Video: Trauma and Addiction

This video explains how substance use and trauma are related. Strategies for service providers and trauma informed principles are covered.

About this video

Production Date: December 18, 2013
Length: 1 hour, 34 minutes
Presenter: Kirsty Prasad

Kirsty has worked with Alberta Health Services (AHS) Enhanced Services for Women since 2002 where she works with women who use substances. In recent years Kirsty has been training other service providers in the strategies and techniques that she and her AHS colleagues have developed. Prior to coming to AHS, Kirsty worked for Streetworks and the Mental Health Unit in the inner city. Kirsty has a strong knowledge and passion for working with marginalized populations with substance use concerns.

Outcomes

This video will help you to understand:

  • substance use and trauma interaction
  • how trauma symptoms can mimic substance use
  • trauma informed principles

Content

  1. The effects of trauma (21:44)
  2. Trauma and substance use (34:33)
  3. What is trauma-informed practice? (50:48)
  4. Strategies for service providers (1:04:32)

The effects of trauma

Trauma deeply impacts the following areas:

  • Identity
    • stable sense of self and a consistent internal locus of conscious awareness
  • Boundary
    • individual’s awareness of the distinction between self and others
  • Affect regulation
    • the ability to experience, tolerate, and integrate feelings
  • Attachment
    • critical role in explaining that it is through attachment that infants develop affect

Trauma and substance use

Research has shown that the kinds of trauma experienced by women who develop serious substance use problems:

  • are often interpersonal in nature
  • are intentional, prolonged and repeated
  • include witnessing violence
  • often occur in childhood or teenage years and extends through adulthood
     

Re-enactment symptoms

Symptoms:

  • attraction to dangerous
  • situations, risk-taking
  • sexual acting-out
  • suicidality
  • self-harm
  • attraction to abusive relationships
  • self-sabotage

What drugs do:

  • alcohol and cocaine facilitate or mimic re-enactment symptoms
  • decrease likelihood of trauma memories breaking through by ensuring that the individual is on an endorphin or adrenaline ‘high’
  • sexually addictive behavior produces a high and involves re-enactment of sexuality as unsafe

 

Persistent expectation of danger

Symptoms:

  • never really feeling safe
  • increased anxiety
  • easily startled
  • sleep problems
  • difficulty with concentration

What drugs do:

  • alcohol and marijuana reduce hyper vigilance
  • cocaine and speed increase hyper vigilance
  • this paradoxically increases the individual’s feeling of power and control which can decrease anxiety

 

Hyper arousal symptoms (intrusion)

Symptoms:

  • flashbacks
  • nightmares
  • emotional/psychological distress
  • body memories (smells, sounds, or tastes)
  • these symptoms are the most frequent and are most likely to trigger relapses

What drugs do:

  • alcohol and marijuana induce relaxation and numbing effects, facilitate dissociation
  • restricting food intake and overeating produces the same effects
  • cocaine combined with alcohol may be used to increase hyper vigilance if the individual becomes very intoxicated
  • heroin and opiates keep intrusive symptoms at bay, dampen rage and aggression

 

Numbing, or hypo arousal symptoms (constriction)

Symptoms:

  • shutting down for self-protection
  • avoidance
  • feeling numb, not having feelings at all
  • dissociating
  • inability to recall certain aspects of the past
  • detachment
  • restricted range of emotional expression

What drugs do:

  • speed, cocaine and self-injury counteract numbing and increase the sense of well-being and of being ‘alive’
  • depressive numbing often leads to suicidal despair or to self-injury
  • stimulants fight numbing and create feeling of safety
  • alcohol can help to mitigate numbing or to induce it at different ‘dosage’

What is trauma-informed practice?

A trauma-informed approach emphasizes understanding the individual and the context in which the individual has lived her life.

10 Principles of trauma-informed services

  1. Recognize the impact of violence and victimization on development and coping strategies
  2. Identify recovery from trauma as a primary goal
  3. Employ an empowerment model
  4. Strive to maximize choices and control over recovery
  5. Based in a relational collaboration
  6. Create an atmosphere that is respectful of survivor’s need for safety, respect and acceptance
  7. Emphasize strengths, highlighting adaptations over symptoms and resilience over pathology
  8. Minimize the possibilities of re-traumatization
  9. Strive to be culturally competent and to understand each person in the context of their life experiences and cultural background
  10. Solicit consumer input and involve consumers in designing and evaluating services

Strategies for service providers

‘Safety’ means different things to different women:

  • work together to define goals and strategies
  • anticipate specific triggers
  • help her to develop a basic skill set for dealing with trauma-based reactions
  • practice healthy self-care

Language is powerful:

  • language must be accurate, sensitive, respectful and appropriate
  • use language that avoids stigmatizing clients or pathologizes their way of coping
  • use the client’s name

Create a safe environment:

  • signage should be legible and clear
  • use welcoming language\
  • avoid commands (‘do’s’ and ‘don’ts’) and instead make reference to ‘rights and responsibilities’
  • ask whether she prefers closed/locked doors or an open environment
  • walk through waiting areas, the reception area, group spaces, and interview rooms with trauma-informed eyes
  • ask women about their experience in the physical space
  • ensure that exits are easily accessible
  • limit distractions
  • provide fidget toys and art supplies

Establish a strong therapeutic alliance:

  • this is the biggest indicator of success
  • a woman may make tentative contacts a number of times before she is able to fully engage in services
  • applying pressure on her is counter to trustworthiness
  • determine and communicate clear boundaries and guidelines
  • work with the woman to help identify her assets – as well as challenges – and appreciate her resilience

Alleviate anxiety and stress:

  • be welcoming, clear and consistent
  • introduce other staff and providers who might be part of the service experience
  • discuss confidentiality processes and protocols, including the legal limits on confidentiality
  • clarify expectations
  • incorporate safety information at every opportunity

Provide psychoeducation:

  • helps women understand their experiences and behaviours
  • teach about how trauma impacts the way one thinks, feels and behaves
  • teach about flashbacks, dissociation and numbing
  • reframe symptoms as responses to trauma

Teach grounding and self-soothing:

  • grounding brings the client into the present and helps her connect with her body to increase her capacity to regulate emotions and distract from triggers and cravings
  • helps manage flashbacks
  • have multiple techniques in your tool kit for diverse clients
  • ask the client to rate her mood before and after to see if it had an impact
  • use terms like ‘grounding’ and ‘self-soothing’ rather than ‘relaxation’
  • for a client with a history of psychosis, do not use guided imagery
  • use activities that involve tactile grounding techniques

Teach containment:

  • containment is about choosing when you will engage in healing
  • it helps you feel that you are in charge of your healing work and allows you to store overwhelming information/images/feelings for exploration at a later time
  • containment can backfire if it is not used in conjunction with emotional regulation
  • clients must learn how to balance

See also

Nancy Poole, ‘Trauma Informed Care

Created:
Modified: 2015-09-09
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