How Trauma Impacts Opioid Addiction: A Look at ACEs (Adverse Childhood Experiences)

Trauma leaves invisible wounds—and for many people, those wounds can last a lifetime. If you or someone you love has struggled with opioid addiction, it may be hard to pinpoint how it all started. But for countless individuals, the roots of addiction trace back to something deeper: unhealed trauma.

One of the most powerful tools we have for understanding this connection is the concept of Adverse Childhood Experiences (ACEs). These early-life stressors—from abuse to neglect to family dysfunction—can shape how our brains respond to stress, pain, and emotional regulation. And as researchers have found, ACEs are strongly linked to substance use disorders, particularly opioid addiction.

At Cedar Recovery, we recognize that addiction is rarely just about substances. It’s about pain, coping, and survival. That’s why understanding the role of trauma—especially in the early years—is so essential for healing.

In this blog post, we’ll explore:

• What trauma and ACEs really are
• Why do they increase the risk of opioid addiction
• How trauma affects the brain
• Why trauma-informed care is essential in recovery

If you’ve experienced trauma, it’s not your fault, and you’re not alone. There is a path forward, and recovery is possible.

What is the Link between trauma and addiction?

To understand the connection between trauma and addiction, we first need to understand what trauma actually is.

Trauma is the emotional, physical, or psychological response to distressing events that overwhelm a person’s ability to cope. These events might include physical abuse, sexual assault, neglect, domestic violence, or the loss of a loved one. But trauma doesn’t always stem from a single, dramatic moment—it can also arise from chronic exposure to stress, like growing up in an unstable or unsafe home environment.

When someone experiences trauma, especially in childhood, the brain and body adapt in ways meant to ensure survival. Unfortunately, these adaptations often come at a cost. Trauma can:

• Disrupt emotional regulation
• Increase sensitivity to stress
• Lead to long-term changes in brain chemistry and hormone function

In many cases, substance use becomes a coping mechanism. People might use opioids to numb emotional pain, escape intrusive memories, or feel a sense of calm and control. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), individuals with a history of trauma are significantly more likely to develop substance use disorders.¹

Addiction, then, is not simply about substance use—it’s often a survival response to pain.

What Are ACEs (Adverse Childhood Experiences)?

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before the age of 18. These include:

• Physical, emotional, or sexual abuse
• Neglect
• Household dysfunction (e.g., parental addiction, mental illness, incarceration, or divorce)
• Witnessing domestic violence

The term originates from the landmark CDC-Kaiser Permanente ACE Study, which found that ACEs are common, with nearly two-thirds of participants reporting at least one. More importantly, the study revealed a dose-response relationship: the more ACEs a person had, the higher their risk for depression, suicide, chronic illness, and substance use disorders.²

For many, early trauma changes how they process stress, form relationships, and cope with emotional pain. Opioids may become a way to self-soothe or numb those feelings, laying the groundwork for addiction.

Understanding ACEs helps shift the question from “What’s wrong with you?” to “What happened to you?”—a critical step in recovery.

The Science: How ACEs Increase Addiction Risk

Research shows that early trauma alters brain development, stress responses, and emotional regulation. In the original ACE study, individuals with four or more ACEs were up to 10 times more likely to inject drugs than those with none.²

A 2017 study published in Substance Use & Misuse confirmed this link, showing that ACEs were strongly associated with earlier substance use, greater severity of use, and increased risk of opioid misuse.³

Why? Chronic childhood stress overactivates the body’s stress-response system. Elevated levels of cortisol and adrenaline rewire the brain’s ability to manage fear and reward. Over time, this dysregulation makes it harder to cope with everyday emotions.

Opioids offer temporary relief by calming the nervous system, creating a fleeting sense of peace or numbness. But over time, this form of self-medication can spiral into dependency, especially when the root trauma remains untreated.

Trauma’s Impact on the Brain and Body

Trauma doesn’t just leave emotional scars; it rewires how the brain and body function. These changes can affect everything from how a person reacts to stress to how they manage emotions, making addiction more likely and recovery more complex.

Childhood trauma can disrupt development in key brain regions:

• The amygdala, responsible for detecting threats, becomes overactive
• The prefrontal cortex, which handles decision-making and impulse control, may become underdeveloped
• The hippocampus, which regulates memory and emotions, can shrink in size ⁴

The result? A brain that’s wired for survival, not balance. This often leads to:

• Chronic anxiety or hypervigilance
• Difficulty managing stress or emotions
• Impulsivity and poor decision-making

These neurological effects increase vulnerability to substance use. For someone in pain, opioids may feel like the only way to self-regulate.

But it’s not a matter of willpower. Addiction is a physiological response to unresolved trauma. Recovery requires treating both.

Signs Trauma May Be Fueling Addiction

Many people don’t realize their substance use is linked to trauma, especially if that trauma hasn’t been acknowledged or processed. But some common signs suggest a deeper emotional root:

• Emotional numbness or disconnection
• Chronic anxiety, panic, or fear
• Difficulty trusting others
• Frequent relapses triggered by emotional stress
• Using opioids to feel “normal”
• Persistent shame, guilt, or low self-worth

If you or someone you love recognizes these signs, trauma-informed treatment may be the missing piece. According to SAMHSA, nearly 75% of individuals in substance use treatment report histories of trauma.²

Why Trauma-Informed Care Matters in Recovery

Trauma-informed care recognizes that people in recovery often carry invisible wounds, and healing requires more than stopping substance use.

According to the Center for Health Care Strategies, trauma-informed care is grounded in five principles: ⁵

1. Safety
2. Trustworthiness
3. Peer support
4. Empowerment
5. Cultural sensitivity

At Cedar Recovery, we integrate these principles into every level of care. Our programs include:

• Individual therapy for co-occurring mental health issues
• Group therapy focused on coping strategies and emotional regulation
• Intensive Outpatient Programs (IOP) for structured, flexible support
• Nonjudgmental, compassionate care across all locations

By treating the whole person, rather than just the addiction, we support long-term, sustainable healing.

Hope for Healing: What Recovery Looks Like After Trauma

Healing from trauma and addiction takes time, but it’s absolutely possible.

Recovery means learning to trust again, feeling emotions safely, and building a life beyond mere survival. For many people in our care, addressing trauma was the turning point—they finally understood why they used substances, and how to break the cycle.

With the right tools and a supportive team, you can rebuild your life—one step at a time.

Get Support with Cedar Recovery

If you’ve experienced trauma and are struggling with addiction, know this: there is hope, and there is help.

At Cedar Recovery, we meet you where you are. Through trauma-informed, evidence-based care, we help you uncover the root of your addiction and begin the healing process in a safe, supportive environment.

Contact us today or find a location near you to take the next step. Recovery is possible, and you don’t have to do it alone.

Sources:

1. SAMHSA. (2014). Trauma-informed care in behavioral health services: A treatment improvement protocol (TIP 57). https://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816
2. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
3. LeTendre, M. L., & Reed, M. B. (2017). The Effect of Adverse Childhood Experience on Clinical Diagnosis of a Substance Use Disorder: Results of a Nationally Representative Study. Substance Use & Misuse, 52(6), 689–697. https://doi.org/10.1080/10826084.2016.1253746
4. Teicher, M. H., & Samson, J. A. (2016). Annual research review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241–266. https://doi.org/10.1111/jcpp.12507
5. Center for Health Care Strategies. (2017). Key Ingredients for Successful Trauma-Informed Care Implementation. https://www.chcs.org/resource/key-ingredients-for-successful-trauma-informed-care-implementation/
6. Centers for Disease Control and Prevention. (2023). Adverse childhood experiences (ACEs). https://www.cdc.gov/aces/about/index.html