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Understanding Trauma in Addiction Treatment

A former military combat serviceman. A woman who was physically abused as a child. A young adult who recently lost a parent. Each person struggling in various ways with issues of past trauma. And each potentially seeking a way to numb the pain or memories with substances like drugs or alcohol.

These are the types of clients seen within treatment programs that serve individuals with co-occurring issues like trauma and substance use disorder (SUD). How does their treatment differ and why is it important?

The prevalence of physical and sexual abuse among women in substance abuse treatment programs is estimated to range from 30 percent to more than 90 percent. In one study, men with post-traumatic stress disorder (PTSD) were five times more likely to abuse substances.

Trauma and substance abuse co-occur frequently and sometimes understanding which came first can be a bit like the chicken and the egg. For example, someone may have had an adverse childhood experience and then used substances to mentally escape the situation. Or they may have started abusing substances which put them in dangerous situations that resulted in a traumatic experience. Sometimes an individual may not even realize they have past trauma until they get into treatment for their SUD. Whatever their story, people’s pain from feeling unsafe and unable to deal with life without substances can seem unbearable. But there is hope.

For these individuals, participating in a treatment program in which one’s trauma and substance use can be addressed concurrently is critical. The National Trauma Consortium published a paper on this topic for SAMHSA that identified three important stages of trauma treatment: establishment of safety, remembrance and mourning, and reconnection with everyday life. The first and last can be said to be true of all clients in treatment, with or without past trauma. The second takes specific training, an approach called “trauma-informed care.”

According to SAMHSA, being trauma-informed means that a treatment center’s staff are trained to be aware of the widespread impact of co-occurring substance use and trauma issues and recognize the signs in order to accurately assess clients. They are taught to be mindful of the potential sensitivities to words, touch, and other things that might trigger an adverse response or what’s known as re-traumatization. Things like hugging or pushing someone too hard to tell “their story,” even in a casual, friendly group session, may be more harmful than helpful.

Ensuring that clients feel safe in their environment is an integral theme in trauma treatment, arguably the most important. For someone who has experienced significant emotional, physical or mental pain, feeling safe and secure enough to work through these issues is the first step to learning how to replace their self-harming, addictive behaviors with self-love and care. Clients who have past trauma may not have felt safe – or trusted anyone – in quite some time. Establishing this foundation is critical and often achieved one-on-one with their trauma-informed therapist.

In many cases, trauma and addiction have fractured a patient’s social/peer networks. Rebuilding these relationships and creating a solid peer support network for clients helps to ensure their long-term recovery success. Group therapy and 12 Step programs are great options, as is re-establishing relationships with healthy family members and friends.

Ultimately, with trust, support and collaboration, a client struggling with past substance use and trauma can begin to feel empowered and strong. They can learn healthier coping mechanisms than self-medicating their pain with substances. And they can begin to realize that while trauma may be a part of their past, it does not need to define them.

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