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Trauma often precedes substance use disorder as people turn to substances as a means of coping. Removing substances can lead to uncovering their wounds and leading the way towards sustainable healing, when handled appropriately.
Dealing only with substance use disorder can cause the person to turn back to substances due to the immense dysregulation in their body — manifesting in chronic illness, pain, and/or an inability to process major stressors and overwhelming emotions. Thus, treating trauma is paramount to sustained recovery, and helping the body reverse its effects on the body’s ability to self-regulate.
It is crucial that mental health and addiction treatment services are trauma-informed. If not, the traumatized person risks being unheard and, even worse, being re-traumatized and returning to use.
Trauma is an epidemic in the United States, as many Americans have faced some form of negative experience in their lifetime, including adverse childhood experiences (ACE’s), domestic abuse, car accidents, military combat, natural disaster, physical assaults, life-threatening illness, or accidents at work. Trauma is now considered to be one of the country’s major public health problems. While for some the psychological and physical impacts of trauma can fade, for others they can last a lifetime and can also be a precursor for chronic disease, substance use disorder, PTSD or complex trauma.
This highlights the need for trauma-specific interventions and for organizations providing mental health and addiction services to be more trauma-informed — understanding the relationship between trauma, mental illness, and substance use disorder.
“When trauma occurs early in life, an already difficult task is made more challenging. Childhood trauma not only leaves people with increased risk for substance misuse and emotional instability but also chronic medical problems,”
explains Gallus Clinical Director Steve Carleton.
“It is necessary early in treatment for substance misuse to assess for trauma,” says Carleton.
He continues, “Too often, ACEs and other traumas go overlooked. Recent studies and estimates demonstrate that up to 75 percent of people struggling with substance misuse have a trauma history. Substances often are the solution to distressing memories and emotional disturbances. Numbing and avoiding emotional and physical pain with substances is a natural and normal human response. Trauma often goes overlooked because addiction is a much louder problem and trauma is silent.”
He argues that by shifting our focus to the idea that substance use might be a symptom of trauma, providers and family members alike start to understand. “We need to stop asking ‘What is wrong with you?’ and instead ask ‘What happened to you?’” he says.
Trauma-specific interventions or treatments are designed specifically to address the consequences of trauma and to facilitate healing. There are many different types of trauma-specific treatments:
The great news is trauma is treatable and we have great tools that help people heal those invisible wounds explains Carleton. “For complex trauma, Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT), and other mindfulness based practices combined with a cognitive element can be transformative.”
Evidence suggests that therapies involving cognitive reprocessing and exposure are effective in treating PTSD. “Prolonged Exposure, Cognitive Processing Therapy, TF-CBT (for kids and families), and EMDR are some of the better options that have helped people recover,” says Carleton.
The most important component in therapy is the relationship between a therapist and a patient Carleton emphasizes. “Treatment works best when both parties are working in a way that feels helpful and is producing change.”
As a clinician treating patients with substance use disorder and trauma histories clinicians should be trauma-aware in their treatments, starting with their first contact with their client.
“Most mental health providers can relate to the pressure felt in an initial assessment to ask pointed questions to gather the information we need to meet state and facility requirements. A pushy assessment is an invalidating experience for a client,” warns Carleton.
Carleton favors more current modalities such as an ACT approach assessment by gathering a client’s “life story” which he believes “gives the client more agency and autonomy to unpack their story how they choose.”
“Motivational Interviewing (an EBP for addressing ambivalence to change) takes the stance that a formal assessment is a barrier to care. Anything we can do to make a client feel more comfortable and give them a sense of control in the treatment process goes a long way.”
Carleton advises that there are various ways that a clinician can practice trauma-informed care, including:
“Assessment should be an opportunity for the client to take a step back and reflect on their life experiences and connect the dots for themselves,” encourages Carleton.
We hope that you have enjoyed our series on trauma and its relationship with substance use disorders, as part of Mental Health Awareness Month. As a recap, this included a guest post by Dr. Jamie Marich, on Trauma as a Wound, the ACE Study and What it Tells Us About Addiction, PTSD, and Complex Trauma.
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