Narrating Suffering Through the Lens of Trauma: A Narcofeminist Analysis of Addiction Narratives

Introduction

The concept of “trauma” has been widely adopted in mental healthcare in recent decades as a way of understanding experiences of distress and suffering, with approaches like “trauma-informed care” increasingly applied in therapeutic practice. The move to “trauma” has also been taken up in the alcohol and other drug (AOD) policy and treatment sectors, where it shapes understandings of a range of AOD-related problems, including addiction, relapse, and overdose (Mills, 2015). In this article, we pursue a feminist, sociological analysis of trauma discourse by exploring the gendered, sociopolitical implications of the expansion of trauma as a paradigm for interpreting emotional distress. Drawing on qualitative interview data from a transnational study of addiction and recovery trajectories conducted across France, Belgium, and Canada, we consider the role of trauma discourse in shaping how people interpret experiences of suffering in relation to addiction, emotional distress, and various forms of violence and discrimination. In doing so, we seek to surface the underlying assumptions and power relations of the trauma paradigm, including its connections to the dominant therapeutic modalities of mental healthcare. Our analysis is guided by the following key questions: How does the concept of trauma function in people's accounts? What does it enable and foreclose in interpreting experiences of suffering? How does it frame people's identities and experiences? In pursuing these questions, we consider both the potential benefits of trauma-informed practices as well as the limits of their transformative capacities in the context of AOD treatment and care. To address these concerns, we draw on feminist intersectional analyses of mental health coupled with narcofeminist approaches attuned to the complexities of drug use. Combining these literatures allows us to consider how the trauma paradigm may be implicated in reproducing forms of social inequality, such as gendered oppressions and the pathologization of marginalized groups, notably gender and sexual minorities, and people who use drugs. In sum, our analysis explores the broader sociopolitical implications of the turn to trauma in mental health and AOD treatment, including its possibilities and limits for challenging drug-related stigma and advancing broader social justice agendas.

Before reviewing the literature that informs our thinking, we offer a brief definitional note. We use the terms “trauma paradigm,” “trauma-informed care,” and the “trauma concept” to refer to the wide-ranging, contested knowledges that address the impacts of adverse life experiences. Influenced by our scholarly heritages in sociology, psychology, and gender studies, we recognize trauma as a socio-cultural phenomenon, shaped and transformed by social, cultural, and historical forces (Wertheimer & Casper, 2016). By extension, the range of phenomena that come to be classified as trauma is contested and open to reinterpretation, depending on particular social, cultural, and political circumstances (Leys, 2000). For example, scholars have traced the etymology of trauma to the Greek word for “wound,” observing that the conception of trauma as a physical injury has existed for centuries (Bond & Craps, 2020). Clinical accounts of trauma as a psychological wound are more recent, originating in nineteenth century studies of hysteria, with Freud later linking “hysterical” symptoms to repressed memories of sexual trauma, pointing to an epidemic of sexual abuse of women (Freud, 1953; Leys, 2000). As historian Ruth Leys observes in her (2000) genealogy of trauma, a key historic moment in the expansion of the trauma concept was attempts by Holocaust survivors and their families to obtain financial compensation from the West German government for Nazi war crimes. In their quest for legal redress, survivors appealed to the concept of trauma to extend the social acknowledgement of past injury, legitimating the psychic harms of the Holocaust by imbuing them with legal valency. Understandings of trauma shifted again in the 1980s in the wake of the Vietnam War with the creation of the diagnostic category of post-traumatic stress disorder (PTSD), a diagnosis designed to capture the long-term psychological effects of physical combat on war veterans. The diagnostic recognition of a “traumatic syndrome” in the form of PTSD was largely due to the political advocacy of psychiatrists, social workers, and activists highlighting the need to officially recognize the suffering of Vietnam War veterans (Leys, 2000). Alongside this advocacy were efforts in the 1970s by women's advocates to address childhood sexual abuse and gendered violence. For example, physician Judith Herman's (1992) book Trauma and Recovery connected the concept of trauma to a political struggle for feminist justice for survivors of sexual abuse. Together, the advocacy for Vietnam war veterans and feminist advocacy against sexual abuse contributed to establishing an integrated approach to trauma, as solidified in the diagnostic category of PTSD (Leys, 2000).

Embedded in psychoanalytic models, PTSD is a disorder of memory in which the experience of trauma is believed to cause a psychic split where trauma victim-survivors are unable to integrate the experience into normal consciousness. Instead, the traumatic event or experience is temporally fixed such that it is “perpetually reexperienced in a painful, dissociated, traumatic present” via flashbacks, nightmares, and intrusive memories (Leys, 2000, p. 2). In centering memory, psychoanalytic conceptions of trauma emphasize the role of the subject in (unconsciously and consciously) interpreting a distressing event, which determines whether and how it is experienced as traumatic. The subjective interpretation of an experience as traumatic relates to the psychoanalytic concept of “Nachträglichkeit” coined by Sigmund Freud in his book Studies on Hysteria (1895) to describe a “mode of belated understanding or retroactive attribution of … traumatic meaning to earlier events” (de Lauretis, 2008, p. 118). The closest English translation of the term is “deferred action,” which describes the process by which a memory is reframed or inscribed as trauma in light of later experience (de Lauretis, 2008; Freud, 1895). Freud explains the double temporality of psychic trauma and the activation of repressed memories thus: “the psychical trauma—or more precisely the memory of the trauma—acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work” (Freud, 1985, p. 6). The psychoanalytic notion of Nachträglichkeit illustrates the significance of memory and temporality in conceptions of trauma, a point to which we return later. These examples demonstrate the changing contours of trauma as a heuristic for delimiting the impacts of distress and suffering. In line with this understanding, we are interested in teasing out the constitutive work that the concept of trauma does in (re)shaping the self and contemporary cultural formations. On this view, trauma has performative power and generates subjectification effects: it constructs a certain type of person (e.g., a “victim-survivor” in contemporary terms) and offers a basis on which they can access legal compensation, state or insurance-funded therapy, and other services (Leys, 2000; Stevens, 2012).

In contrast to this analytic approach, trauma is defined more narrowly in the mental health sector as the psychological impacts of exposure to actual or threatened death, serious injury, or sexual violence (American Psychiatric Association [APA], 2013). Diagnostic criteria for trauma-related disorders have been included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-V (APA, 2013), accompanied by the proliferation of measures of trauma exposure (e.g., Norris & Hamblen, 2004) and biopsychosocial approaches that elaborate the connections between trauma, neuro-psychological processes, and social attachment (Calhoun et al., 2022). In the context of AOD treatment, trauma is understood as a public health problem resulting from emotionally harmful and distressing experiences, including violence, war, abuse, and neglect (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Given that experiences of trauma are thought to be associated with health risks, including chronic illness and mental health problems, addressing trauma is increasingly recognized as a key aspect of health service delivery. In the psychiatric and public health literature, trauma is identified as a risk factor for drug dependence or addiction, but the evidence for the trauma-addiction link is contested, and it is well established that people respond differently to traumatic events depending on their circumstances and social settings (Konkolÿ Thege et al., 2017). This points to the importance of considering factors beyond the individual to understand the relationship between trauma and AOD-related problems. These include structural factors such as access to healthcare and social support, stigma, marginalization, and institutional neglect. Moreover, there is a growing acknowledgement within health policy and practice that measures designed to support people can themselves be trauma-inducing or retraumatizing, often obscuring the structural violence embedded in institutional systems (Carlton & Russell, 2023). For example, invasive procedures in the medical system or punitive disciplinary practices in educational systems can produce significant distress (or “trauma” in contemporary discourse), acting as a barrier to effective outcomes. This recognition has led to a growing focus on mitigating the impact of trauma, with many health service systems adopting trauma-informed approaches. While these approaches vary across jurisdictions, an influential guide in the AOD treatment sector has been developed by the U.S.-based Substance Abuse and Mental Health Services Administration (2014), which sets out six principles for trauma-informed care, including safety; trustworthiness and transparency; peer support; collaboration and mutuality; and empowerment, voice, and choice. Importantly, the principles evince a focus on the organizational environment (e.g., trustworthiness and transparency, collaboration and shared decision-making) and a broader concern with the social dimensions of trauma, including cultural, historical, and gender issues. The Substance Abuse and Mental Health Services Administation (SAHMSA) guidelines also recognize that the impact of trauma can ramify beyond individuals and affect wider communities, as captured by the notion of historical or intergenerational trauma.

While the SAHMSA guidelines present a nuanced understanding of trauma that includes structural dimensions, the principles themselves are broad and complex, and their implementation varies widely across the AOD treatment and mental health sectors (Berring et al., 2024). For example, studies have found that trauma-informed approaches are not well understood by clinicians or organizations, with staff expected to deliver trauma-informed care with limited training or guidance on practical implementations (Berring et al., 2024; Tompkins & Neale, 2018). In line with these findings, a 2023 study by sociologist Elizabeth Armstrong distinguishes between trauma-informed care and a trauma services approach, suggesting that the latter is more limited as it addresses trauma through discrete interventions (such as individual or group counseling) but without attention to the broader context of service provision and the need for transformation in organizational practices to enact the values of trust, collaboration, safety and empowerment. Moreover, as the register of trauma expands into popular discourse, its meanings have proliferated to characterize diverse experiences ranging from those that are life-threatening, abusive, and oppressive to more mundane, everyday stressors. In an edited collection on critical trauma studies, trauma scholars Wertheimer and Casper highlight the expansion of trauma into the “everyday and the spectacular,” arguing that, “the register of trauma is ever more frequently employed to account for understandings of ourselves, our actions, and the things that are done to us (and that we do to others)” (2016, p. 5). In this sense, trauma discourse can be understood as expansionist, with clinicians annexing related forms of expertise, for example, neuroscientific knowledge and psychoanalytic theories, in an effort to explain how traumatic memory is encoded in the brain and body, in the process cementing trauma as a target for therapeutic intervention (Leys, 2000; Wertheimer & Casper, 2016). Relatedly, individuals are encouraged to frame their suffering through the lens of trauma in order to make a claim to the exceptional character of their experience, a move that commodifies individual suffering and therapeutic intervention, and erases structural injustice and collective struggles (Gavey & Schmidt, 2011; Saketopoulou, 2023a, 2023b).

In a reflection on the affective dimensions of the contemporary moment and the ways in which trauma functions as a genre or heuristic for framing experiences, feminist scholar Lauren Berlant makes a similar point arguing that “we still live in a trauma culture, but it's really a crisis culture borrowing trauma's genres to describe what isn’t exceptional at all in the continuous production and breakdown of life” (2012, p. 82). This observation suggests the significance of the broader geopolitical contexts and contemporary crises that have shaped the ascendance of trauma as a cultural object. As critical trauma scholar Maurice Stevens (2014, n.p.) asks, “Is there something particular or different about the contemporary moment that calls us to reflect upon injury and trauma in new ways? In the forms of mass labor exploitation, proliferating military conflict zones, industrial catastrophe, natural disasters, state austerity plans, and ecological system collapse, the past decade has given evidence of increasing harms being experienced by most of the world's population.” Other scholars have likewise observed the rise of trauma in the last few decades. For example, in their book Hatred of Sex, queer theorists Oliver Davis and Tim Dean offer a psychoanalytically informed critique of what they refer to as the “traumatological turn,” arguing that it is “entwined with the rise of liberal-governance-carceral feminism, which privileges victims and their experience” (2022, p. 57). Charting the ascendance of trauma as a governing concept in therapeutic practice, Davis and Dean express concerns about the “commitment to the diagnostic ‘naming’ of trauma, even in situations where the patient has never construed their experience as traumatic or suspected that past trauma may be the root of their present suffering” (2022, p. 57). They suggest that the emphasis on trauma (or “traumatology”) is “a weaponised form of attachment theory […] according to which a traumatic event will be thought to have had a decisive impact on all areas of [the patient's] subsequent life and experience, an impact that only more therapy can assuage” (2022, pp. 57–58). In terms that chime with this critique, psychoanalytic theorist Avgi Saketopoulou argues that appeals to trauma in therapeutic discourse support capitalist, imperialist projects, enabling trauma to be depoliticized and reduced to an individual problem disaggregated from its social context. As she explains in reference to the treatment of U.S. war veterans in the therapeutic encounter:

trauma does not just describe the psychic condition of injury, it has been conceptually engineered to convert the damage incurred by individuals in the course of fighting imperial projects in which they are recruited, to turn them into interiorized problems that can be addressed individually in the consulting room […] for American soldiers the trauma of having served and having become wounded (physically or psychically) in Afghanistan where they were sent to murder others to ensure the Unites States’ world supremacy, that trauma is treated as a privatized matter. As an individual problem, trauma is then disaggregated from the social context in which it arose, appearing as apolitical when it is nothing but (Saketopoulou, 2023b, p. 334).

Trauma, Drug Consumption, and Addiction

A large body of quantitative literature aims to document the prevalence of trauma exposure among people who use drugs (e.g., Colledge et al., 2020; Levin et al., 2021). This work tends to frame trauma as a universal risk factor for so-called “polydrug use” and addiction, in the process reinscribing a causal link between trauma and drug-related problems. However, despite enduring claims of a direct association between trauma and drug-related problems, the nature of this relationship remains contested (Konkolÿ Thege et al., 2017). We suggest that the ineffability of trauma makes it difficult to clarify precisely how it shapes subsequent behavior, including alcohol and other drug consumption. Nonetheless, theories abound with neuroscientific approaches positing that traumatic experiences, particularly in childhood, alter the brain's stress-reward circuits, which enhance the effects of drugs, heightening craving and increasing the risk of relapse (Garami et al., 2019). Thus, the experience of trauma is thought to increase the risk of developing “addictive disorders” even as the link between trauma exposure and subsequent addictive behaviors is inconsistently reported in observational studies (Konkolÿ Thege et al., 2017). Meanwhile, psychological explanations postulate that childhood trauma experiences can lead to insecure attachment and developmental deficits (Lewis et al., 2020; Moustafa et al., 2021). This, in turn, is thought to detrimentally impact coping strategies, leading trauma survivors to self-medicate using alcohol and other drugs (Costanzoet al., 2023). Underpinning the self-medication hypothesis is a view of AOD use as a maladaptive response to trauma. The concept of trauma is also mobilized in the fields of social work and harm reduction, with trauma-based models of care increasingly adopted to address the connections between trauma and structural inequities, including experiences of colonization, systemic racism, precarity, and institutional neglect (Ross et al., 2023). Yet, despite the move to trauma-informed care across these sectors, limited empirical research on those affected has been conducted to date.

In recent decades, a burgeoning critical literature has developed that challenges prevailing assumptions about addiction, including its link to trauma, suffering, and compulsion (see, e.g., Fomiatti et al., 2023; Moore et al., 2017). This work emphasizes variation in the kind of regular, heavy drug consumption that would attract the label addiction (Dennis, 2020; Pienaar & Dilkes-Frayne, 2017). It also questions addiction-related concepts such as triggers and relapse (Dennis, 2016), revealing the empirical shakiness of understandings of addiction. Via careful attention to the structural dynamics of illicit drug use, research in this vein tracks the sociocultural forces enfolded in addiction and other drug-related issues, demonstrating the ways in which the harms all too readily attributed to drugs are just as much driven by stigma (Fomiatti et al., 2022), punitive treatment approaches (Fomiatti et al., 2017), and the pathologization of illicit drug use (Fraser et al., 2017; Jauffret-Routside et al., 2025). In what follows, we build on this scholarship by critically examining the constitutive work of trauma in the narratives of people who frame their experiences through the dual rubrics of addiction and trauma. In reading their accounts, we consider the functions that trauma performs as a heuristic for understanding the dynamics of drug consumption and various forms of suffering.

Approach: (Re)Thinking Trauma Through a Narcofeminist Lens

Our analysis is informed by the activist concept of narcofeminism, which seeks to highlight the unique issues facing women and gender minorities who consume drugs as distinctly feminist concerns. Both a conceptual approach and an ethical orientation, narcofeminism combines feminist concerns with drug user activism and rights-based advocacy to agitate for more humane drug policy, harm reduction, and decriminalization. The term “Narcofeminism” was coined in 2018 by an international group of women and gender diverse people who use drugs at a meeting of the Association for Women's Rights in Development (AWID) in Berlin. Narcofeminism champions the “right to use drugs,” “reclaim … bodily sovereignty,” and “live in safety and freedom” (Eurasian Harm Reduction Association, 2019). While it has an established lineage in drug user activism, the concept of narcofeminism has only recently been put into conversation with scholarly work. A 2023 edited collection by Fay Dennis and colleagues (Dennis et al., 2023b) applies narcofeminism as an analytic tool to reorient the sociology of drugs away from an overdetermined concern with the oppressive dimensions of drug use toward the provocation that drug use can be a feminist practice with generative affordances for women and gender minorities. Challenging the overdetermined focus on drugs as technologies of control and sources of harm, narcofeminism proceeds on the promise that drugs and their effects are socially produced and thus they have the “potential … to disrupt dominant orders and create alternative modes of care and connection” (Nagington, 2025, p. 7). The collection seeks to shift dominant understandings of drugs through a dual focus on the risks and benefits of drug consumption, reflecting on how consumers navigate these tensions in their situated practices of drug use. This double vision has important implications for efforts to govern illicit drugs: it calls for nuanced responses capable of attending both to the need to minimize drug-related harms as well as the generative, affirming dimensions of drug use (Dennis et al., 2023a).

With this dual focus in mind, it strikes us that narofeminism is especially relevant to an analysis of trauma-informed care as it invites attention to the centripetal tensions at work in the trauma paradigm: between the everyday and the spectacular, damage and cure, body and mind, and the past and the present. Moreover, trauma-informed approaches have unique implications for gender and sexual minorities as they are increasingly mobilized in LGBTQ+ health services, with the concept of trauma, along with minority stress, often used to explain the relationship between gendered and sexual violence and higher rates of LGBTQ+ drug consumption (Kelleher, 2009). In drawing connections between trauma-informed approaches and narcofeminism, we acknowledge that they share some concerns, such as the emphasis on peer support and empowerment, and on transforming organizational practices to ensure a safe environment for service users. However, we also note some key points of difference in their conceptual orientation and emphasis: by using trauma and/or minority stress as an explanatory frame for interpreting drug use, trauma-centered accounts implicitly reinforce a pathologizing view of queer drug use as a form of self-medication to cope with trauma related to sexual violence, stigma, homophobia, and other systemic oppressions faced by minority groups. With their overdetermined focus on risks and harms, such accounts tend to overlook the affordances and transformative potential of drug use for queer communities, including its role in cultivating new forms of connection, care, and non-normative gender/sexual identities (Pienaar et al., 2020; Race et al., 2026).

A similar risk paradigm is also evident in dominant accounts of women as uniquely vulnerable to AOD-related problems due to the prevalence of gender-based violence and childhood trauma (Lotzin et al., 2019). Here, women's AOD consumption is conceptualized as a self-medication strategy to cope with ongoing trauma symptoms connected to experiences of rape, family violence, or sexual assault. Such understandings have explanatory power with the heuristic of trauma providing a useful frame for legitimating often invisible experiences of oppression. In this sense, the trauma concept arguably has emancipatory potential. However, it can function as “a double-edged template” (Gavey & Schmidt, 2011, p. 43) for narrating suffering as it also risks reducing such experiences to individual tragedies unmoored from power imbalances and structural inequalities. As feminist scholars have shown in relation to gendered violence, the emphasis of trauma discourse on women's vulnerabilities can position them as helpless victims of trauma, enabling paternalistic practices of care. It also risks placing abuse and violence at the center of the identity of survivors, making it the dominant lens through which their experience is understood. In an analysis of discourses of gendered violence, scholars Nicola Gavey and Johanna Schmidt argue, “the trauma of rape discourse carries a degree of absoluteness that can readily default to a presumption of traumatic impact, and then cascades into a set of meanings that formulate a unique and lasting cast of damages” (2011, p. 449). In line with these concerns, feminist critiques highlight how the mobilization of trauma to address the impacts of gendered violence reinscribes a cultural and therapeutic fixation on victim-survivors (especially women and children), rather than on perpetrators and the cultures of violence and misogyny that enable gendered violence, thus serving to depoliticize the issues at stake (Fahs, 2016; Gavey & Schmidt, 2011). A narcofeminist approach to the trauma paradigm invites close attention to these issues as they apply to women and LGBTQ+ people who consume drugs, exploring both the potential benefits and limits of trauma-informed approaches for articulating diverse experiences of drug use and promoting systemic change beyond the individual subject of “trauma.”

Methods

Our analysis draws on research conducted for a transnational study called “Project Gender Arp.” The project explores how gender and sexuality shape AOD use, health risks, recovery, and service utilization among young people experiencing difficulties with their drug use or who identify as having an “addiction” or drug-related problem. It includes semi-structured qualitative interview datasets from three countries, namely France, Belgium, and Canada. The study aimed for a roughly even distribution across each country, with the sample of 180 participants comprising 61 from France, 43 from Belgium, and 75 from Québec, Canada. It included diversity across age (ranging from 19 to 50+, with the majority aged 19–39, reflecting the study's focus on young people), gender and sexual identities, and socio-economic status (as indexed by educational and income level). The research received approval from the Ethics Committee of the CIUSSS-Chus-E-research center (MP-31-2020-3294). Recruitment was conducted through relevant AOD, harm reduction, and LGBTQ+ health services; social media advertising; targeted posts to relevant social media groups and snowball sampling. All participants were provided with a plain language statement explaining the project, and they gave informed written or oral consent before the interview. Depending on participant preference and geographic location, interviews were either conducted in person or online by the third and fourth authors. Topics included experiences of drug consumption; concerns about drugs and risk practices; service trajectories and motivations for accessing services; and, where relevant, recovery trajectories. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. A coding frame was developed deductively in relation to the study's focus on how gender and life stages shape addiction and recovery trajectories. The data were then coded in NVivo with the research team using an inductive approach to refine the coding frame in relation to emerging themes.

In this article, we analyze data generated from the interviews with 25 of the 180 participants, focusing only on data featuring references to the term “trauma” or related trauma-centered language, e.g., references to “post-traumatic stress disorder,” “traumatise,” “traumatic.” In terms of the geographic spread of the participants who referenced trauma in their interviews, 3 were from France, 12 from Québec, and 10 from Belgium. These differences in the use of trauma discourse could partly reflect the socio-legal context and drug policy approach of each country. France has a paradoxical approach to illicit drug use in that it has one of the most repressive drug policies in Europe (Jauffret-Roustide et al., 2013) but also boasts one of the highest level of state-funded access to opioid agonist therapy (OAT) (Nguemeni Tiako et al., 2022). While France has adopted harm reduction measures since the mid-1980s (Nguemeni Tiako et al., 2022), it has only recently implemented trauma-informed approaches in government-funded drug treatment facilities. For a long time instead, it has taken an integrated medical-social approach that includes government investment in social infrastructure, such as the provision of social support and housing for people who use drugs, access to naloxone (an overdose reversal drug), and widespread access to OAT (Nguemeni Tiako et al., 2022), measures that tacitly acknowledge the social and structural dimensions of drug-related issues, rather than attributing them to individual trauma. Québec has a progressive drug policy approach: cannabis was legalized in 2018, and while other drugs remain criminalized, harm reduction measures are available, such as safe injecting centers and the free distribution of sterile injecting equipment (Milot et al., 2025). Trauma-informed approaches have informed the Canadian mental health, gendered violence, and drug treatment systems for over a decade (Lee et al., 2021), and as early as 2013, the British Columbia Centre of Excellence for Women's Health published a detailed guide for trauma-informed clinical practice including examples of trauma-informed approaches in residential drug treatment programs (BC Centre of Excellence for Women’s Health, 2013). Finally, in Belgium, OAT has been available since 2022, and harm reduction is one of three pillars of the national drug strategy (Antoine et al., 2024). However, a 2022 report by the Belgian Science Policy Office's Drugs Research program criticized the government for taking a fragmented and outdated drug policy approach, with health professionals and drug user advocates calling for more humane, harm-reduction-oriented approaches (The Brussells Times with Belga, 2023). In line with this, Belgium's Federal Research Program on Drugs has initiated the implementation of trauma-informed care for people with substance use disorders and identified a need for healthcare professionals and AOD workers to be trained on the principles of trauma-informed care (Chantry et al., 2024; Schamp et al., 2026).

While trauma was not explicitly coded in the data, the study aimed to explore the links between social precarity and drug use trajectories, which meant that trauma surfaced in participants’ accounts as an interpretive frame for articulating and making sense of particular experiences. Sometimes references to trauma were in response to the interviewers’ prompts, highlighting the interviewers’ role in framing accounts of extreme suffering through the lens of trauma. At other times, references to trauma appeared as part of participants’ framing of their own experiences, suggesting a trauma-focused self-concept. The data were searched for references to trauma, and only those data featuring explicit mention of trauma were included in the corpus for this analysis. The corpus was translated from the original French into English by the first author. Then, the last author, a native French speaker, checked the translations for accuracy. All participants were assigned a number, and identifying material was removed from the transcripts.

Analysis

As noted above, dominant discourses tend to frame drug consumption as a maladaptive strategy for coping with the effects of adverse life circumstances and structural inequalities, including violence, oppression, and stigma. Such accounts equate heavy, regular drug use with addiction and reproduce dominant explanations of addiction as an attempt to palliate to intense emotional pain, as encapsulated in the following quote by trauma clinician Bessel van der Kolk ¹ : “How many mental health problems, from drug addiction to self-injurious behavior, start as attempts to cope with the unbearable physical pain of our emotions?” (2014, p. 89). Consistent with this commonly held view, some participants interviewed for this study assign the label “trauma” to experiences of intense suffering and emotional upheaval, a label which we argue lends their suffering the weight and credibility associated with psychiatric terminology. We begin by analyzing these accounts where trauma is mobilized in terms that chime with prevailing conceptions of drug use as a form of self-medication, drawing attention to the explanatory power and constitutive effects of the trauma concept. We then turn to a counter-example where a participant resists being interpellated via the heuristic of trauma and discuss some of the tensions that this example highlights in relation to the emancipatory potential of trauma.

Trauma in the Making of Drugged Relations and Subjects

Underpinning our analysis is the recognition that trauma has constitutive power to call into being particular types of subjects and identities. As trauma theorist Maurice Stevens explains, “trauma is not simply a concept that describes particularly overwhelming events, nor is it simply a category that ‘holds’ people who have been undone by such events; but it is a cultural object whose function produces particular types of subjects” (2016, p. 20). In this section, we trace some of the subjectification and explanatory effects that appeals to the notion of trauma produce for those who interpellate themselves through its rubric.

Across the interview data, trauma was often invoked to present drug consumption as a means of coping with overwhelming suffering and pain connected to experiences of violence, abuse, and gender or sexuality-related assault or discrimination. In these accounts, trauma has explanatory power to rationalize drug use as an understandable response to the extreme distress of adverse life experiences. For example, a gay male participant explains the enduring impact of a homophobic attack involving serious physical assault that left him with life-threatening injuries and temporarily unable to walk:

Unfortunately, I was in [overseas city] in January 2018, and I was coming out of a gay bar. Someone saw me coming out of the gay bar, a homophobe […] who attacked me in the street and left me for dead. So […] I was in intensive care in [city] for several weeks, and then I had to be escorted here with a doctor on the plane in case I had a stroke. It was really […] serious. I had to learn how to walk again. Then I was off work for a year. During that year, I was using [drugs]. I used and used. It was really easy for me to lie to everyone and to my family because I’d just say: ‘Oh, I’m experiencing post-traumatic stress, I don’t want to see anyone. I don’t want to see anyone’. So I used and used. Then finally, one day everything exploded in my face. My family knew everything that had happened […] They were the ones who found me the [Narcotics Anonymous] meetings and all that. So when I went there, that's when I realised I had a problem. So from 2014, when I started using, until 2018, I would say that I hadn’t seen that I had a problem or I didn’t identify with reality, the reality that I had a problem. I just wanted to find ways of controlling my drug use and not stopping it altogether, and I made excuses. I found lots of things to explain my bad behaviour, the fact that I wasn’t having any fun here in [this city], it was like a lot of the same things.

(Participant 008, Canada)

Another participant similarly drew a link between the experience of violence and drug use, suggesting that in their case, the experience of childhood neglect contributed to their consumption of crack cocaine, a drug that they characterize as particularly destructive and even lethal with extended use: Interviewer:

Okay. And have you ever experienced violence in your life as a victim? Have you ever been a victim of violence?

As author and sexual abuse survivor Dorothy Allison puts it in reflecting on how to present a narrative that refuses the deadening effects of trauma: “what still fascinates me is what you do, it's what happens after … it really is the question of how you survive what no one believes is survivable” (2016, p. 255, original emphasis). In reflecting on these questions, Allison elaborates a living theory of trauma, grounded in her own experiences of violence, abuse, and suffering. Her account offers a powerful critique of academic obfuscation, arguing that for trauma survivors to narrate their experiences of trauma, they need to have already done the work of engaging with it: “No one writes about death or loss or grief without having already done so much of the work. You have to find a place to stand that is safe and strong and solid, and it's going to move under you as you do the work, but you have to have done the work first. You have to have found a way to live with your own story before you make a story you can give other people” (2016, p. 250). Allison's approach reorients the focus beyond the suffering and pain on which trauma discourse hinges towards the practices of reclamation and survival that people pursue to rebuild themselves in the wake of intense suffering that would attract the label “trauma.” These practices may include drug consumption and broader acts of self-determination that chime with the values of narcofeminist advocacy, in particular its resistance to stigma and marginalization, and its unswerving commitment to living on one's own terms, often in the face of violence and brutality (Dennis & Pienaar, 2023). In the next section, we explore a participant account that can be understood in narcofeminist terms as an act of refusal in that it resists the pathologizing effects of trauma discourse and highlights instead the participant's agentive efforts to reconstruct the self.

Some of the people interviewed for this study had experienced severe violence and neglect, in some cases connected to their gender and/or sexual identity. In light of these experiences, some suggested that drug treatment services could take better account of the link between traumatic experiences and the kind of heavy drug use that is routinely characterized as addiction. In such accounts, drug use is framed as a strategy for coping with the pain and other physical and emotional sequelae of distressing life events. As the following participant explains, they started consuming drugs to manage the emotional distress of being assaulted: Interviewer:

And if we talk, for example, about other difficulties that may be linked to drug use? For example, we were talking about your physical health earlier or your experiences of violence. Is this something they take into account in their services?

Consistent with symptoms that fall under the diagnostic rubric of post-traumatic stress disorder, the concept of trauma helped some participants explain the persistent, often uncontrollable effects of adverse experiences, such as hypersensitivity to perceived threats, disturbing flashbacks, nightmares, and dissociations. As one participant explained, they suffered physical violence as a child, and now, if there is a threat of violence, they retreat into themselves as a self-protection mechanism. Participant:

I have a lot of trauma linked to physical violence. I’m very uncomfortable about it myself, very shy. I wouldn’t do it either [be physically violent….]

Resisting Trauma Discourse, Centering the Agentive Self

One of the subjectification effects of trauma discourse is that it produces the victim-survivor as the object of a story, rather than the subject (Jackson, 2016). In this way, it can obscure the agency and courage it takes to rebuild the self in the aftermath of trauma. One of the people we interviewed resisted being interpellated as a damaged subject with its essentializing view of trauma as central to their identity.

Then, I think I indicated throughout the recording that my gender and sexuality was never an issue, I also barely talked about my gender and sexuality because I was like, ‘Look, it's absolutely not an issue, I’m super comfortable with it’. I also said to the psychologist, ‘Look, this isn’t related to my trauma at all, it's got nothing to do with it’. And I started hearing it from other people and I know of at least three transgender people who have been sexually abused who have said exactly the same thing. So, yes, the pathologisation of gender and sexuality is still very present. Yes and I’ll say it, it's very painful and you get so little recognition and you’re basically told you’re just trans because you’re broken or something […] But yes [the institution of psychiatry] is mainly psychoanalytic um, which is great for dealing with trauma, but the problem is that they then start pathologising everything.

(Participant 04, Belgium, emphasis added)

Extrapolating from this participant's observations about the pathologizing effects of trauma discourse, we are reminded of the critiques of trauma scholars who note that the trauma paradigm relies on a fixation with repair, issuing from a view of trauma as a source of harm that irrevocably damages the subject (Saketopoulou, 2023a, 2023b). Psychoanalytic scholar Avgi Saketopoulou argues that this dominant view is underpinned by a traumatophobic sensibility insofar as it treats trauma as a harmful force and thus remains beholden to fantasies of cure that reproduce “pathologizing relations to minoritarian experience vis-à-vis race, gender, ability and so on” (2023b, p. 323). It is these pathologizing relations to gender and sexuality embedded in trauma discourse that the participant quoted above resists. In a similar vein, other scholars have observed that trauma-informed approaches reproduce a conventional mental health model: they retain a deficit lens, promote a standardized therapeutic response, and locate the site of trauma (and thus the target of intervention) in the individual. In the process, the concept of trauma leaves unchallenged the dominant assumptions and therapeutic modalities of mental healthcare. As Tseris argues trauma-informed interventions constitute a “business as usual” approach to mental health: “while the notion of trauma exerts some influence on how the causation of mental distress is being understood and managed, it does so in a way that ultimately fails to disturb the everyday assumptions and practices of mental health service provision” (2019, p. 46). Trauma scholar Maurice Stevens (2016, p. 23) characterizes the co-option of the trauma concept in the service of recuperative agendas as a form of “territorialization” which reinforces, rather than disrupts, prevailing ideologies. These ideological agendas include the location of symptoms within the individual and the resulting focus on treating individual pathology rather than the broader structural factors that shape which experiences come to be classified as “traumatic,” and by extension, which social groups are targeted for intervention (disproportionately women and LGBTQ+ communities). In other words, by reinscribing a deficit-laden, individualizing, and depoliticized account of suffering under the rubric of “trauma,” the trauma concept can function to efface forms of systemic oppression and structural violence. As critical drug scholar Maurice Nagington has argued in relation to chemsex, while the conceptual vocabulary of trauma may offer a “necessary sense of psychological coherence” for interpreting distressing experiences (2025, p. 44), it has a double-edged potential in that it also works to circumscribe people's understandings of their experiences, defining them in restrictive and individualizing ways.

While the participant quoted above does not address addiction or drug use in their account, their comments prompted us to consider how appeals to the heuristic of trauma as a means of explaining individual conduct relate to addiction discourses. Similar to dominant, abstinence-based addiction recovery discourses (Fomiatti et al., 2017), at the center of the trauma paradigm is a tension between the acceptance of a “damaged” self in the aftermath of trauma and the expectation to engage in therapy and ongoing work on the self to attenuate the effects of trauma (Tseris, 2019). This risks placing victim-survivors of abuse and violence in a triple bind by positioning them as in need of expert support and as responsible for managing the effects of trauma, even as doing so requires them to accept they have been irremediably altered by the experience. Implicit here is an expectation of self-management where the individual is expected to cope with the impact of trauma, which works to elide the structural factors (e.g., gendered and social inequalities) enfolded in traumatic experiences. Furthermore, and consistent with dominant models of addiction recovery, the curative imaginary of trauma-informed therapies requires the acceptance of a significant injury, along with the embodied display and narration of a damaged self (Fomiatti et al., 2017; Stevens, 2016). It is this curative imaginary and its assumption of a damaged, disordered identity that the participant quoted above refuses in relation to their gender and sexual identity, even as they recognize the value of psychiatric interventions for addressing trauma.

Conclusion

Animated by an interest in identifying the assumptions and performative effects of trauma discourse, our analysis has considered the explanatory power of trauma for articulating experiences of suffering and emotional distress. In this respect, our participants’ accounts demonstrate that the concept of trauma offers a heuristic for interpreting suffering and rationalizing heavy, regular substance use as a means of coping. By rendering the experience of distress legible within a socio-medical frame, it validates it as severe and therefore as warranting treatment. In other words, appeals to the psychological language of trauma lend legitimacy and weight to suffering, and highlight otherwise invisible experiences of oppression, violence, and abuse. However, insofar as the notion of trauma reifies suffering, it has definitional power to place the experience of suffering at the center of a person's identity. With its emphasis on individual vulnerability and the damaged self, the trauma concept can become the dominant heuristic through which a person frames their experiences and identity, constraining their capacity to understand themselves outside the terms of suffering and distress. As queer scholars Davis and Dean put it in their radical critique of the therapeutic turn to trauma, “If only all suffering could be explained as confidently as traumatology does: for those who are suffering but are unsure why, traumatology constructs and curates an agglomerating victimized identity in relation to which all of their manifold misfortune becomes intelligible” (2022, p. 65). Applying the insights of narcofeminism to our analysis also reveals how the notion of trauma is often mobilized to conceive women and gender and sexual minorities as uniquely vulnerable to drug-related issues due to their risk of experiencing gendered violence, a conception that detracts attention from the systemic nature of such violence and its relationship to cultures of misogyny.

Therapeutic modalities informed by the concept of trauma are often lauded for their recognition of the broader socio-cultural factors imbricated in individual suffering. While such recognition of the structural dimensions of suffering is of course a welcome move in psychiatric and psychological understandings that otherwise center individual pathology, the widening scope of trauma to describe a diverse range of phenomena risks homogenizing experiences that share little in common, “leaving limited opportunity for their varying socio-political contexts to be differentiated, and with a very strong focus instead being placed on trauma symptoms and treatment focused concerns” (Tseris, 2019, p. 68). In glossing over the specificities of people's experiences, trauma can readily be put into the service of universalizing disparate forms of violence, abuse, and oppression. Given narcofeminism's concern to highlight structural inequities, it is also worth noting that the legibility and recognition of traumatic injury is socially produced: it depends on normative assessments of whose trauma is visible and valid. For example, the systemic injuries and suffering inflicted on people in carceral settings are generally not framed as trauma, which allows the traumatogenic character of institutions such as prisons, immigration detention centers, and residential drug treatment centers to remain largely invisible and unchecked. Furthermore, as our analysis has shown, the turn to trauma in mental health and drug treatment does not inoculate trauma-informed therapies from power relations and biases. Indeed, despite claims to neutrality and objectivity, therapeutic modalities are inflected with normative values, most notably the location of disorder in the individual and the concomitant emphasis on individual behavior change and treatment, rather than broader social change. On this view, the rise of trauma-centered thinking is imbricated in and buttresses neoliberalism with its individualizing impulses that work to reify trauma as a privatized, individual problem, in the process erasing systemic injustices and the significance of collective action in effecting social change (Saketopoulou, 2023b; Tseris, 2019).

Similar to dominant imaginaries of addiction, essentializing, deficit-focused accounts of “traumatized” individuals promote assumptions about the adverse psychological effects of violence, abuse, or oppression. In terms that echo the ruin-redemption narrative underpinning addiction recovery (Pienaar & Dilkes-Frayne, 2017), they may reinscribe a fatalistic, and stigmatizing view that such effects are inevitable and that those who have experienced abuse, violence or oppression will succumb to a downward spiral of distress, suffering and pathology—a trajectory that has been described as the “trauma-tragedy disciplinary apparatus” to capture the pathologizing, restrictive effects of such accounts (Nagington, 2025, p. 47). As such, this therapeutic model risks undermining the agency and resilience of trauma survivors. This would dilute the potential of the trauma concept to address structural violence (including gendered and sexual violence) and promote systemic interventions that target social inequalities and intersecting oppressions, including drug-related stigma and discrimination. Moreover, a narcofeminist reading of trauma-centered theories of drug use reveals how such accounts may obscure people's varied experiences and trajectories of drug use, including its potential benefits and life-affirming dimensions (Dennis et al., 2023a). Drawing on the insights of narcofeminist approaches, we therefore suggest that trauma-informed services reckon with these complexities and structural dimensions, and offer gender-sensitive, strengths-based interventions that center clients’ agency in managing distressing experiences that would likely attract the label “trauma.” Addressing these concerns entails recognizing the complex and varied associations between trauma, violence, and drug use (Dennis et al., 2023a, 2023b), including the ways in which people navigate these countervailing forces in their everyday lives and “survive what no one believes is survivable” (Allison, 2016, pp. 255). Such a recognition invites us to rethink the dominant view of trauma as an exceptional rupture of ordinary experience. As Lauren Berlant has argued in a discussion of trauma and the ordinary, even the worst events which might readily attract the label “trauma” are in fact “embedded in life” and “twist continuity rather than shattering it” (2018, p. 117). In line with related research on the promises and pitfalls of trauma-informed care (Armstrong, 2023), we also highlight the need for critical attention to the larger context of service provision, including the importance of transforming organizational cultures and practices that may themselves be (re)traumatizing, and centering the values of safety, trust, and peer support (Jauffret-Roustide et al., 2025). In exploring the possibilities and limits of trauma-informed care, we do not seek to undermine the significance of feminist activism that has contributed to trauma-informed practices; nor do we wish to minimize the pernicious effects of violence, oppression, stigma, and discrimination. Instead, our analysis has sought to consider how some enactments of the trauma concept might elide complexities, promote particular agendas in healthcare, and circumscribe the range of experiences that can be considered.