Trauma & Addiction: Creating Safety for Clients in Dual Recovery Tracy Harvey, MSW, RSW Certified Clinical Traumatologist Alberta Health Services Addiction & Mental Health Lethbridge Area Office 1 DISCLOSURE There are no relevant financial relationships to disclose that would present a conflict of interest. 2 Although the world is full Of suffering, it is also full of the overcoming of it. Helen Keller 3
Objectives Re-Define Trauma from a Dual Recovery perspective Explore issues of safety in Dual Recovery Introduce guidelines to create safety in Dual Recovery 4 Understanding Trauma PTSD DESNOS DTD Symptoms in context 5 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. 6
Type 1 and Type 2 Trauma Type 1 One-time event Likelihood of good outcome (recovery) Type 2 On-going trauma Unaviodable Recovery more challenging 7 There were 100 disasters in Canada between 1991 and 1997 approximately 1.2 per month 68 were due to natural causes. Stats Canada 8 70% of Adults experience trauma 20% develop PTSD PTSD Alliance, 2004 90% of mental health clients experienced trauma Baranowsky, 2011 9
The most violent place in America Perry, 1995 10 Up to 50% all people who seek substance abuse treatment suffer PTSD A maltreated child is up to 12 times more likely to develop addiction van Der Kolk, 2003 11 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 12
Issues for Clients in Dual Recovery 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 13 Issues for Clients in Dual Recovery 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 14 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). 15
Therapeutic Process Therapeutic Alliance Safety Adapted from Oz, s. and Ogiers, SJ, 2006 W A L L OF F E A R 16 Creating Safety in Dual Recovery Education Assessment Collaboration Psycho education Skill development Respect 17 Essential aspects of treatment Works to prevent crisis by developing skills to manage feelings and memories Separates past from the present without minimization Recognizes behaviors as coping and offers strategies for creating new behaviors Identifies triggers and provides skills for grounding Highlights harm reduction approach On-going assessment for safety Trauma specific work where indicated 18
Let your heart guide you. It whispers, so listen closely. Molly Goode 19 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. 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. 20 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. 21
Websites www. ncptsd.org www.ptsdalliance.org www.sidran.org www.childtrauma.org www.trauma-pages.com www.traumacenter.org 22 EVALUATION Thank you for your participation. Due to technical difficulties a separate email will be sent to all participants with the evaluation link. If you require a Certificate of Attendance, please send an email within 30 days to concurrent.disorders@albertahealthservices.ca. Certificates can be expected one week to 10 days from your request date. 23