Given the vast overlap between substance use disorders and post-traumatic stress disorder, it is crucial for substance abuse treatment to address underlying trauma. Trauma-informed care treatment refers to therapies that recognize the role that trauma plays on behavior, emotions, and thought patterns. At NuView Treatment Center, all of our clinicians are educated and up-to-date on the latest trauma-informed practices.
What is Trauma-Informed Care?
Individuals who have experienced trauma or suffer from post-traumatic stress disorder are often drawn to substances or addictive behaviors to “numb” the pain they experience. Drugs, alcohol, and even sex, gambling, and food can all help people temporarily forget their past experiences.
When an individual develops a substance use disorder as a result of intense personal trauma, it is crucial to address the trauma as well. Even if the individual’s substance abuse is clearly harming them, it is important to recognize that their drug or alcohol abuse is also likely serving an important purpose. Self-medication is generally a bad idea, but the proper alternative is effectively treating the underlying trauma — not simply removing drugs and alcohol
As such, trauma-informed care treatment is a type of integrated treatment. It incorporates multiple therapeutic techniques from different modalities to simultaneously address both addiction and post-traumatic stress disorder.
Trauma and PTSD
What counts as trauma? Traumatic events can vary widely. In fact, what one person experiences as unpleasant, another person might experience as traumatic. Ultimately, it depends on a person’s resilience, history, and current mental state at the time of an experience. Traumatic experiences can occur during adolescence, childhood, adulthood, and even in old age. What makes an event traumatic is the way it overwhelms a person’s ability to process it productively and healthily.
Traumatic events can be sudden and one-time occasions, such as surgery, an automobile accident, an assault, or the death of a family. However, many people experience trauma over long-term protracted periods. These long-term stressors can include domestic partner abuse, going to war, incarceration, neglect, or sexual abuse.
Whether a person’s experience of trauma is sudden or long-term, the experience can lead to extreme fear for their physical safety as well as long-term problems with psychological and emotional stability.
Not all people who experience trauma develop post-traumatic stress disorder (PTSD). However, in severe cases of trauma post-traumatic stress disorder is often the result. PTSD can last many years after a traumatic event. It can lead to a wide range of symptoms, including anxiety, confusion, depression, and memory loss.
Individuals who suffer from PTSD often also experience intense feelings of low self-esteem, hopelessness, and despair.
Other common symptoms of PTSD include:
- Detachment and emotional numbness
- Problems staying asleep or falling asleep
- Avoiding events that remind one of the traumatic events
- Disruptive or intrusive memories of the traumatic event (flashbacks)
- Difficulty concentrating
Trauma and Substance Abuse
Individuals who are dealing with these difficult and painful thoughts, emotions, and physical symptoms often look for relief wherever they can find it. For this reason, it is extremely common for people with PTSD to engage in drug and alcohol abuse. For these individuals, their abuse of drugs and alcohol might even be considered a form of self-medication.
While drugs and alcohol can indeed provide relief from the symptoms of PTSD, it is important to recognize that the relief it provides is very short-term. Over time, drugs and alcohol can worsen the disruptive symptoms of PTSD.
It is also important to recognize that individuals who abuse drugs and alcohol are also more likely to be exposed to trauma. The lifestyles and behavior patterns that characterize addiction often put addicts and alcoholics at serious risk. Individuals who abuse drugs and alcohol are more likely to engage in risk-taking behaviors. As such, they are more likely to experience traumatic events, such as a violent assault or a car accident.
Because post-traumatic stress disorder and substance addiction tend to mutually reinforce one another, they are often referred to as comorbid. Individuals suffering from comorbid substance use disorders and post-traumatic stress disorder are known as dual diagnosis patients.
Studies show that roughly 50% of people with addiction also suffer from one or more comorbid mental health disorders. Moreover, half of all people with mental illness suffer from drug or alcohol addiction to some extent. Post-traumatic stress disorder is one of the most prevalent mental health conditions for dual diagnosis patients.
Addiction and Adverse Childhood Experiences (ACEs)
Researchers do not fully grasp what causes addiction. Studies point to a variety of factors influencing addiction. Most of these factors boil down to two categories: genetics and life experiences. A family history of addiction is often looked at as a strong predictor of addiction because having parents with substance abuse problems means that a person has both genetic and experience-based reasons to develop a substance abuse issue.
In recent years, the effect of early childhood trauma on addiction has been explored further. The Centers for Disease Control and Kaiser Health launched a study in 1998 known as the ACE study. Their research showed that children who underwent “adverse childhood experiences,” or ACEs, were significantly more likely to develop drug and alcohol use disorders later in life.
There is a distinction between adverse childhood experiences and post-traumatic stress disorder. Moreover, not all adverse childhood experiences are necessarily traumatic — but they often operate in similar ways on the brain. Examples of adverse childhood experiences that the ACE study identified include:
- Emotional or physical neglect
- Emotional, physical, or sexual abuse
- Parents getting divorced
- Domestic violence
- Suffering from bullying or racism
- Living in a dangerous neighborhood
- Living in foster homes
- Living with a person who has substance abuse problems
- Living with a person struggling with mental illness
- Living with someone who is struggling with the criminal justice system
- Being witness to violence
The ACE study demonstrated that individuals who qualify for four or more of the above experiences are dramatically more inclined to developing drug or alcohol addictions. Moreover, they have much higher rates in adulthood of anxiety disorder, major depression, and post-traumatic stress disorder, as well as physical health conditions.
Trauma-informed Care in Substance abuse Treatment
A trauma-informed approach to addiction treatment recognizes the strong relationship between comorbid PTSD and addiction. Any therapeutic modality can be trauma-informed. Qualified and trained clinicians who practice trauma-informed care treatment utilize a diverse range of therapeutic approaches. However, what makes a therapy trauma-informed is when a therapist follows a number of best practices.
The Substance Abuse and Mental Health Services Administration (SAMSHA) suggests that staff members and clinicians keep the following three principles in mind when working on trauma-informed care treatment:
- Realize how trauma can impact addiction and many other aspects of a client’s life — and how there are many routes to recovery.
- Recognize the symptoms and signs of trauma.
- Seek to avoid exposing a client to additional trauma and preventing re-traumatization.
Integrated and trauma-informed care treatment programs offered by outpatient treatment centers follow several underlying principles. These include:
- Safety. It is absolutely crucial for clients who have experienced trauma to feel safe during treatment. People who have been traumatized or who suffer from PTSD are often uniquely vulnerable to triggers. If they do not feel safe, it is possible for them to be re-traumatized or relive the traumatic event. This can lead to an increase in stress hormones and ultimately cause them to relapse. As such, treatment centers should aim to provide safe, comfortable, and trigger-free environments.
- Transparency and Trustworthiness. Therapists, psychiatrists, and counselors should recognize that clients need to trust them before they will open up. Individuals with a history of trauma are often guarded, reserved, or skeptical. This makes sense: they are protecting themselves. It is the clinician’s job to earn the trust of their client by being open, honest, and transparent. Staff members at a treatment center should be communicative and helpful as much as possible. This can facilitate an ideal environment for recovery.
- Peer Support. Research shows that when individuals who have suffered from trauma can share their experiences, stories, and challenges, they find it easier to recover. This kind of comradery builds trust, hope, and strength. Moreover, peer support helps clients develop the techniques and coping skills they need to manage the symptoms of PTSD.
- Mutuality and Collaboration. SAMSHA recommends that treatment providers aim to model these principles as much as possible for clients. Trauma-informed care means that treatment centers and rehabs should operate on the principle that healing happens in the context of relationships. It is never a solitary battle. As such, healing can occur on many levels: between a patient and therapist, between therapists and their support staff, between several patients, and even between a rehab administration and the public at large.
- Voice, Empowerment, and Choice. Trauma-informed care entails that a clinician will try to empower their clients as much as possible. In practice, this means recognizing and valuing the resiliency, strength, and abilities of trauma survivors. Rather than viewing them as powerless victims, it is crucial to understand that it is their strength that allows them to recover from PTSD as well as substance use disorders. To that end, clients should be allowed to direct the course of their own treatment plans and be given as much choice as possible.
- Historic, Cultural, and Gender Issues. Treatment providers should aim to move past dangerous stereotypes about gender, gender identity, race, ethnicity, age, sexual orientation, geography, or religion. Nonetheless, rehabs need to recognize how institutional and historical trauma has an effect on PTSD as well as addiction.
Following these guidelines can assist trauma-informed care treatment centers in serving patients who suffer from complicated comorbid PTSD and addiction. Moreover, these best practices allow rehabs to create environments that are safe and effective places for recovery.
When treatment staff and clinicians understand trauma and its various effects, they can be of more service to survivors who are working to learn new coping skills, move forward, and break the painful cycles of mental illness and addiction.