Trauma informed care Prof. Edward Ogden PSM
Who Gets PTSD? It depends on: Severity Duration Proximity PTSD is mitigated or worsened by: Childhood experience Personality characteristics Family history Social support
Prevalence of PTSD More men (61%) than women (51%) experience a trauma at some point in their lives, but women experience PTSD at twice the rate of men (10% vs. 5%) Kessler, Ronald C., Amanda Sonnega, Evelyn Bromet, Michael Hughes, and Christopher B. Nelson. "Posttraumatic stress disorder in the National Comorbidity Survey." Archives of general psychiatry 52, no. 12 (1995): 1048-1060. Tolin, David F., and Edna B. Foa. "Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research." Psychological bulletin 132, no. 6 (2006): 959.
LaCoursiere, R. B., Godfrey, K. E., & Ruby, L. M. (1980). Traumatic neurosis in the etiology of alcoholism: Viet Nam combat and other trauma. The American Journal of Psychiatry, 137, 966 968. Day/Month/Year Footnote to go here Page 4
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>20% of veterans with PTSD also have SUD. War Veterans with PTSD tend to be binge drinkers in response to bad memories of combat trauma. ~30 % of veterans seeking treatment for SUD have PTSD. Smoking is almost double for those with PTSD (60%) ~10% of returning soldiers for Afghanistan and Iraq have SUD https://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp Day/Month/Year Footnote to go here Page 6
Examined the health records of 565,024 veterans 48% of returned service personnel 2001 2009 11% substance use disorder 10% alcohol 5% drugs 3% both 75% had PTSD and/or depression 16% had a mental health diagnosis Day/Month/Year Footnote to go here Page 7
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432 patients with SUD 158 had PTSD (36.6%) I drank to stop my negative feelings and to not be burdened by them. I don t allow myself to feel anything and I use alcohol as a means to get rid of my feelings. When I use, I think about nothing, not about the negative things, the things that happened, the memories At that moment, I feel great! But it only lasts for a short time and I feel depressed when it s over. all the patients reported self-medicating behavior and craving after trauma intrusions. They declared that coping motives were the most important reasons they used substances and that relapse often happened when they perceived no other means of coping with a difficult situation. Day/Month/Year Footnote to go here Page 9
At baseline, almost 95% of the sample (n=126) reported a trauma history 41% (n=55) met criteria for current PTSD. women 50%, n=34 men 32%, n=21 Unremitted PTSD is a prognostic indicator for deleterious SUD outcome Day/Month/Year Footnote to go here Page 10
Trauma informed care Practice Realises the impact of trauma & Principles Understands the paths to recovery Recognises the signs of trauma in clients, families, staff and others Responds by integrating knowledge into practice and policy Resists re-truamatisation Day/Month/Year Footnote to go here Page 11
Resources The Trauma Recovery Group: A Guide for Practitioners (2011), Michaela Mendelsohn, Judith Herman, Emily Schatzow, and Diya Kallivayalil Seeking Safety (1998), Lisa Najavits http://www.seekingsafety.org Trauma Focused-Cognitive Behavioral Therapy : http://tfcbt.musc.edu International Society for Traumatic Stress Studies: http://www.istss.org http://www.motivationalinterview.org/ clinical/metdrugabuse.pdf Motivational Enhancement Therapy Manual (1994), NIH Pub. No. 94-3723. Order from http://pubs.niaaa.nih.gov/publications/ match.htm. Self-assessment Mental Health screening http://www.militarymentalhealth.org/ Computer-based Problem-solving therapy http://startmovingforward.t2.health.mil/ Wellness resources http://afterdeployment.t2.health.mil/
Self-Help Mobile Applications http://www.t2health.org/mobile-apps PTSD Coach T2 MoodTracker Breathe 2 Relax Tactical Breather LifeArmor (includes family section)
Self-Help Mobile Applications http://www.militarymentalhealth.org/ articles/media/ Virtual Hope Box Positive Activity Jackpot Provider Resilience