Priyanka Upadhyaya, Psy.D. Clinical Instructor, NYULMC . Psychologist- World Trade Center Health Program, Bellevue Hospital . Defining Trauma. Prevalence and Impact of Trauma. Understanding Addiction. ID: 750425
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Exploring the Intersection of Trauma and Addiction
Priyanka Upadhyaya, Psy.D
Clinical Instructor, NYULMC
Psychologist- World Trade Center Health Program, Bellevue HospitalSlide2
Prevalence and Impact of Trauma
Relationship between Trauma and AddictionTreatment ModelsTrauma Informed Care
Trauma comes from the Greek word meaning
hen is something traumatic? When our capacity to cope is overwhelmed or is inadequate.
It is more than the incident...it is the interpretation and perception of that experience as
What is Trauma?Slide4
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes individual trauma as resulting from
“an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”Slide5
“The world is neither safe nor predictable.”
It disrupts this ability to accurately read others, rendering the mechanism of threat detection defective - either too sensitive or less able to detect danger
The trauma survivor may become either less able to detect danger or more likely to misperceive danger where there is none.
How Does Trauma Impact a Person?Slide6
Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation: direct experiencing, witnessing
Avoidance of stimuli associated with the traumaCognitions and Mood: negative alterations Arousal and reactivity symptomsDuration of symptoms longer than 1 monthFunctional impairment due to disturbances DSM-5® Nutshell Definition of PTSDPosttraumatic Stress DisorderSlide7
Lifetime prevalence : 60% for Men & 50% for Women
About 80-90% of us have had a traumatic experience ( Sledjeski et al., 2008)
Estimates: 10-20% develop PTSD ( Norris & Sloane, 2007)Long term prevalence of PTSD 7-9% ( Kirkpatrick et al., 2013)Slide8Slide9
Two groups of substance-related disorders: Substance-use disorders
Criteria for Substance Use Disorders
Taking the substance in larger amounts or for longer than you're meant to.Wanting to cut down or stop using the substance but not managing to.Spending a lot of time getting, using, or recovering from use of the substance.Cravings and urges to use the substance.DSM-5: AddictionSlide11
Not managing to do what one should at work, home, or school because of substance use.
Continuing to use, even when it causes problems in relationships.
Giving up important social, occupational, or recreational activities because of substance use.
Using substances again and again, even when it puts a person in danger.Continuing to use, even when the person knows they have a physical or psychological problem that could have been caused or made worse by the substance.Needing more of the substance to get the effect they want (tolerance).Development of withdrawal symptoms, which can be relieved by taking more of the substance.DSM-5: AddictionSlide12Slide13
Co-morbidity: Trauma & Addiction
( Kessler et al., 1995)
National Co-morbidity Survey 199580% of those with PTSD meet criteria for at least 1 psychiatric disorder16% of them have one additional disorder17% have two other diagnosesNearly 50% have 3 or more disorders The most common disorder is Substance Use Disorders (SUDs), Anxiety & DepressionMen & Alcohol Abuse or Dependence - 52%Men & Drug Abuse or Dependence - 35%Women & Alcohol Abuse & Dependence - 28%Women & Drug Abuse or Dependence - 27%Slide14
Unclear and evolving
What do we know?
Self-medication hypothesis Addiction creates vulnerability for re-traumatizationSimilar brain regions are implicated in both Trauma and Addiction Stress and trauma create a vulnerability towards maladaptive coping The Relationship Between Trauma (PTSD) & AddictionSlide15
The Work of Trauma Treatment: Recovery & Healing
The challenge of recovery is to re-establish ownership of your body and your mind — of yourself.
This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed.
For most people this involves finding a way to become calm and focusedlearning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the pastfinding a way to be fully alive in the present and engaged with the people around younot having to keep secrets from yourself, including secrets about the ways that you have managed to survive (allowing for opportunities for validation)Reducing harm to oneself, in one’s environment and to healthSlide16
The Inherent Paradoxes of Trauma Treatment
Re-visit the trauma without sensory overload which in turn can re-traumatise
Reciprocity through social contact and connectedness
Feeling safe needs a visit to an unsafe and disturbing past - in mind, body and spiritSlide17
Incorporate and understanding of relationship between SUD and PTSD/trauma
The role of the addictive behavior in managing the trauma, its triggers and various manifestations
The origins of both in the traumatic past
The reality that recovering from either requires recovering from both Abstinence & Withdrawal - ripe ground for re-activation of trauma Vulnerability to relapse Confrontational approaches Systemic/Programmatic challenges - integration of treatment The Challenge of Trauma and SUDsSlide18
PE (Prolonged Exposure): In-vivo and imaginal
SIT (Stress Inoculation Training)
TREM (Trauma Recovery & Empowerment) STAIR (Skills Training in Affective & Interpersonal Regulation) EMDR (Eye Movement Desensitization Re-processing) Somatic Experiencing (Peter Levine)PTSD Treatment ApproachesSlide19
PTSD & SUDs: Integrative Treatment Models
Seeking Safety (Najavits, 1998): Women with co-occurring PTSD and SUDs.
ATRIUM Addictions & Trauma Recovery Integration Model (Miller & Guidry, 2001)
TARGET Trauma Affect Regulation: Guidelines for Education & TherapySlide20
Domains of change: Decreased symptoms of PTSD
Increased adherence in abstinence
Reduction in missed appointments
Motivational interviewing: powerful strategies for improving aftercare initiation & attending more treatment sessions Across models, PE, CBT, Psycho-education interventions, effects of treatment were maintained. TREM model: Improvement noted largely due to the development of trauma skills- Overall functioning PTSD symptoms, Reduction in use of ER services & HIV risk behaviors Decreased substance useTreatment EffectivenessSlide21
Before any clinician can engage in past-oriented trauma treatments focused on resolution, a set of coping skills must be in place.
Cultivation of recovery capital- social support systems
Therapeutic relationship elements and boundary setting are also imperativeDealing with ambivalence in addiction treatment - motivational interviewing Psycho-education Building emotional expertise: The role of emotion regulation Lifestyle changes Relapse prevention Guiding PrinciplesSlide22
Core components: Outreach & Engagement
Screening & Assessment
Parenting skillsResource linkage Advocacy Trauma specific clinical services Crisis interventionPeer facilitated services Lessons Learned: For the ProviderSlide23
Lessons for Systems: Trauma Informed Care
Trauma and addiction are systemic challenges and require a culture shift in treatment
Safety comes first
Cross training of staff - Trauma informed care Staff peer support, self care and supervision Mindfulness & breath work for staff and clients alikeIt’s unclear which may have have come first, but most likely trauma sets the biochemical stage for maladaptive coping, one of which is problematic substance use Trauma and addiction affect trust - building relationships and sustaining themSlide24Slide25Slide26
Websites: Resources for professionals on children, adolescents and adults
https://www.drugabuse.gov/https://www.hazeldenbettyford.org/https://www.integration.samhsa.gov/clinical-practice/traumaBooks: https://www.treatment-innovations.org/best-self---new-book.htmlTrauma services for women in Substance abuse treatment: An Integrated approach https://www.treatment-innovations.org/seeking-safety.htmls