A Quiet Storm: Addressing Trauma & Addiction through a Trauma Informed Lens

Transcription

1 A Quiet Storm: Addressing Trauma & Addiction through a Trauma Informed Lens P R E S E N T E D B Y : B R E N D E N A. H A R G E T T, P H. D., L P C, L C A S, N C C, M A C A L G R E E N E A D D I C T I O N I N S T I T U T E B O O N E, NC J U N E

2 Learning Objectives Participants will explore dynamics of trauma in consideration for treating substance use disorders. Identify and discuss best practice approaches to addressing clients with trauma histories. Participants will gain an overview of trauma informed care principles for systems of care.

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4 Sam?

5 Understanding Trauma and Addiction

6 What is Trauma? The three E s Individual trauma results from (a) an EVENT, series of events, or set of circumstances; (b) that is EXPERIENCED by an individual as being physically/ emotionally harmful or threatening and (c) has lasting adverse EFFECTS on the individual s physical, social, or emotional well-being, or spiritual wellbeing.

7 The Data

8 Adverse Childhood Experiences Recurrent physical abuse Recurrent emotional abuse Contact sexual abuse An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized, or suicidal Mother is treated violently Parents separated Emotional neglect Physical neglect

9 Impact of Trauma ACE Study effects are neurological, biological, psychological and social Changes in neurobiology Social, emotional and cognitive impairment Health risk factors Severe and persistent behavioral health, physical health, and early death

10 Trauma Effects Trauma can lead to behaviors that affect the child s experience of the world and the world s view of the child. These behaviors include: Aggression Sleep disturbances Substance abuse Learning disabilities Attention difficulties Low self-esteem Unhealthy attachments Increased medical problems

11 More than 68% of children and adolescents experience a potentially traumatic event by age 16. Adolescents and Trauma More than 60% of youth age 17 or younger have been exposed to crime, violence and abuse either directly or indirectly. Almost 50% of children and adolescents were assaulted at least once in the past year. 8% of year old's reported a lifetime prevalence of sexual assault

12 Adolescents and Trauma Adolescents have access to psychoactive substances that can dull the effects of stress. Teens who had experienced physical or sexual abuse/assault THREE TIMES MORE LIKELY to report current or past substance abuse. Substances are used to self-medicate and manage stress associated with effects of trauma.

13 Trauma and Adults 90% (89.7) of adults reported exposure to at least one DSM 5 Criterion A event Disaster (50.3%) Accident/fire (48.3%) Exposure to hazardous chemicals (16.7%) Combat or warzone exposure (7.8%) Physical or sexual assault (53.1%) Witnessed physical/sexual assault (33.2%) Witnessed dead bodies/parts unexpectedly (22.6%) Threat or injury to family or close friend due to violence/accident/disaster (32.4%) Death of family/close friend due to violence/accident/disaster (51.8%) Work exposure (11.5%) 60% of men and 50% of women will experience at least one traumatic event in their life.

14 Trauma and Adults Three-fourths of individuals who receive treatment for substance use also have a history of exposure to trauma. Individuals who have suffered assault or sexual abuse are three times as likely to abuse drugs and/or alcohol. A person will begin using drugs and alcohol after experiencing a trauma up to 76% of the time. Up to 59% of people with PTSD will develop a problem with alcohol and/or drugs.

15 People who have experienced trauma are: 15 times more likely to attempt suicide 4 times more likely to develop an alcohol use disorder 4 times more likely to inject drugs 3 times more likely to experience depression Trauma and Life

16 What is Addiction? Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. Addiction is considered a brain disease because drugs change the structure of the brain and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs.

17 Substance-Related Disorders Two Groups: Substance Use Disorders Involves: impaired control, social impairment, risky use, and pharmacological criteria Substance-Induced Disorders Includes intoxification, withdrawal, and other substance/medication-induced mental disorders

18 Substance Use Disorder Using larger amounts or for longer time than intended; Persistent desire or unsuccessful attempts to cut down or control use; Great deal of time obtaining, using, or recovering; Craving; Fail to fulfill major roles (work, school, home), Persistent social or interpersonal problems caused by substance use

19 Substance Use Disorder Important social, occupational, recreational activities given up or reduced; Use in physically hazardous situations; Use despite physical or psychological problems caused by use; Tolerance Withdrawal

20 Severity Severity Depends on # of symptom criteria endorsed Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms

21 Trauma and Substance Use Substance use will precede traumatic exposure up to 66% of the time. Alcohol and drug use leads people to engage in risky behavior that may result in injury such as: driving under the influence fighting placing themselves in dangerous situations unsafe sexual behavior increased risk-taking self-harm

22 Trauma, Substance Use and Recovery Cognitive, psycho-social, and behavioral impairment is linked to alcoholism and drug addiction Persons with substance use disorders are unable to properly cope after experiencing a traumatic event. Substance use is a coping mechanism for persons with trauma history, will initially feel better, due to two factors: Drugs and alcohol activate the brain s reward centers, so the abuser will enjoy temporary pleasurable sensations People who abuse alcohol and/or drugs mask their negative emotions, so they never have to fully experience and process them

23 Trauma and PTSD Many persons with substance use disorders have experienced trauma, often as a result of abuse. A significant number of them have the recognized mental disorder known as PTSD. Strong correlations between trauma and addictions. Childhood abuse is a contributor in the development of substance use disorders

24 Consider the possibility of trauma history even before the assessment begins. Be sensitive to previous traumatic experiences and expect guardedness Promote safety in the interview through providing support and gentleness. Trauma Sensitivity All questioning should avoid retraumatizing the client

25 Screening/Assessment Trauma screening should evaluate: Exposure to potentially traumatic events/experiences, including traumatic loss Traumatic stress symptoms/reactions Screening typically covers the following types of symptoms/reactions: Avoidance of trauma-related thoughts or feelings Intrusive memories of the event or nightmares about the event Hyper-arousal or exaggerated startle response Irritable or aggressive behavior Behavioral problems Interpersonal problems Other problems based on the developmental needs and age of the person

26 Screening Instruments Screening and Assessment Child Trauma Screening Questionnaire (Ages 7-16) Adverse Childhood Experiences Screener (All ages) Trauma Symptom Checklist for Children (TSCC) [Ages 8-16] Life Event Checklist (LEC) Post traumatic checklist (PCL-C) Assessment Gathers key information and engages the client Understanding the readiness for change, problem areas, diagnosis(es), disabilities, and strengths. Examines functioning and well-being of the client University of Rhode Island Change Assessment Scale (URICA) Addiction Severity Index (ASI) Mental Health Screening Form-III Symptom Distress Scale (SDS)

27 Symptoms of Trauma? Aggression Sleep disturbances Substance abuse Learning disabilities Attention difficulties Low self-esteem Unhealthy attachments Increased medical problems Multiple Diagnoses Attention Deficit Disorder Mood Disorders Anxiety Disorders Oppositional Defiant Disorder Conduct Disorder Post Traumatic Stress Disorder Reactive Attachment Disorder Acute Stress Disorder Disinhibited Social Engagement Disorder

28 Trauma and Stressor - Related diagnoses

29 Trauma and Stressor Related Disorders Reactive Attachment Disorder Emotionally withdrawn behavior Social/emotional disturbance reduced responsiveness, limited affect &/or irritability, sadness or fearfulness Exposure to extremes of insufficient care Social neglect/deprivation, repeated changes in caregivers, rearing in unusual settings Disinhibited Social Engagement Disorder Reduced/absent reticence when interacting with unfamiliar adults Behaviors not limited to impulsivity but include socially disinhibited behavior Exposure to extremes of insufficient care Social neglect/deprivation, repeated changes in caregivers, rearing in unusual settings

30 Trauma and Stressor Related Disorders Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorders Other Specified Trauma- and Stressor-Related Disorder Unspecified Trauma- and Stressor-Related Disorder Posttraumatic stress disorder (PTSD) is recurring, intrusive recollections of an overwhelming traumatic event; recollections last > 1 mo and begin within 6 mo of the event. Acute stress disorder is a brief period of intrusive recollections occurring within 4 wk of witnessing or experiencing an overwhelming traumatic event. Retains various subtypes (depressed, anxiety, disturbed conduct, mixed) AD with duration more than 6 months without prolonged duration of stressor Subthreshold PTSD Persistent complex bereavement disorder Ataques nervios and other cultural symptoms (attack of nerves) Symptoms but not clinically significant for other areas.

31 Treatment Competencies Competency I: Integrated Diagnosis of Substance Use and Trauma (mental Disorders). Competency II: Integrated Assessment of Treatment Needs. Competency III: Integrated Treatment Planning. Competency IV: Engagement and Education. Competency V: Early Integrated Treatment Methods. Competency VI: Longer Term Integrated Treatment Methods.

32 Treatment Interventions and Trauma Informed Care

33 Trauma-Focused Interventions Trauma-focused" - treatment focuses on the memory of the traumatic event or its meaning. Involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. They usually last about 8-16 sessions. The trauma-focused psychotherapies with the strongest evidence are: Prolonged Exposure (PE) Teaches how to gain control by facing negative feelings. It involves talking about trauma with a therapist/counselor and doing some things that have been avoided since the trauma. Cognitive Processing Therapy (CPT) Teaches one to reframe negative thoughts about the trauma. It involves talking with a therapist/counselor about negative thoughts and completing short writing assignments. Eye-Movement Desensitization and Reprocessing (EMDR) Helps to process and make sense of one s trauma. Involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone). Seeking Safety (adults and adolescents) Helps people attain safety from trauma and/or substance abuse through manualized treatment

34 Trauma- Focused Interventions Trauma Recovery and Empowerment Model (TREM) Designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse. Drawing on cognitive restructuring, psychoeducational, and skillstraining techniques. Adolescent Community Reinforcement Approach (ACRA) An outpatient program for youths and young adults between the ages of 12 and 24 who have substance use and co-occurring mental health disorders. Trauma Systems Therapy A model of care for traumatized children that addresses both the individual child s emotional needs as well as the social environment in which he or she lives. Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS Manually-guided and empirically-supported group treatment designed to improve the emotional, social, academic, and behavioral functioning of adolescents exposed to chronic interpersonal trauma and/or separate types of trauma Trauma Focused (CBT)-Cognitive Behavioral Therapy Designed to help children and adolescents who experience symptoms of post-traumatic stress disorder (PTSD).

35 Trauma Informed Care and The three R s Trauma Informed Care is an organizational structure and treatment framework that involves addressing the effects of all types of trauma. What is a Trauma-Informed Service System? This system realizes, recognizes and responds to the impact of traumatic stress including children, caregivers, and service providers. These systems should: (1) routinely screen for trauma exposure and related symptoms; (2) use culturally appropriate evidence-based assessment and treatment; (3) make resources available on trauma exposure, its impact, and treatment; (4) engage to strengthen the resilience and protective factors to those vulnerable to trauma (5) address parent and caregiver trauma and its impact on the family system; (6) emphasize continuity of care and collaboration across child-service systems; and (7) maintain an environment for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff resilience.

36 Trauma-Informed Care Principles Safety: throughout the organization, staff and the people they serve feel physically and psychologically safe; Trustworthiness and transparency: organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members of people being served by the organization. Peer support and mutual self-help: are integral to the organizational and service delivery approach and are understood as a key vehicle for building trust, establishing safety, and empowerment. Collaboration and mutuality: there is true partnering and leveling of power differences between staff and clients and among organizational staff from direct care staff to administrators; there is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.

37 Trauma-Informed Care Principles Empowerment, voice and choice : Throughout the organization and among the clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary. The organization aims to strengthen the staff's, clients', and family members' experience of choice and recognize that every person's experience is unique and requires an individualized approach. This includes a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. This builds on what clients, staff, and communities have to offer, rather than responding to perceived deficits. Cultural, historical, and gender issues: the organization addresses cultural, historical, and gender issues; the organization actively moves past cultural stereotypes and biases (e.g. based on race, ethnicity, sexual orientation, age, geography, etc.), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.

38 Thank you!! Closing Questions/Comments Contact Information Brenden A. Hargett

39 Trauma screening Research projects focusing on the needs of