6/4/2018. Integrating Addiction Recovery and Trauma Healing. Introductions. Learning Objectives

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1 1 Integrating Addiction Recovery and Trauma Healing BOB CARTY, LCSW, CADC, CCJP VANESSA LOWREY, LCPC, CADC JIM NICHOLAS, LCPC, CRADC Introductions 2 Co-Presenters from Hazelden-Chicago Bob Carty: Director of Clinical Services Vanessa Lowrey: Clinical Supervisor Jim Nicholas: Mental Health Specialist Learning Objectives 3 Discuss importance of integrating addiction and trauma services Describe the impact of gender-specific groups in this work Define vicarious traumatization List three benefits of a guide team Others? 1

2 4 Linkage Between Addiction and Trauma Trauma and Addiction 5 Familiar to addiction treatment Guilt and Shame often residue of traumatic experience Things Done to Me Things I ve Done Experience of trauma - Predisposition to addictive behavior Neurobiological Changes Attachment Regulation of Impulses Regulation of Stress Responses Trauma and Addiction 6 Experience of Trauma Precipitates Addictive Behavior Substance Use as a Coping response Coping in the Sense of Reducing Subjective Distress Emotional Numbing Cognitive Numbing Use Coupled with Neural Dysregulation 2

3 Big T and Little t 7 Definitions / Examples Big T: Severe Once or Repeated May be Public Little t: Severe Once or Repeated May be Private 8 Integrated Treatment Model Integrated Process 9 Assessment of CD and MH, including trauma-related concerns MHP for individual therapy and EMDR Group therapy with masters level counselors educated on trauma Addiction Psychiatrist for psych evaluation, MAT for both CD & MH Addictionologist as PCP WHG & MRG using Covington curriculum FIT assessments Guide Team 3

4 Integrated Process 10 Herman s (1997) 3 stages of trauma treatment Establishment of Safety Stabilization, psych & physical safety Remembrance and Mourning Understanding links between trauma & substance use Reconnection with Everyday Life Utilization of coping strategies in recovery Choosing Curriculum 11 Overview and Theoretical Approach Duration and Intensity of Services Open vs. Closed Sessions Adaptations Training and Facilitator Qualifications Cost Availability, Willingness, & Education of Staff 12 Gender-Specific Healing Groups 4

5 Men s Resilience Groups (MRG) 13 Participation Criteria Normalization of Trauma Experience Education on Big and Little t distinction MRG 14 Education on trauma reactions Neurochemical Emotional Behavioral Setting Group Norms Establishing Trust and Safety MRG 15 Encountering Emotions Practicing Use of Coping Skills Grounding Self-Soothing Exploration of Interpersonal Reactions Addictive Behavior Avoidance / Isolation Maladaptive Use of Power and Control 5

6 Women s Healing Groups (WHG) 16 Approximately 65-84% of women meet criteria for PTSD before development of SUD Among women who have experienced 3-4 forms of violence, 90% experienced a resulting mental health disorder and 47% developed a SUD Up to 80% of women entering SUD treatment have experience physical or sexual abuse Approximately 43-59% of women in SUD treatment meet criteria for PTSD WHG 17 Healing Trauma by Covington and Russo Gender-specific curriculum for women designed for settings in which short-term intervention is needed Promotes strength-based approach Seeks to empower women & increase sense of self WHG 18 Focuses on emotional development & coping strategies Healthy expression & containment of feelings Psychoeducational & CBT techniques, expressive arts, body-focused exercises, mindfulness, & relational therapy 6

7 WHG 19 Overview of sessions Welcome and Introduction to the Subject of Trauma Power and Abuse The Process of Trauma and Self-Care The ACE Questionnaire and Anger Healthy Relationships Love, Endings, and Certificates Clinical Implications & Observations 20 Guide Teams WHAT IS IT? ITS FUNCTIONS DEVELOPING ONE What Is a Guide Team? 21 A group of 8-10 people committed to process of becoming trauma-informed and trauma-responsive Represents a cross-section of administration and staff Includes a senior leader, supervisory staff, support staff, and possibly people seeking services Meets once to twice monthly Requires position of Team Leader, which can be single individual or co-leaders, but does not have to be in a supervisory position 7

8 Functions of Guide Team Leaders 22 Must be committed to trauma-responsive culture change Needs formal authority as leaders of the change process by organization s leadership Generate interest in the overall change efforts and be responsible for keeping the initiative as an important overall strategic goal More Functions of Guide Team Leaders 23 Act as point persons for the Guide Team to ensure the principles are implemented across the organization Ensure the Guide Team has representation from various levels/departments within the organization Monitor delivery of all trauma-informed & traumaresponsive processes in order to report to senior leadership the efficacy and work of the ongoing change initiative Development of Guide Team 24 Determine Team Leader(s) Invite staff interested in promoting trauma-responsive culture Establish Mission, Vision, and Values Incorporate new members Conduct survey regarding current culture Meet at least monthly 8

9 25 Vicarious Traumatization WHAT IS IT? SIGNS AND SYMPTOMS HEALING What is Vicarious Traumatization? 26 A.K.A. = secondary trauma or compassion fatigue Not to be confused with professional burnout (deterioration in job performance due to continued involvement in high-stress work environments) Vicarious traumatization: impact of clinicians bearing witness to the trauma of their clients Can occur from one particularly graphic experience; more likely occurs from many experiences over time Signs and Symptoms 27 May include Either emotional numbing or reactivity Either interrupted or extended sleeping Either no appetite or increased appetite Other symptoms: heightened anxiety, hypervigilance, increased startle response, and overly protective of loved ones (especially children) 9

10 EAP and Vicarious Traumatization 28 EAPs frequently work with clients impacted by trauma, so there is a high risk for vicarious traumatization Try searching EAP and vicarious traumatization -- what I found was how EAPs help others who experience vicarious traumatization, but nothing on how to heal from their own Who helps the EAP professional? Healing from Vicarious Traumatization 29 Recognize that you have been triggered De-brief after intense sessions involving trauma Seek help from trusted colleagues, friends, and therapists Practice self-compassion enhance your self-care Identify what part of the traumatic story you have absorbed Establish new supports to enhance your resilience Takeaways and Next Steps 30 What takeaways do you have from today s training? What can you do to apply what you have learned? 10

11 Recommended Readings 31 Brown, C., PhD, LMSW, Killeen, T., PhD, & Haynes, L., MSW. (2010). Challenges of Implementing Trauma Intervention into a Clinical Treatment Program. Counselor, The Magazine for Addiction Professionals,11(September/October), Stephanie Covington and Eileen Russo. Healing Trauma: A Brief Intervention for Women. Hazelden Publishing, Stephanie Covington and Roberto Rodriguez. Exploring Trauma: A Brief Intervention for Men. Hazelden Publishing, Dimeff, L. A., & Koerner, K. (2008). Dialectical behavior therapy in clinical practice: applications across disorders and settings. New York: Guilford. Recommended Readings 32 Finkelstein, N., VandeMark, N., Fallot, R., Brown, V., Cadiz, S., & Heckman, J. (2004). Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment (pp. 1-12, Publication). Sarasota, FL: National Trauma Consortium. doi: Freeman, A., Pretzer, J., Fleming, B., & Simon, K. M. (2004). Clinical applications of cognitive therapy. New York: Kluwer Academic/Plenum Publishers. Herman, J. L. (1997). Trauma and recovery: the aftermath of violence, from domestic abuse to political terror. New York: Basic Books, a member of the Perseus Books Group. Killeen, T. K., Back, S. E., & Brady, K. T. (2015). Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs. Drug and Alcohol Review,34(3), doi: /dar Mate, Gabor (2010). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books. Recommended Readings 33 Meichenbaum, D., PhD. (2009). Trauma and Substance Abuse: Guidelines for Treating Returning Veterans. Counselor, The Magazine for Addiction Professionals,10(August/September), Stotts, A. L., & Northrup, T. F. (2015). The promise of third-wave behavioral therapies in the treatment of substance use disorders. Current Opinion in Psychology,2, doi: /j.copsyc

12 Contact Information 34 Bob Carty (312) Vanessa Lowrey (312) Jim Nicholas (312) Closing Comments 35 For too many years, professionals failed to recognize the linkage between trauma and addiction Now, we have new approaches to treat these issues in an integrated manner We hope that you have gained new insights and tools to help you to help others 12