Booze, Drugs and Trauma: The Role of TIC in Recovery. Dr. Ronald W. Luce Executive Director The John W. Clem Recovery House, Athens, Ohio

Transcription

1 Booze, Drugs and Trauma: The Role of TIC in Recovery Dr. Ronald W. Luce Executive Director The John W. Clem Recovery House, Athens, Ohio

2 Ron Luce Executive Director for the John W. Clem Recovery House in Athens, Ohio, a recovery house for men 18 years of age and up President of the Ohio Recovery Housing (ORH) organization Serves on the board for The National Alliance for Recovery Residences (NARR) Certified Ohio Peer Supporter and trainer Trauma-Informed Care(TIC) trainer

3 Luke In trouble with the law since early teen years Children s Services involvement Didn t complete high school Depressed Beats guys up for reasons most would consider insignificant Didn t find psychological counseling to be helpful Used heroin Had trouble in relationships with women Went to prison for assault and other charges Came to Clem House to work on recovery (age: early 30 s) Described himself as a monster

4 What happened to you, Luke? Born into poverty. Mother left when he was very young; raised by father and brothers. Father had sex with him (and brothers) regularly from time he was 5 up to 21.

5 Learning Objectives Upon completion of the workshop, you will be able to do the following: Recognize that recovery cannot be limited to substance use if the underlying trauma is the trigger and it is not adequately dealt with by appropriately trained people. Explain the importance of assessment for trauma as part of the continuum of care for people with substance-use disorders. Explain some of the ways early childhood trauma affects the development of substance-use disorders and the behaviors we see in adult addicts. (continued)

6 Identify basic principles of trauma-informed care and competence to be used by family, loved ones, staff, volunteers, and recovery group leaders (non-experts). State limitations in dealing with trauma and how we can re-traumatize people who are seeking recovery if we are not trained in TIC or TC. Recognize that recovery is part of a Recovery-Oriented System of Care (ROSC), and, in most cases, is a life-long task and goal. TIC and TC are essential parts of a ROSC.

7 Beyond Being Trauma Informed TIC = Trauma-Informed Care [knowledge] TC = Trauma Competent or Trauma Competence [practice, skills and ability to perform]

8 Case Studies Jason, Jake & John

9 Of course they used! Substance use is often a coping mechanism for dealing with trauma!

10 % With a Lifetime History of Depression Childhood Experiences and Chronic Depression Women Men >=4 ACE Score

11 % Alcoholic Childhood Experiences and Adult Alcoholism ACE SCORE

12 Slightly under 3% of people with an ACE Score of 0 report adult alcoholism. For people with an ACE score of 1 that becomes 6%, for a score of 2, the percentage climbs to 10%, for 3 to just under 12% and for people with a score of 4, the percentage tops at 16%. Experiencing 4 or more adverse childhood experiences raises your adult alcoholism risk by more than 500%.

13 % Attempting Suicide Childhood Experiences and Suicide ACE SCORE

14 The likelihood of adult suicide attempts increases 30-fold, or 3,000%, with an ACE score of 7 or more.

15 Likelihood of Becoming an Injection Drug User A male with an ACE score of 6 is 46 times more likely to become an injection drug user at some time in his life than a male with an ACE score of 0.

16 Because ACEs seem to account for one-half to twothirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to the types of common, stressful, and disturbing childhood experiences by pediatric practice.

17 We can assess for trauma!

18 Recognizing Trauma Non- experts often have to deal with other people s trauma... whether we want to or not, often times when we don t even recognize that we re dealing with trauma. In this session we will look at the roles of friends, peers, community support groups, caring staff members and volunteers in recognizing potential underlying trauma, trauma-driven behaviors, and effective means for being helpful.

19 Screen and Assessing for Trauma Formal screening and assessment instruments: o o o Adverse Childhood Experiences (ACE) Traumatic Antecedents Questionnaire (TAQ) Structured Interview for Disorders of Extreme Stress (SIDES) & Self- Report Instrument for Disorders of Extreme Stress (SIDES-SR): Informal screening (motivational interviewing) o o o What happened to you? vs. What s wrong with you? Tell me about yourself. What was your home life like when you were a child?

20 Warning Signs Self-destructive behaviors (drug and alcohol disorders) Heightened arousal symptoms o Hypervigilance o Exaggerated startle responses Problems focusing or paying attention Sleep disturbance Increased irritability/outbursts of anger Depression and/or anxiety Zoning out inability to concentrate Sensitivity to triggering stimuli

21 Common Trauma-Related Beliefs RESPONSIBILITY: I should have done something. I did something wrong. I am to blame. CHOICE: I have to be perfect/please everyone. I am trapped. I have no options. SAFETY: I cannot trust anyone. I am not safe. I cannot show my emotions. POWER: I cannot succeed. I cannot stand up for myself. I am powerless/helpless. VALUE STATEMENTS: I am a bad person. I am worthless/inadequate. I am a failure. I am permanently damaged. I am stupid. I am ugly.

22 Dealing with Trauma and Addiction While the ACE score is a pretty good guideline as to what red flags from a person's childhood could have been seen and dealt with, we have to remember that mitigating factors can alter the long-term effects of trauma. ( Resiliency )

23 We can do some things to help people even if we are not therapists.

24 The hallmarks of the transforming therapeutic interaction are Safety Predictability Nurturance Bruce D. Perry, MD, PhD

25 Treatment of Addiction Must Include Trauma-Informed Care and Trauma Competence at all levels NARR s Social Model of Recovery: People are social creatures who need human interaction to drive and sustain their physical, intellectual and emotional development. The determination of who they interact with from the time of birth throughout their lifetimes is critical to who they become, how they behave, and how they are perceived (or misperceived) by others outside their immediate social environment. Becoming immersed in new environments filled with caring, positive, empathetic, empowering people can have significant impact on people whose ability to thrive has been compromised by childhood trauma, adverse life experiences and substance-use disorders. A properly implemented social model plan can enhance a person s recovery process. Ron Luce

26 Some Basic Competency Requirements from the work of Gabor Maté Success will require love, in a pure way that is not adulterated with judgment, vindictiveness, or a tone of rejection. Don t corrode your own soul with resentment because the person is not like you think a person should be. Recognize that if the developmental roots of the addiction process lie in insufficient attachment, recovery includes forming attachments. [Recovery requires positive social interactions.] (continued)

27 It is not what we do that has the greatest impact but who we are being as we do it. Conduct a compassionate self-inquiry. Examine your own anxieties, agendas, and motives. How free am I? Do I have an insistent need to change this person for the better? I say that I want this person to reach his/her own genuine possibilities, but am I on the path to fulfilling my own? (continued)

28 The more people around the substance user who can shoulder responsibility for their own attitudes and actions without blaming and shaming the addict, the greater the likelihood that everyone will come to a place of freedom. Many painful situations could be avoided if we recognize that we are responsible for the way we enter into the interaction.

29 Acquire Trauma Competence Support and encourage the individual s engagement with a professional trained in trauma care. Practice acceptance. Practice validation. Learn patience. Learn to be quiet. Learn how and when to challenge without intimidation. 1

30 Help the person (when s/he wants it) with processing. Learn the art of Motivational Interviewing. Recognize that your voice, tone, word choices, and body language are conveying messages constantly and people who are hypervigilant can misread you or see through phony baloney if you are using it. Learn to read verbal and nonverbal responses and respond to them. 2

31 Avoid unexplained slogans and simplistic solutions that may play into the person s trauma. Work from a strengths-based perspective. Be culturally sensitive. Have back-ups if the person goes deeper than s/he can handle and when you are unqualified to deal with what a person is suddenly determined to have you deal with. 3

32 Encourage routine. Be consistent and fair. Teach basic coping skills (when the person is ready). Do not question or countermand doctors / psychiatrists orders or prescriptions in front of the resident/peer/client/patient. Maintain professional ethics at all times! Have closing strategies. 4

33 Remember that you are NOT solely responsible for helping this person get clean/sober/well. It takes a community to care for traumatized people: Recovery-Oriented System of Care (ROSC) Trauma-Informed and Trauma Competent! 5

34 Summary 5

35 Keys Assume trauma Provide safety Be non-judgmental and be genuine Build trust with your words, body, and heart Listen, listen, listen... Don t just hear Don t pry, but listen for clues Know your limitations Encourage professional help 4

36 The end or the beginning?