Trauma & Addiction: Creating Safety for Clients in Dual Tracy Harvey, MSW, RSW Alberta Health Services Addiction Services March 12, 2009 Although the world is full Of suffering, it is also full of the overcoming of it. Helen Keller 2 Objectives Re-Define Trauma from a Dual perspective Explore issues of safety in Dual Introduce guidelines to create safety in Dual 3 1
Non-diagnostic Definition of Trauma An actual or perceived event or experience that compromises one s physical, mental, spiritual or emotional sense of security. A traumatic experience may include a number of emotions and a wide variance of intensity level. A number of protective and risk factors along with the type of trauma, intensity of risk, and emotion around the event will influence the response one may have to the event or experience. 4 Connection Between Trauma and Addiction Rates of sexual abuse in general population are identified as 15 30%, in the addict population the rates are as high as 85% Najavits, 2002 Addicted women have higher rates of intimate partner violence (87% vs 28%) Downs, Miller, and Panek, 1993 5 Connection Between Trauma and Addiction After a significant flood in West Virginia, alcohol consumption increased by 30% PTSD significantly increases the risk for addiction issues Stewart, 1996 6 2
Issues for Clients in Dual Symptoms are often masked by either the trauma or addiction Both trauma and addiction are prone to minimization Tendency to become overwhelmed or disorganized Reliance on substances to contain trauma symptoms 7 Issues for Clients in Dual Lack of ability to create healthy boundaries Tendency to engage in self-destructive behaviors Typical treatments for addictions may not be appropriate (12 step) Difficulty in distinguishing am safe vs feel safe 8 Challenges for Therapists Failure to appropriately address the impact of clients trauma histories has been cited as one factor that may contribute to relapse Evans and Sullivan, 1995 Studies show that therapist confidence and knowledge prevents assessment and referral for trauma survivors Hanson, Hesselbrock, Tworkowski and Swan (2002) and Slayers, Evans, Bond, and Meyer (2004). 9 3
Therapeutic Process Therapeutic Alliance Safety Adapted from Oz, s. and Ogiers, SJ, 2006 W A L L OF F E A R 10 Education Creating Safety in Dual Assessment Collaboration Psycho education Skill development Respect 11 Let your heart guide you. It whispers, so listen closely. Molly Goode 12 4
Resources Briere, J., and Scott, C. (2006). Principles of Trauma Therapy; A guide to symptoms, evaluation, and treatment. California; Sage Publications. Dayton, T. (2000). Trauma and Addiction: Ending the Cycle of Pain Through Emotional Literacy. Florida: Health Communications Inc. Downs, W., Miller, B., and Panek, D. (1993). Differential patterns of partner to woman violence: A comparison of samples of community, alcohol-abusing and battered women. Journal of Family Violence 8, 113-135. 13 Resources Evans, K., and Sullivan, M. (1995). Treating the Addicted Survivors of Trauma. New York: The Guilford Press. Hanson, T., Hesselbrock, M., Tworkowski, S., and Swan, S. (2002). The prevalence and management of trauma in the public domain: an agency and clinician perspective. The Journal of Behavioral Health Services & Research, 29 (4), 365-380. Haskell, L. (2003). First Stage Trauma Treatment; A guide for mental health professionals working with women. Canada; Centre for Addiction and Mental Health. 14 Resources Najavits, (2002). Seeking Safety; A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press. Slayers, M., Evans, L., Bond, G., Meyer, P. (2004). Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives. Community Mental Health Journal, 40 (1), 83-112. Stewart, S. (1996). Alcohol abuse in individuals exposed to trauma: a critical review. Psychological Bulletin, 120 (1), 83-112. Oz, s. Ogiers, SJ. (2006). Overcoming Childhood Sexual Trauma. New York: Howorth Press. 15 5
Questions/Discussion 16 Thank you for your participation For information about Telemental Health education sessions: (403) 783-7736 www.amhb.ab.ca Initiatives Telemental Health Current Telelearning Sessions 17 6