increases the risk for co-occurring substance use and mental health conditions.

• Adverse Childhood Experiences: Higher ACE scores are associated with greater risk of alcohol and drug use, depression, and suicide attempts (Current Psychiatry Reports; Substance Use & Misuse).

• Native American Populations: Historical trauma is strongly linked to SUDs, depression, and suicide rates that surpass those of the general population (Journal of Ethnicity in Substance Abuse).

• Codependency and Trauma: Early relational trauma and attachment disruptions are connected to increased vulnerability to both addiction and mental health disorders (Addictive Behaviors Reports).

What Trauma-Informed Care Actually Means 

Trauma-informed care (TIC) is now ubiquitous—found on websites, in policy manuals, and on laminated posters. But the reality is much messier. It's not just about avoiding "triggers" or being "nice." It's about fundamentally rethinking how we view our clients—and, let's be honest, ourselves.

Here's what genuine trauma-informed care looks like (supported by a 2021 systematic review in Frontiers in Psychiatry that found trauma-informed care models improve outcomes for people with co-occurring SUDs and PTSD.

• Assume Trauma Is Present: Not "if," but "how." If you don't see it, you're missing the point.

• Safety First—For Real: Physical, emotional, and cultural safety. For Native clients, this may mean integrating traditional healing, respecting cultural practices, and acknowledging the impact of historical trauma.

• Empowerment, Not Paternalism: Clients Are the Experts on Their Own Lives. Our role is to walk alongside them, not to drag them behind or push them ahead.

• Collaboration Over Compliance: Recovery isn't about obeying orders; it's about rebuilding trust in relationships—one honest, sometimes awkward, conversation at a time.

• Cultural Humility: Especially with Native populations, we need to check our egos (and assumptions) at the door. Learn, listen, and become comfortable with "I don't know."

Why We Keep Messing This Up (And How We Can Fix It)

So why, despite all this evidence, do we still get it wrong? The answer is simple: it's easier to blame, diagnose, and prescribe than it is to sit with someone's pain. It's easier to check boxes than to confront our own discomfort with suffering. And the system—overworked, underfunded, obsessed with outcomes and productivity—favors speed over depth.

But here's the truth: you can't heal a wound you refuse to see. You can't treat addiction or depression without addressing the trauma that fuels them. And you can't do any of this alone.

How We Can Do Better (Yes, You. Yes, Me. Yes, All of Us.)

• Get honest about trauma: stop pretending it's rare or "just" a background issue. Make it central.

• Educate yourself—then unlearn what doesn't work: read the research, sure. But also listen to your clients. They'll tell you what trauma looks like in real time.

• Advocate for change: push for trauma-informed policies, funding, and training. Call out systems that retraumatize. Support Indigenous healing initiatives and culturally tailored interventions.

• Take care of your own trauma: burnout isn't a badge of honor. We're all carrying something. Supervision, therapy, mutual aid—use them. Laugh at the absurdity of it all, but don't ignore your own wounds.

• Speak up about harm: if you see a colleague, supervisor, or system causing harm, speak out. Silence equates to complicity—and complicity is trauma in disguise.

The Core Message

We're not just addressing symptoms; we're confronting stories—some openly shared, some buried deep, and some passed down like unwanted family heirlooms. Trauma is the common thread in co-occurring disorders, and if we ignore it, we're not truly helping.

Let's commit to doing better—for our clients, for ourselves, and for the profession. Not because it's fashionable or because a grant mandates it, but because this work truly matters.

And if you need a reminder to lighten the mood: if trauma is the invisible elephant, at least we're finally talking about the smell.

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Belinda Morey earned a Bachelor's Degree in Substance Abuse/Addiction Counseling. You can contact Belinda at: progressisprogressmilormil@gmail.com

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