On September 22, 2026, the Greenville County Coroner's Office reported that Hayden Panettiere's toxicology report showed fentanyl and other undisclosed substances in her system at toxic levels. The actress died on August 16 at age 36. Associated Press
Toxicology reports only give us a how. They cannot tell us what someone was feeling, what they understood about the substances they were taking, or why they were using them.
When discussing addiction, it is vital to discuss the why—why some people use substances to relieve the distress of living in chronic dysregulation. It is this understanding that helps explain why addiction treatment must address both the substance use and the suffering behind it, a theme documented in research on trauma and the risk of substance dependence. PubMed
This article describes general clinical patterns for educational purposes. It is not an assessment of Ms. Panettiere’s health, history, or circumstances.
When the danger has passed, but your body is still on alert
Imagine getting through an entire day looking as though you are managing. You answer emails, take care of your children, and handle your responsibilities. Then you get into bed, exhausted, and still do not feel settled. Your thoughts keep moving. Your muscles stay tense. You feel anxious, waiting for something to go wrong.
For people with trauma histories, this sense of being on high alert can become a daily part of life. Trauma affects the systems involved in recognizing and responding to danger, leaving someone more easily startled, more reactive to conscious or unconscious reminders of past experiences, and less able to re-regulate after stress. U.S. Department of Veterans Affairs
This can look like irritability, disrupted sleep, difficulty concentrating, or constantly watching for signs that something is wrong. Someone may understand intellectually that they are not in immediate danger while still experiencing a strong physical alarm response. U.S. Department of Veterans Affairs
Trauma does not inevitably lead to addiction, and not everyone who develops a substance use disorder has a trauma history. The relationship is a risk pathway, not a universal explanation. Because trauma and chronic stress are linked to a higher risk of substance use problems, a thorough biopsychosocial assessment is necessary to explore how those experiences are affecting a person today. Combined with an understanding of someone's daily life, this assessment helps clinicians determine the person's window of tolerance—what symptoms their drug of choice may be alleviating. National Institute on Drug Abuse
What is the "window of tolerance"?
The window of tolerance is a clinical model describing the range in which you can experience emotions without becoming so overwhelmed or disconnected that it is difficult to function. It is a way of understanding your reactions, not a diagnosis or a literal window inside your body. Psychology Tools
Being inside your window does not mean you are happy or calm all the time. You can feel angry, disappointed, anxious, or sad and still remain present enough to think, communicate, and decide what to do next. In everyday language: "This is difficult, but I can handle what I am feeling."
Outside the window, above: everything feels too intense
When your activation rises too high, you may feel panicked, agitated, defensive, or desperate to get away from what is happening. Your thoughts might race, and it can become difficult to concentrate or listen. Clinicians call this hyperarousal—a state of being highly activated or on guard. U.S. Department of Veterans Affairs
Outside the window, below: you feel numb or disconnected
At the other extreme, you may feel emotionally flat, withdrawn, or mentally absent. Clinicians call this hypoarousal. Someone who is dissociated may appear quiet or "checked out." Despite looking calm on the outside, they may feel numb, disconnected from their body or surroundings, or as though they are watching what is happening from a distance. Psychology Tools
For example, imagine receiving a message from your partner that says, "We need to talk." If you are within your window of tolerance, you might feel concerned but ask what is wrong. If you are outside your window and above it, you might immediately panic or start an argument. If you are outside your window and below it, you might go blank and feel unable to respond.
Understanding your window of tolerance helps you recognize what happens when distress becomes difficult to manage, and identify what support might help.
"Substance use becomes an attempted form of self-regulation: I need something to make this feeling manageable."
Why opioids can feel like relief
Opioids, including fentanyl and certain prescription pain medications, affect the systems involved in pain and pleasure. They can produce temporary feelings of relaxation and relief. They can also cause confusion, sedation, and dangerously slowed breathing. National Institute on Drug Abuse
For someone who feels persistently overwhelmed, these short-term effects may become part of the appeal. The goal of use is to quiet the fear, escape painful feelings, or stop feeling so intensely uncomfortable.
Using the window-of-tolerance model, one way to understand this pattern is that a person may be trying to bring overwhelming activation down into a range they can bear. Substance use becomes an attempted form of self-regulation: I need something to make this feeling manageable. This is a proposed explanation for some trauma-related substance use, not an explanation for every person who uses opioids. Sage Journals
Self-medicating for temporary relief
Someone can feel less distressed while becoming more sedated, less aware of their surroundings, and medically endangered. Opioid misuse does not reliably return the nervous system to a healthy, tolerable state. National Institute on Drug Abuse
Repeated use can also create another source of distress. As physical dependence develops, reducing or stopping opioids can bring withdrawal symptoms, including anxiety, agitation, pain, and gastrointestinal symptoms. A person may then continue using both to escape their original distress and to avoid withdrawal. National Institute on Drug Abuse
Why nervous system regulation matters in addiction recovery
When trauma-related activation is helping drive substance use, learning to manage that activation is a vital part of a broader recovery plan. Treatment needs to consider what happens before the urge to use, what relief the substance seems to provide, and how those needs can be addressed more safely. Sage Journals
Nervous system regulation does not mean eliminating every uncomfortable emotion. The goal is to become better able to experience distress, stay connected to the present, and recover after something upsetting happens. Progress means learning to identify triggers, pause so you can respond rather than react, and use learned coping skills to sit with distress without using substances. U.S. Department of Veterans Affairs
Trauma and substance use can be treated together
When PTSD and a substance use disorder occur together, both deserve attention. Evidence-based trauma-focused therapies can be provided alongside addiction treatment, with care coordinated around the person's needs and safety. Treatment should not assume that addressing one condition will automatically resolve the other. U.S. Department of Veterans Affairs
A useful question in therapy is:
"What tends to be happening right before you feel you need to use?"
That question creates room to explore fear, grief, physical pain, conflict, withdrawal, and other experiences without assuming that every urge has the same cause.
You do not have to wait until you "hit rock bottom"
Perhaps the question is not whether your experience is "bad enough" to deserve treatment. Perhaps it is whether you are increasingly relying on a substance to get through feelings you do not know how to manage.
Support through PAWC
You do not need to decide on your own whether the problem is trauma, dependence, anxiety, or a combination of concerns. Seeking an assessment is a way to begin answering those questions.
Psychiatric Alternatives and Wellness Center (PAWC) offers therapy and psychiatric care, including evaluations and medication management. Telehealth is available across California, with in-person care offered in the Bay Area.
To get started, complete the Connect With a Provider intake process and describe what you are experiencing. Mention trauma symptoms, emotional overwhelm, or substance use concerns so the intake team can help identify an appropriate clinician based on your needs and preferences.
Frequently Asked Questions
Does Trauma Cause Addiction?
Trauma can increase the risk of substance use problems, but it does not determine someone’s future. Many people who experience trauma do not develop addiction, and substance use disorders have multiple contributing factors. Treatment should explore the individual’s history rather than assume a single cause (NIDA, n.d.).
How Can I Tell Whether I Am Outside My Window of Tolerance?
You may feel so overwhelmed that it becomes difficult to think or communicate, or so shut down that you struggle to stay engaged. The useful question is whether you can work through what you are feeling or need help becoming more present and able to respond. The window of tolerance is a descriptive model, not a diagnosis (Children and Family Health Devon, n.d.).
Can Therapy Help With Trauma and Substance Use at the Same Time?
Yes. People with both PTSD and a substance use disorder can benefit from treatment that addresses both conditions. Therapy and addiction care should be coordinated around the person’s needs and safety, rather than assuming one problem must be completely resolved before the other receives attention (Norman et al., 2025).
Should I Start With a Therapist or a Psychiatrist?
A therapist can help you work on emotional responses, coping, and behavioral patterns. A psychiatrist can provide a medical assessment and evaluate medication needs. Some people benefit from both. When opioid use or withdrawal is involved, ask specifically about access to addiction treatment, because additional medical services may be necessary (CDC, 2024b; Psychiatric Alternatives and Wellness Center, n.d.-b).
Citations
A.D.A.M., Inc. (n.d.). Opiate and opioid withdrawal. MedlinePlus. https://medlineplus.gov/ency/article/000949.htm
Centers for Disease Control and Prevention. (2024a, April 2). What to do if you think someone is overdosing. https://www.cdc.gov/stop-overdose/response/index.html
Centers for Disease Control and Prevention. (2024b, April 9). Opioid use disorder: Treating. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html
Centers for Disease Control and Prevention. (2024c, August 12). Treatment of opioid use disorder. https://www.cdc.gov/overdose-prevention/treatment/opioid-use-disorder.html
Centers for Disease Control and Prevention. (2025, June 9). Fentanyl. https://www.cdc.gov/overdose-prevention/about/fentanyl.html
Children and Family Health Devon. (n.d.). Window of tolerance. https://childrenandfamilyhealthdevon.nhs.uk/window-of-tolerance/
Collins, J. (2026, September 22). Hayden Panettiere died from an overdose involving fentanyl. She had just gone to rehab, coroner says. AP News. https://apnews.com/article/hayden-panettiere-cause-of-death-drugs-fentanyl-229349e2bb6e19d985372d8524b09fc8
Lanius, R., Miller, M., Wolf, E., Brand, B., Frewen, P., Vermetten, E., & Spiegel, D. (2025, December 9). Dissociative subtype of PTSD. National Center for PTSD, U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/essentials/dissociative_subtype.asp
National Center for PTSD. (2025a, March 26). Coping with traumatic stress reactions. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/coping_stress_reactions.asp
National Center for PTSD. (2025b, October 17). Substance use and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/understand/related/substance_misuse.asp
National Center for PTSD. (2026, August 25). PTSD basics. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/understand/what/ptsd_basics.asp
National Institute of Mental Health. (n.d.). Finding help for co-occurring substance use and mental disorders. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
National Institute on Drug Abuse. (n.d.). Trauma and stress. https://nida.nih.gov/research-topics/trauma-and-stress
National Library of Medicine. (2024, March 27). Opioids and opioid use disorder (OUD). MedlinePlus. https://medlineplus.gov/opioidsandopioidusedisorderoud.html
Norman, S., Hicks, T., Klein, A., & Hamblen, J. (2025, October 15). Treatment of co-occurring PTSD and substance use disorder in VA. National Center for PTSD, U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp
