Justice Notes: Trauma and Addiction
A White-Collar Journal forum for criminal justice, lived experience, and the personal search for redemption
Trauma is often the hidden root of addiction, and, too often, a defining thread running through the lives of those who become incarcerated. Yet the connection between trauma, substance use, and incarceration is frequently ignored in public discourse and policy alike. For this week’s Justice Notes, I want to share a powerful guest essay from Gina Pendergraph that explores these overlooked realities and challenges us to rethink addiction not as a moral failure, but as a response to untreated pain.
Trauma and Addiction by Gina Pendergraph
Every year, thousands of Americans set out to quit drugs. They detox, they try willpower, and many of them fail. Not because they are weak, but because no one has treated what drove them to use in the first place. The substance was never the real problem. The pain underneath it was.
To lay out the terms that will be used throughout this essay, the following definitions are added for clarity: Drug trafficking is defined as sales, distribution, possession with intent to distribute or sell, manufacturing, and smuggling of controlled substances. Self-medication is medication of oneself, especially without the advice of a physician. Trauma is a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury. And demand is something claimed as due or owed.
The United States has responded to that pain primarily with handcuffs. We had “The War on Crime” in the 1960s, “The War on Drugs” in the 1970s. The 1980s brought “Just Say No,” championed by Nancy Reagan, and the LAPD’s “Drug Abuse Resistance Education,” or D.A.R.E. program. On January 20, 2025, his first day back as president, Trump signed an order calling drug cartels terrorist groups. In February 2025, he signed another order saying illegal drugs coming from Mexico, Canada, and China were a reason to put tariffs on imports from those countries and that the tariffs would remain in place until the importation of illegal drugs was significantly reduced.
Decades of failed enforcement, anti-drug programs, and education focused on abstinence have filled prisons, yet the overdose death toll continues to climb. Nearly 80,000 Americans died of drug overdoses in 2024 alone. Something fundamental is being missed: Why are Americans demanding so many drugs?
The United States Sentencing Commission reported that in 2024, about 30% of all federal criminal convictions were related to drugs, making drug offenses the second most common federal crime. During that year, federal courts issued 18,281 sentences for drug-related cases, with nearly all involving the production, distribution, or transportation of illegal substances.
Most individuals convicted of drug trafficking were U.S. citizens, accounting for 80% of offenders. Just three drugs made up over 85% of these convictions: methamphetamine, fentanyl, and cocaine.
Trafficking persists not because of a lack of enforcement, but because untreated trauma drives people to self-medicate, and until the U.S. prioritizes mental health treatment and addiction recovery over criminalization, the demand that fuels the drug trade will never disappear. The cycle of trauma and drug use connects to the broader trafficking problem.
The most recent data from the CDC available as of May 3, 2026, shows the United States experienced a decrease in overdose deaths to about 69,000 in 2025, bringing the country back to pre-Covid 2019 numbers after increases between 2020 and the peak in 2023. Synthetic opioids such as fentanyl are responsible for tens of thousands of those deaths. Men ages 35–44 were among the groups most affected. In 2003, before fentanyl dominated the illegal drug supply, the United States recorded roughly 25,000 overdose deaths per year; today that number is more than triple, showing how untreated addiction and sustained demand have intensified the crisis over time.
The ACEs framework measures adverse childhood experiences linked to long-term health and behavioral outcomes. Unresolved trauma, especially childhood trauma, is often a primary driver of substance use, as individuals use drugs to cope with emotional pain they cannot otherwise manage. Individuals with co-occurring PTSD and substance use disorders showed significantly higher rates of childhood complex trauma than those with either condition alone.
Substance use is not the only way trauma survivors attempt to manage their pain. Trauma can trigger compulsive behaviors in different forms. Alcohol use disorder, compulsive spending, hoarding, eating disorders such as anorexia or bulimia, sex or porn addiction, and self-harm are all responses to unresolved psychological suffering. What makes drug addiction uniquely devastating, however, is its ability to kill. Unlike other self-medicating behaviors, drug use — particularly with synthetic opioids like fentanyl — carries the risk of fatal overdose. The stakes of leaving trauma untreated are, in the case of substance use disorder (SUD), literally a matter of life and death.
Read the full essay here: Trauma and Addiction
Justice Notes is an ongoing series examining incarceration, rehabilitation, storytelling, institutional power, and the lives that exist behind prison walls.
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This is a strong and important essay. What stood out to me most is the way you connect trauma, self medication, demand, and drug trafficking into one larger cycle. The argument moves beyond punishment and asks the more difficult question: what pain is driving the demand in the first place?
I also appreciated the distinction between substance use and other trauma driven behaviors. The point that drug use becomes uniquely lethal in the fentanyl era gives the essay real urgency.
The piece makes a compelling case that enforcement alone cannot solve a problem rooted in untreated psychological suffering.