When a car crash stirs up past trauma or substance use
Safer ways to cope, from a trauma clinician and an addiction specialist
A recent crash can bring back a scary experience from your past. A sound tied to both events may set off a strong reaction. Or you may feel upset and not know why. You might also reach for alcohol, cannabis, extra pain medicine or a sleep aid to get through the night. A trauma clinician and an addiction specialist would meet these changes with curiosity and without blame. They’d want to know what’s happening now and what would make coping safer. [1, 2]
Notice when the past shows up
Past trauma can shape how a person reacts to a new event. Even so, not everyone with a hard history will develop a disorder. Old memories may come back. Fear may feel stronger, or you may feel a familiar pull to withdraw. Part of the reaction may also come from a current injury or stress. [1, 3]
Give a clinician enough to guide your care. You could say, ‘This crash is bringing back something from earlier in my life.’ You don’t have to share every detail at the first visit. [1, 3]
If a clinician asks about trauma, it’s fine to ask questions back. Why does it matter? How will the information be used? Which topics can you choose not to discuss yet? Good care should give you choices and explain what happens next. [4]
Keep an eye on changes in substance use
Check in with yourself. Are you using more often or in larger amounts? Are you taking a medicine differently than the label says? Is the main reason you use something to shut out memories, pain or fear?
Look at the fallout too. That could be worse sleep, missed care, arguments, unsafe driving or needing more to get the same effect. Any of these is a reason to talk with a clinician. That holds even if the word ‘addiction’ doesn’t fit how you see yourself. [2]
At first, alcohol may seem to help you sleep. It can still make your sleep poorer. Mixing alcohol with opioid pain medicine or benzodiazepines, a type of sedative, can slow your breathing and cause an overdose. Ask a pharmacist or prescriber about each medicine you take. Find out if alcohol or any other substance is unsafe to use with it. Never take more than prescribed to cope with distress. [2, 5]
A safer way to answer the urge
- Stop and name what you need. Is it sleep, pain relief, company or a break from a memory?
- Match the support to the need. Call your treating clinician about pain, or ask someone you trust to stay with you. If a reminder has been set off, try a grounding step.
- Make access safer. If it’s appropriate and you’re on board, have someone hold on to extra medicines. Store medicines as directed, above all when children are around.
- Be honest with a clinician about what you used and when. With that knowledge, they can head off dangerous interactions and choose your treatment. [5]
Do you drink heavily most days, or might your body depend on alcohol or another drug? Get medical advice before you stop all at once. Withdrawal can be dangerous. A clinician can help you build a safe plan. [6]
Get help for trauma and substance use together
You can talk about trauma before you finish treatment for substance use. The reverse is true too. Both problems can be checked and treated at the same time. A primary care provider, trauma therapist or addiction specialist can help you sort out priorities. Together you can decide what to tackle first for safety and what can move forward alongside it. [2]
In the United States, SAMHSA’s National Helpline gives confidential referrals for treatment at 1 800 662 HELP. The website FindTreatment.gov lists services for mental health and substance use. You could open with: ‘Since the crash, my use has changed and I want help before it gets worse.’ [7]
Signs of an emergency
Call 911 if someone’s breathing slows or becomes hard, or if you can’t wake them. Seizures and any immediate danger also call for 911. In the United States, call or text 988 if you’re thinking about suicide or might hurt yourself. You can get help without first proving things have gotten bad enough. [5, 7]
Name one change out loud
Write down one change you’ve noticed since the crash. Share it with a clinician or someone you trust. Talking early and in specific terms can make your next move safer.
Sources and further reading
- 1VA: PTSD basics and risk factors
- 2VA: Substance use and PTSD
- 3NIMH: Coping with traumatic events
- 4VA: Trauma informed care
- 5FDA: Opioids with alcohol or sedatives
- 6NIAAA: Alcohol related medical concerns
- 7SAMHSA: Find treatment
This article gives general U.S. education from the fields of trauma and addiction care. Do not change prescribed medicines, or suddenly stop heavy regular use of a substance, without medical advice. Get urgent care for warning signs of overdose or withdrawal.
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