Sober, But Still Struggling? The Missing Piece in Addiction Recovery

There is a painful and confusing phenomenon that isn't discussed enough in recovery circles: people in recovery who suddenly become suicidal, develop a new mental health disorder, or experience a return to use. We also see countless others who, despite their best efforts, struggle to stop or reduce their use in the first place.

This is often framed as the nature of a "chronic relapsing disease." I believe it's connected to a more profound truth: we are not conceptualizing addiction holistically. When these struggles happen, it's not because the person’s disorder is “treatment-resistant” or “they haven’t tried hard enough.” It's because a crucial piece of the puzzle is missing. In my work, I've come to see that for many, recovery requires two distinct, parallel journeys:

Addiction Recovery: Dealing with the substance or compulsive behaviors.

Trauma Recovery: Dealing with the origins of the pain.

“I believe it's connected to a more profound truth: we are not conceptualizing addiction holistically.”

If either part is missing, quality of life could be impacted. People are told their mental health disorder is simply a "chemical imbalance" or that their substance use is purely "genetic." While biology is a factor, these models are incomplete. They leave out the most crucial element: the interpersonal and environmental origins of toxic shame.

The Frozen Inner Child and the False Self

A significant component of adults in recovery are also ‘Adult Children of Alcoholics’ or, more broadly, ‘Adult Children of Trauma’. To survive an unbearable environment, many grew up with the unwritten rules of a ‘shame-based’ family system:

• Don't Talk

• Don't Trust

• Don't Feel
  Source:  (Black, 2018)

When a child's authentic self is invalidated, they learn not to trust their own gut. This is the "frozen inner child," a concept known in psychoanalytic and Jungian trauma theory (Kalsched, 1996). To survive, the true self is 'frozen' or 'split off' for protection.

Because children are developmentally egocentric, they cannot conclude, "My parent is unsafe." They instead conclude, "I am bad." To survive, they reject their true self and develop a false, adapted self—one often marked by a "not good enough" core, grandiosity, people-pleasing, hypervigilance, codependency, or emotional numbness (Kauffman, 1989). The false self is built off shaky foundations of toxic shame, ‘the false belief the self is broken’ (Bradshaw, 1998), not the truth

Anyone who has worked with these demographics or sat in a 12-step meeting will have heard the same theme again and again: Even before I sipped a drink, I felt “not good enough,” “like I didn’t belong,” or “like I was different in a bad way.” The shame was already there. The substance is a solution to a pre-existing wound.

Children of trauma and/or parents who misused substances are consistently let down by non-holistic systems. The data on this is stark: children of substance-abusing parents are four to six times more likely to develop an alcohol use disorder, and one study found that 53% of children with a parent with an SUD had developed an alcohol use disorder by young adulthood as compared to 25% of their peers (Solis et al., 2012).

A More Integrated Way of Looking at Addiction & Trauma

The danger of fragmented approaches is that they miss these interpersonal and environmental origins. If we are told we simply have cognitive "distortions," it misses the point: the brain is brilliant in its adaptation. Toxic shame makes sense in the context of an unsafe environment.

“Toxic shame makes sense in the context of an unsafe environment.”

Here forms the basis of a 5-part etiological model I use to explain the developmental pathway from trauma to addiction, which I will break down into five parts:

1. The Core Wound: The origin is chronic, inescapable toxic stress. This stems from intergenerational trauma, which can shape our biology before we are born, and is compounded by Adverse Childhood Experiences (ACEs: parental substance abuse, mental illness, incarceration, divorce, death of a parent etc), adverse community environments (poverty, violence), or systemic oppression (racism, microaggressions).

2. The Neurobiological Scar: This chronic stress, especially during sensitive developmental windows, impairs brain development. It weakens the critical connectivity between the prefrontal cortex (the 'brakes') and the amygdala (the 'gas pedal' for fear) (Gee et al., 2013). This creates a consistent internal "thumbprint":

   1. A Weakened Prefrontal Cortex that cannot regulate emotions (Arnsten, 2009).

   2. A Hyperactive Amygdala that is over-reactive to perceived threats (Shin & Liberzon, 2010), leaving the nervous system with no "calm" (lacking GABA).

   3. A Blunted Dopamine System, where chronic stress alters baseline reward levels (Pechtel & Pizzagalli, 2011), creating an internal "void" or anhedonia (an inability to feel pleasure).

   4. This manifests as Severe Affect Dysregulation—the direct psychological result of this neurobiological split (Etkin et al., 2015).

   5. This toxic stress can alter gene expression (epigenetics).

3. The "Solution": The individual, suffering from this chronic internal state, discovers a substance or behavior that alleviates it. This is a brilliant, adaptive attempt to regulate a dysregulated nervous system (Cheetham et al., 2010; Khantzian, 1997).

4. The Hijack: The "solution" provides powerful, temporary relief. Alcohol, for instance, chemically mimics the GABA (calm) the brain is starved of, quieting the hypervigilant amygdala. It also surges dopamine (the reward system) to fill that internal "void." But this temporary relief becomes a devastating hijack: chronic alcohol use fundamentally alters GABA receptors (Kumar et al., 2009) and results in profound dopamine dysregulation (Koob & Volkow, 2016), making the baseline anxiety, insomnia, and anhedonia infinitely worse.

5. The Systemic Failure: The person seeks help and is met by a fragmented system that treats only the addiction and ignores the wound. This is the critical part: when that core wound is left unhealed, even if the solution (the substance) is removed, the person might, without intervention, remain stuck in a 'trauma world’ (Sieff, 2015), a state Sieff defined as characterized by ‘fear, shame, and dissociation.' This unaddressed trauma can not only be a painful place to live, but it can also manifest as different mental health disorders. Still, it can also show up as relationship difficulties, returns to use, and can lead people to unknowingly re-traumatize themselves or others through disowned or projected shame. This, in my opinion, is how the pain is sometimes “transmitted”, not simply genetically, but also through these unhealed wounds.
   
   

The Path to Healing: Beyond the Cognitive

As clinicians and as people in recovery, we must combine lived experience with science. It is possible to go from living in a trauma state of mind, brain, and body to a more peaceful one - but it requires doing the deep, challenging, and meaningful work. It requires reconnecting with our felt sense (not the logical, cognitive brain of what we think happened or what we believed to survive), but the embodied truth of what we felt happened.

It is possible to go from living in a trauma state of mind, brain, and body to a more peaceful one - but it requires doing the deep, challenging, and meaningful work.

We find freedom by sharing our trauma and shame in a safe place, by connecting to our childhood feelings to understand and release trapped emotions that we often didn't even know we had. This is the work of turning to face our 'frozen inner child.' When we can finally validate their pain—the pain we split off from to survive—we metaphorically 'embrace' them. The 'frozen' parts begin to 'melt,' and we start the process of 'coming home' to ourselves.

This is not a single event; it's a process. It takes time to heal the different dynamics and ways we were hurt. But with each act of connection, we start to generate self-compassion for what happened, showing up for that little person inside as the safe, loving adult we always needed. There is a science behind healing, too—we know that, as the brain is neuroplastic throughout the lifespan, we can rewire the brain and body. Still, it requires a holistic approach and doesn’t happen overnight, much like our clinical landscape might lead us to believe.

The Outcome: Integration

This is the work that leads to a lighter, more connected, and, finally, autonomous life. If shame consists of the ‘breaking of the interpersonal bridge,’ then the healing process is the reconnection of it. 

This is the development of self-trust. Trust comes from repeatedly showing up for ourselves, day after day, with our words and behaviors in alignment. But it goes deeper when we also rebuild the interpersonal bridge within ourselves, reconnecting with the "frozen" parts we split off to survive. From that place of integration, we can meet ourselves and others where we truly are, rather than through the distorted visor of our pain.

This is not a "one-and-done" process. Being conscious of our fear and shame and the times when we do slip back into a 'trauma world’ (our neurocircuitry slipping back into an old trauma route) is paramount, especially if we want healthy relationships. The first step to healing is knowing that you are in one in the first place. Over time, you live in a connected, conscious world, and this becomes your new normal. When we first experience this new way of being, it feels such a remarkable change that we think that the trauma and shame have gone. I know that’s how it was for me. However, that initial release is not the end – it is a journey of changing the relationship to the wound, becoming more self-aware when you do slip back into it, and spending more time in a conscious world. This journey is what Carl Jung called "individuation."

I believe it is the intended path of recovery: the journey of becoming who you truly are: who you were designed to be all along, before ‘what happened to you’. You get to genuinely experience the world in a completely new way. 

There are many valid paths to healing in recovery, and people find lasting recovery through a multitude of ways. But, for the person who is 'sober, but still struggling,' this integration can be the missing piece. It is the work that finally allows freedom from hypervigilance and low self-esteem, not by fighting the addiction, but by healing the wound that led to it. This is the work that can pull us out of the darkness and into who we really are, into experiencing inner peace. And finally, to those who have struggled to get sober or recover from a mental health disorder: maybe the problem isn’t you, maybe it’s that no one ever diagnosed your shame.

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I am currently expanding some of these insights into a paper for academic publication. To follow my work, follow me at Resilience, Instagram @discoverywithjosie

LinkedIn: www.linkedin.com/in/josie-mansergh-johnson-ma-65893427

How to Cite This Post: Mansergh-Johnson, J. (2025, November 6). Sober, but still struggling? The missing piece in addiction recovery. [Resilience Therapy Blog]. [www.resiliencetherapypllc.com/blog/sober-but-still-struggling-the-missing-piece-in-addiction-recovery]

© 2025 J. Mansergh-Johnson. All rights reserved.

References

Arnsten, A. F. T. (2009). Stress signaling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648

Bradshaw (1988) Healing the Shame That Binds You, Health Communication Inc.

Black (2018) Unspoken Legacy, the impact of trauma and addiction on the family, Central Recovery Press.

Cheetham, A., Allen, N. B., Yücel, M., & Lubman, D. I. (2010). The role of affective dysregulation in substance use. Clinical Psychology Review, 30(6), 621–634. https://doi.org/10.1016/j.cpr.2010.05.004

Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation. Nature Reviews Neuroscience, 16(11), 693–700. https://doi.org/10.1038/nrn4044

Gee, D. G., Humphreys, K. L., Flannery, J., Goff, B., Telzer, E. H., Shapiro, M., Hare, T. A., Bookheimer, S. Y., & Tottenham, N. (2013). A developmental shift from positive to negative connectivity in human amygdala–prefrontal circuitry. The Journal of Neuroscience, 33(10), 4584–4593. https://doi.org/10.1523/JNEUROSCI.3447-12.2013

Grant, B. F., & Dawson, D. A. (1998). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse, 10(2), 163–173. https://doi.org/10.1016/s0899-3289(98)90009-8

Kalsched, D. (1996). The inner world of trauma: Archetypal defenses of the personal spirit. Routledge.

Kaufman, G. (1989). The psychology of shame: Theory and treatment of shame-based syndromes. Springer Publishing Co.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550

Koob, G. F. (2004). A role for GABA mechanisms in the motivational effects of alcohol. Neuropharmacology, 47(Suppl 1), 141–152. https://doi.org/10.1016/j.neuropharm.2004.06.012

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8

Kumar, S., Porcu, P., & Morrow, A. L. (2009). The role of GABAA receptors in the acute and chronic effects of alcohol: a decade of progress. Psychopharmacology, 205(4), 529–564. https://doi.org/10.1007/s00213-009-1562-z

Pechtel, P., & Pizzagalli, D. A. (2011). Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology, 214(1), 55–70. https://doi.org/10.1007/s00213-010-2009-y

Russell, M. (1990). Prevalence of alcoholism among children of alcoholics. In M. Windle & J. S. Searles (Eds.), Children of alcoholics: Critical perspectives (pp. 9–38). The Guilford Press.

Shin, L. M., & Liberzon, I. (2010). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology, 35(1), 169–191. https://doi.org/10.1038/npp.2009.83

Sieff (2015) Royal Society of Arts. (2015, March 20). Daniela Sieff on emotional trauma [Video]. YouTube. https://www.youtube.com/watch?v=Hmg2ZIAnYLQ

Solis, J. M., Shadur, J. M., & Burns, A. R. (2012). Understanding the diverse pathways of risk for children of parents with a substance use disorder. Current drug abuse reviews, 5(2), 135–149. https://doi.org/10.2174/1874473711205020135