Women, Trauma and Addiction: Spirals of Recovery and Healing Stephanie S. Covington, PhD, LCSW Institute for Relational Development Center for Gender and Justice 7946 Ivanhoe Ave., Suite 201B La Jolla, CA 92037 (858) 454-8528 (858) 454-8598 FAX Email: sc@stephaniecovington.com www.stephaniecovington.com www.centerforgenderandjustice.org April 30, 2018 California WIC Association Annual Conference Plenary San Diego, CA
WOMEN, TRAUMA AND ADDICTION: SPIRALS OF RECOVERY AND HEALING April 30, 2018 California WIC Association Annual Conference Plenary San Diego, CA Stephanie S. Covington, PhD, LCSW Center for Gender and Justice La Jolla, CA WOMEN AND ADDICTION Historical Overview Victorian era Women s movement Cultural perspective Today 2 EVOLVING TREATMENT APPROACHES 3 Plenary WTA April 30, 2018 1
WOMEN S ISSUES: AN INTERNATIONAL PERSPECTIVE Shame and Stigma Physical and Sexual Abuse Relationship Issues fear of losing children fear of losing a partner needing partner s permission to obtain treatment 4 WOMEN S ISSUES: AN INTERNATIONAL PERSPECTIVE Treatment Issues lack of services for women not understanding treatment long waiting lists lack of childcare services Systemic Issues lack of financial resources lack of clean/sober housing poorly coordinated services 5 HELPING WOMEN RECOVER: A PROGRAM FOR TREATING ADDICTION Theory of Addiction Holistic health model Chronic neglect of self in favor of something or someone else Theory of Women s Psychological Development Relational Cultural Model (Stone Center) Theory of Trauma Three Stage Model (Herman) Upward Spiral A Transformational Model (Covington) 6 Plenary WTA April 30, 2018 2
Addiction 7 ADDICTION: A HOLISTIC HEALTH MODEL Physiological Emotional Social Spiritual Environmental Political 8 UPWARD SPIRAL Transformation Addiction (constriction) Recovery (expansion) 9 Plenary WTA April 30, 2018 3
Addiction: A pediatric-acquired disease 10 ADOLESCENCE & ALCOHOL Start drinking before age 14 47% alcohol dependent Start drinking after age 21 9% alcohol dependent (n=43,000) (Source: Archives of Pediatrics & Adolescent Medicine, July 2006) 11 RISK FACTORS FOR ADDICTION Genetic predisposition Traumatic or highly stressful childhood experiences Experiencing abuse and violence Early substance use Spending a lot of time around people who use alcohol or other drugs Poor coping mechanisms 12 Plenary WTA April 30, 2018 4
RISK FACTORS FOR ADDICTION (CONT.) High levels of stress Poor nutrition Chronic illness Grief and loss Inability to deal with difficult or painful feelings 13 14 Psychological Development 15 Plenary WTA April 30, 2018 5
RELATIONAL-CULTURAL THEORY Some women use drugs: To maintain a relationship To fill in the void of what s missing in a relationship To self-medicate the pain of abuse in relationships (Covington & Surrey, 1997) 16 ADDICTION AS A RELATIONSHIP Love Love-Hate 17 Trauma 18 Plenary WTA April 30, 2018 6
Trauma Gender Differences 19 GENDER AND ABUSE Childhood: Girls and boys at equal risk from family members and people they know Adolescence: Young men at risk from people who dislike or hate them. Boys at greater risk if they are gay, young men of color, gang members or transitioning. Young women at risk from lovers or partners people to whom they are saying, I love you. Adulthood: Men at risk from combat or being victims of crime Women at risk from those they love 20 DIFFERENCES IN RISK Worldwide, 1 in 4 women and 1 in 8 men experience psychological abuse from partner 38% of female homicides are committed by male partners, while 6% of male homicides are committed by female partners 1 in 5 women will be raped, while 1 in 71 men will be raped Transgender population is at greater risk and has a higher rate of abuse 21 Plenary WTA April 30, 2018 7
PROCESS OF TRAUMA Retreat Isolation Dissociation Depression Anxiety Traumatic Event Overwhelms the physical and psychological coping skills Response to Trauma Fight, flight, or freeze Altered state of consciousness, Body sensations, Numbing, Hypervigilance, Hyperarousal, Collapse Sensitized Nervous System Changes in the Brain Brain-Body Connection Psychological and Physical Distress Current stressors, Reminders of trauma (triggers) Sensations, Images, Behavior, Affect (emotions), Memory Emotional and/or Physical Responses Harmful Behavior to Self Substance use disorders Eating disorders Deliberate self-harm Suicidal actions Harmful Behavior to Others Aggression Violence Rages Threats Physical Health Issues Lung disease Heart disease Autoimmune disorders Obesity 22 PROCESS OF TRAUMA (CONT.) Traumatic Event Overwhelms the physical and psychological coping skills Response to Trauma Fight, Flight or Freeze Altered state of consciousness, Body sensations, Numbing, Hyper-vigilance, Hyper-arousal, Collapse Sensitized Nervous System Changes in the Brain Brain Body Connection 23 PROCESS OF TRAUMA (CONT.) Psychological and Physical Distress Current stressors, Reminders of trauma (triggers) Sensations, Images, Behavior, Emotions, Memory Emotional and/or Physical Responses Retreat Isolation Dissociation Depression Anxiety Harmful Behavior to Self Substance use disorders Eating disorders Deliberate selfharm Suicidal actions Harmful Behavior to Others Aggression Violence Rages Threats Physical Health Issues Lung disease Heart disease Autoimmune disorders Obesity 24 Plenary WTA April 30, 2018 8
ACE STUDY (ADVERSE CHILDHOOD EXPERIENCES) Before age 18: 1. Recurrent and severe emotional abuse 2. Recurrent and severe physical abuse 3. Contact sexual abuse 4. Emotional neglect 5. Physical neglect 25 ACE STUDY (ADVERSE CHILDHOOD EXPERIENCES) Growing up in a household with: 6. Both biological parents not being present 7. Your mother being treated violently 8. An alcoholic or drug-user 9. A mentally ill, chronically depressed, or family member attempting suicide 10. A family member being imprisoned (N = 17,000) 26 ACE STUDY (ADVERSE CHILDHOOD EXPERIENCES) Results ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity (Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE). 27 Plenary WTA April 30, 2018 9
HIGHER ACE SCORE CHRONIC HEALTH CONDITIONS Heart disease Autoimmune diseases Lung cancer Pulmonary disease Liver disease Skeletal fractures Sexually transmitted infections HIV/AIDS 28 ACE STUDY Women 50% more likely than men to have a score of 5 or more. (Felitti & Anda, 2010) 29 ACE SCORES AND IMPACT Adverse childhood experiences are underlying factors for: Chronic depression Suicide attempts Serious and persistent mental health challenges Addictions Victimization of rape and domestic violence 30 Plenary WTA April 30, 2018 10
LINK BETWEEN CHILDHOOD TRAUMA AND SCHOOL Those with ACE score of 4 or more are more likely to have learning or behavioral problems in school (51%) than those with an ACE score of 0 (3%). (David Brooks. The Psych Approach. New York Times, Sept 2012) 31 GENDER-RESPONSIVE TREATMENT Creating an environment through: site selection staff selection program development content and material that reflects an understanding of the realities of the lives of women and girls, and addresses and responds to their strengths and challenges. (S. Covington Women and Addiction: A Trauma-Informed Approach. Journal of Psychoactive Drugs, SARC Supplement 5, November 2008, 377-385.) 32 GUIDING PRINCIPLES FOR GENDER-RESPONSIVE SERVICES Gender Environment Relationships Integrated Services Economic & Social Status Community 33 Plenary WTA April 30, 2018 11
GUIDING PRINCIPLES Gender: Acknowledge that gender makes a difference. Environment: Create an environment based on safety, respect, and dignity. 34 GUIDING PRINCIPLES (CONT.) Relationships: Develop policies, practices, and programs that are relational and promote healthy connections to children, family, significant others, and the community. Services: Address substance abuse, trauma, and mental health issues through comprehensive, integrated, and culturally relevant services. 35 GUIDING PRINCIPLES (CONT.) Socioeconomic status: Provide women with opportunities to improve their socioeconomic conditions. Community: Establish a system of comprehensive and collaborative community services. (Bloom, Owen, Covington 2003) 36 Plenary WTA April 30, 2018 12
TRAUMA-INFORMED SERVICES These are services that are provided for problems other than trauma but require knowledge about violence against women and the impact of trauma thereby increasing their effectiveness. 37 CORE VALUES OF TRAUMA-RESPONSIVE SERVICES Safety (physical and emotional) Trustworthiness Choice Collaboration Empowerment (Fallot & Harris, 2006) 38 CORE VALUES OF TRAUMA-RESPONSIVE SERVICES Safety: Eye contact; consistency; explanations; procedure to report abuse Trustworthiness: Following through; model trust; maintaining appropriate boundaries; and making tasks clear Choice: Emphasizing individual choice and control; informed consent 39 Plenary WTA April 30, 2018 13
CORE VALUES OF TRAUMA-RESPONSIVE SERVICES Collaboration: Empowerment: Solicit input; acknowledge insights about herself; explain options Teaching skills; provide tasks where she can succeed 40 Mental Illness Addiction HIV/ AIDS Other Health Problems Trauma (Vivian Brown, Ph.D.) Homelessness 41 LEVEL OF BURDEN Burden defined as the total number of problem conditions: Use of alcohol and/or other drugs Homeless Co-occurring mental health problem Significant health disorder HIV/AIDS Cognitive impairment History of childhood or adult abuse (Vivian Brown, Ph.D.) 42 Plenary WTA April 30, 2018 14
GENDER-RESPONSIVE MATERIALS WOMEN AND GIRLS Helping Women Recover Beyond Trauma: A Healing Journey for Women Healing Trauma: A Brief Intervention for Women A Woman s Way through The Twelve Steps Beyond Violence Beyond Anger and Violence Women in Recovery Voices: A Program of Self-Discovery and Empowerment for Girls 43 GENDER-RESPONSIVE MATERIALS MEN AND BOYS Helping Men Recover Exploring Trauma: A Brief Intervention for Men A Young Man s Guide to Self-Mastery (2019) 44 GENDER-RESPONSIVE MATERIALS STAFF Moving from Trauma-Informed to Trauma-Responsive Becoming Trauma Informed (criminal justice) The Trauma-Informed Effective Reinforcement (TIER) System Women and Addiction: A Gender-Responsive Approach 45 Plenary WTA April 30, 2018 15
CHANGING THE QUESTION What is wrong with her to What has happened to her? 46 BRIEF CONVERSATION Normalize Help is available Some coping exercises 47 UPWARD SPIRAL Transformation Addiction and Trauma (constriction) Recovery and Healing (expansion) 48 Plenary WTA April 30, 2018 16
About your presenter. Dr. Stephanie S. Covington is an internationally recognized clinician, author, organizational consultant, and lecturer. She is a pioneer in the field of women s issues, addiction, trauma and recovery. She has developed an innovative, gender-responsive, and trauma-informed approach that results in effective services in public, private, and institutional settings. Her presentations, staff-development seminars, and technical assistance focus on systems change and the development of caring, compassionate, and empowering therapeutic environments. They provide professionals an opportunity to learn new skills for dealing with personal, institutional, and societal changes and are always in demand, both nationally and internationally. Dr. Covington s clients include the Betty Ford Treatment Center, the Hanley Center, CeDAR (Center for Dependency, Addiction & Rehabilitation), the United Nations Office on Drugs and Crime, the Center for Substance Abuse Treatment in Washington, D.C., the California Department of Corrections and Rehabilitation, and numerous other treatment and correctional settings. Dr. Covington was a workshop chair for the women s treatment improvement protocol (TIP) published by SAMHSA. She is also the co-author of a three-year research project, Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders, for the National Institute of Corrections. This publication received the University of Cincinnati Award for its outstanding contribution to the field of corrections in the U.S. and Canada. Educated at Columbia University and the Union Institute, Dr. Covington has served on the faculties of the University of Southern California, San Diego State University, and the California School of Professional Psychology, and she is a former chair of the Women's Committee of the International Council on Alcoholism and Addiction. She is a board-certified Diplomate of the National Association of Social Workers and the American Board of Sexology and is a member of the American Association of Marriage and Family Therapy and the American Psychological Association. She has also served on the Advisory Council for Women s Services for the federal agency SAMHSA. She was the featured consultant and therapist on the Oprah Winfrey Network docu-reality show entitled Breaking Down the Bars. Dr. Covington is based in La Jolla, California, where she is co-director of the Institute for Relational Development and the Center for Gender and Justice, which seeks to expand gender-responsive policies and practices for females who are under criminal justice supervision. Among the many articles and books written by Dr. Covington are: Women and Addiction: A Gender-Responsive Approach Awakening Your Sexuality: A Guide for Recovering Women Leaving the Enchanted Forest: The Path from Relationship Addiction to Intimacy She has also published gender-responsive and trauma-informed program materials. The following curricula include training manuals for professionals and complementary materials for participants: Helping Women Recover: A Program for Treating Addiction (with a special edition for the criminal justice system) Beyond Trauma: A Healing Journey for Women Voices: A Program of Self-Discovery and Empowerment for Girls A Woman s Way through The Twelve Steps Beyond Violence: A Prevention Program for Criminal Justice-Involved Women Beyond Anger & Violence: A Program for Women Becoming Trauma Informed: A Training Program for Correctional Professionals (USA, Canadian, and UK versions) Healing Trauma: A Brief Intervention for Women (co-authored with Eileen Russo) Helping Men Recover (co-authored; also with a special edition for the justice system) Exploring Trauma: A Brief Intervention for Men (co-authored with Roberto Rodriquez) For a list of Dr. Covington s recent articles, and descriptions of her current seminars for professionals, visit: www.stephaniecovington.com and www.centerforgenderandjustice.org. About Your Presenter February 2018