Trauma & Addiction: Impact on Individuals and Families - PowerPoint Presentation

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Trauma & Addiction: Impact on Individuals and Families

By Jill Perry, MS, NCC, LPC, CAADC, SAP

November 9, 2017Slide2

What is Trauma?

An experience, or collection of experiences, that are out of the ordinary and cause a person to struggle to accept it and move on.

Extraordinary events happening to ordinary people and causing them to get stuck.Slide3

What is Trauma?

Greek translation = WOUNDSlide4

What is Trauma?

Wounds come in all shapes and sizes

Body has natural resources for healing wounds IF surrounded by right circumstancesSlide5

What is Trauma?

Different wounds effect people in different ways

Wound healing area may look different when healedSlide6

What is Trauma?

Wounds are usually obtained quickly but take time to heal thoroughly

If wounds are left untreated, they can impact others around them tooSlide7

What is Trauma?

Post-traumatic Stress Disorder (PTSD) in a nutshell

Exposure to actual or threatened death, serious injury or sexual violation; direct experiencing, witnessing

Intrusion

symptoms (flashbacks, panic, freeze response)

Avoidance

of the stimuli associated with the trauma (isolation, freeze response, phobias, addiction)

Cognitions and Mood

: negative alterations (“the world is bad/dangerous”)Slide8

What is Trauma?

Post-traumatic Stress Disorder (PTSD) in a nutshell

Arousal and reactivity

symptoms (hypervigilance, increased startle response, irritability , anger,

wrecklessness

, self-destructiveness, sleep and concentration problems

Duration of symptoms longer than 1 month

Functional impairment due to disturbancesSlide9

What is Trauma?

Trauma & Stress Related Disorders

Reactive Attachment Disorder

Disinhibited Social Engagement Disorder

Acute Stress Disorder

Adjustment DisordersSlide10

We haven’t had a chance since birth!Slide11

How We Process Information

The neurobiological processing system is intrinsic, physical and adaptive (we are hard-wired to process)

Geared to integrate internal and external experiences

Memories are stored in associative memory networks and are the basis of perception, attitude and behavior (what’s passed is present)

Experiences are translated into physically stored memories

Stored memory experiences are contributors to pathology and to healthSlide12

How We Process Information

Trauma causes a disruption which results in unprocessed information being

dysfunctionally

held in memory networks (gets in the way of the natural flow)

New experiences link into previously stored memories which are the basis of interpretations, feelings and behaviors (file folders)

If too difficult, they may be stored in the implicit/non-declarative memory system (subconscious, emotional “downstairs” brain)

These memory networks are stored in a way that does not allow them to connect with routine processing system Slide13

Trauma & Addiction: Which Comes First?

Behaviors to help a trauma feel “better” or “numb” may be maladaptive (drugs, video games, sex,

etc

)Slide14

Trauma & Addiction: Which Comes First?

The Culture of addiction includes on-going trauma for individuals and their familiesSlide15

Trauma & Addiction

Military veterans with PTSD reported using alcohol to specifically cope with re-experiencing and hyperarousal symptoms which result in the development of an alcohol use disorder

Alcohol abuse impedes recovery and even worsens symptoms of posttraumatic healing

Substance-dependent individuals with co-occurring PTSD relapsed more quickly than those without PTSDSlide16

Trauma & Addiction

Between 55 and 99 percent of

women

in substance abuse treatment have had traumatic experiences, typically childhood physical or sexual abuse, domestic violence, or rape

Of these, between 33 and 59 percent have been found to be experiencing current PTSDSlide17

Trauma & Addiction

Greater violence leads to more serious substance abuse and other addictions along with higher rates of depression, self mutilation, and suicidal impulses among women

Addiction places women at higher risk of future trauma, through their associations with dangerous people and lowered self-protection when using substancesSlide18

Trauma & Addiction

Pre-existing alcohol misuse contributes to posttraumatic psychiatric maladjustment in Veterans

Problematic drinking prior to the traumatic combat experience may be a risk factor for some soldiers to exhibit PTSD symptoms following combat exposure.

PTSD symptoms, but not combat exposure, significantly predicted problematic drinking outcomesSlide19

Trauma & Addiction

Teens who use marijuana have 8 times higher rate of suicidal ideation than non-marijuana users and a 16% times higher rate of suicide attempts

.Slide20

Trauma & Addiction

People who inject drugs have a 14X greater risk for suicide

JP Counseling

Healing for Adults, Youth and FamiliesSlide21

Trauma & Addiction

Abuse of alcohol and/or drugs is a major risk factor in suicide

Alcohol is associated with 25-50% of all suicides

Between 5-27% of all deaths of people who abuse alcohol are caused by suicide

Lifetime risk for suicide among people who abuse alcohol is 15%Slide22

Trauma & Addiction

The relationship between alcohol misuse and (traumatic brain injury) TBI often is complex because heavy drinking may predate and predispose individuals to experiencing a TBI (i.e., TBI can result from accidents that occur when people are under the influence of alcohol)

Alcohol misuse can exacerbate the complications of TBI by worsening TBI symptom severity (e.g., persistent memory problems) and by further increasing an individual’s risk for experiencing additional alcohol-related TBI eventsSlide23

Trauma & Addiction

Of Veterans in VA health care with co-occurring PTSD and substance use disorders (SUD), cannabis use disorder has been the most diagnosed SUD since 2009.

The percentage of Veterans in VA with PTSD and SUD who were diagnosed with cannabis use disorder increased from 13.0% in 2002 to 22.7% 2014.

As of 2014, there are more than 40,000 Veterans with PTSD and SUD seen in VA diagnosed with cannabis use disorder Slide24

Family DynamicsSlide25

Three Approaches of Family Therapy 

The old-style paradigm

 believes that something wrong in the family produced the substance use disorder. In other words,

the family caused it.

The second paradigm

 focuses on

risk and protective factors

by working with families to reduce the risk factors and increase the protective factors. Slide26

Three Approaches of Family Therapy

The third paradigm of family therapy

takes a

multisystemic

or multidimensional perspective in the therapeutic process. Therapy includes all family members and possibly peers or other significant loved ones. In effect,

the family or the group is the patient

. Slide27

Family Systems Theory

When there is a change in any individual member of the family, others in the family system are impacted.

Families are seen as organisms that continuously change and reconstitute themselves.

JP Counseling

Healing for Adults, Youth and FamiliesSlide28

JP Counseling

Healing for Adults, Youth and FamiliesSlide29

Addiction is a Family Disease

Denial

Justification

Co-dependence

SecretsSlide30

How Families Get Stuck

Denying there is a problem

Minimizing the problem

Avoiding discussions about the problem

Blaming others or lashing out with anger

Joining in the rationalizations/justifications of the problemSlide31

How Families Get Stuck

Taking over responsibilities

Continuing to provide financial support

Helping to resolve legal problems

Promising unrealistic rewards for abstinenceSlide32

How Families Get Stuck

Threatening to kick them out and not following through with the boundaries set

Provoking arguments/nagging

Avoiding getting help for themselves

JP Counseling

Healing for Adults, Youth and FamiliesSlide33
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Engage the Family

Motivation and Involvement in Treatment

Regardless of internal or external motivation

Improve Interactions Among Family Members

All family relationships change with addiction

Help family members appreciate how the values and perspectives of each family member may differ from their own, but that differences do not have to be a source of conflict

Improve Outcomes

Bolster the family members' self-confidence and at the same time help them improve their boundaries

Allow Healing for All

JP Counseling

Healing for Adults, Youth and FamiliesSlide36

Engage the Family

Primary relationships in the client’s life can have the most benefit for them before and during the recovery period.

Working together with loved ones to rebuild relationships damaged during active addiction can play a significant role in recovery, especially if the client will be returning home to live with family members after treatment.

Empowering family members to connect with treatment can allow them to heal in their own ways.

JP Counseling

Healing for Adults, Youth and FamiliesSlide37

Engage the Family

Family members often can quickly cut through to the reality of a situation.

Open and improved communications can often eliminate the family secrets that have enabled the client to continue keep from making positive changes.

JP Counseling

Healing for Adults, Youth and FamiliesSlide38

Working with People with Trauma

In screening for a history of trauma or in obtaining a preliminary symptoms of post-traumatic stress,

it can be damaging to ask the client to describe traumatic events in detail.

This is true for individuals and family members.Slide39

To screen, it is important to limit questioning to very brief and general questions:

“Have you ever experienced childhood physical abuse?

Have you ever experienced sexual abuse?

Have you ever experienced a serious accident?

JP Counseling

Healing for Adults, Youth and FamiliesSlide40

To screen, it is important to limit questioning to very brief and general questions:

Have you ever experienced violence or the threat of it?

Have there been experiences in your life that were so traumatic they left you unable to cope with day-to-day life?

Is there anything else significant in your life that you think I should know?Slide41

After an Overdose

Family members may feel:

Guilt over things that they could have or should have done to prevent the loss

Guilt that the person suffered and caused others to suffer

Guilt over relief that the addiction is over

Obsession over what the person could have done differently to support the personSlide42

After an Overdose

Family members may feel:

Shame the their loved one suffered from addiction

Shame for enabling them

Shame for not doing enough to help

Shame for the person who diedSlide43

After an Overdose

Family members may feel:

Blame against those who used with the person who died

Self-blame for the person being addicted

Self-blame for the death

Blame toward the person who died for their death

Blame toward family members for not preventing the death

Obsession over actions done/not done to support the personSlide44

After an Overdose

Family members may feel:

Fear that others will start using

Fear that others who are using will overdose

Fear that those in recovery will relapseSlide45

Working with People with Trauma

Healing from the INSIDE OUT

Stabilization from the OUTSIDE INSlide46

Working with People with Trauma

6 Key Principles:

Safety

Trustworthiness and Transparency

Peer support

Collaboration and mutuality

Empowerment, voice and choice

Cultural, Historical, and Gender IssuesSlide47

Working with People with Trauma

Recognize the individual’s or family’s need to be respected, informed, connected, and hopeful regarding their own recovery

Recognize the interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety

Recognize the need to work in a collaborative way with individuals, family and friends of the survivor, and other human services agencies in a manner that will empower peopleSlide48

Working with People with Trauma

We need to explain in detail

over and over again

the following foundation concepts:

WHY sobriety is a prerequisite for safety and self-care

HOW substances which were once life-saving have become so dangerous

WHY having an addiction recovery program is essential in the battle against impulsivity and the “quick fix”

HOW the mind-altering properties of drugs now impair the ability to recover from the trauma

HOW the trauma symptoms equally impair the ability to stay clean and soberSlide49

Working with People with Trauma

• Knowledge is Power: use psychoeducation to facilitate mindful, nonjudgmental attention to symptoms and behavior

• Boring them into health: with mindful attention to any breaks in safety and self-care

• Re-framing symptoms and behavior, no matter how impulsive and self-destructive, in such a way that they can be “owned” and thus integrated with constructive, wise and thoughtful states of mind

• Remembering is Not Recovering”: keeping that the goal of “trauma work” is not to remember what happened but to be able to live today and to tolerate the ups and downs of a normal life in spite of what has happenedSlide50

MYTH: Since most adolescents who use drugs and/or alcohol have experienced some kind of trauma, there is no need to treat trauma as a unique clinical entity.

FACT: Although not all youth who experience traumatic events develop PTSD, it is important to be prepared to address the multiple ways youth respond to trauma. Traumatic stress and PTSD are associated with unique (and challenging) symptoms that require targeted, trauma-informed treatment to optimize recovery. Effective treatment approaches and interventions have already been developed for patients suffering from traumatic stress and PTSD. Making use of these techniques as part of a comprehensive treatment plan offers the greatest hope of treatment success for adolescents dealing with the effects of substance abuse and traumatic stress.

MYTH: When dealing with an adolescent who has a history of trauma and substance abuse, you need to treat one set of problems at a time.

FACT: Because the symptoms associated with traumatic stress and substance abuse are so strongly linked, the ideal treatment approach is to address both conditions. Unfortunately it is not uncommon for substance abuse programs to deny admission to patients with PTSD, and for trauma treatment programs to deny admission to patients who have not achieved sobriety. The decision about which symptoms and behaviors to address first therefore requires a careful assessment of the relative threat that each condition poses to a youth’s safety, health, and immediate well-beingSlide51

Working with People with Trauma

TRUE or FALSE:

Since most people who use drugs and/or alcohol have experienced some kind of trauma, there is no need to treat trauma as a unique clinical entity. Slide52

Working with People with Trauma

TRUE or FALSE:

When dealing with an individual or family with a history of trauma and substance abuse, you need to treat one set of problems at a time. Slide53

Occupational RisksSlide54
Slide55

Where Do the Stories Go at the

End of the Day?Slide56

Occupational Risks

Charles

Figley

(1995) suggests that work with clients who have suffered traumatic experience has specific occupational health risks: ‘…there is a cost to caring…the most effective therapists are most vulnerable to this contagion effect…those who have enormous capacity for feeling and expressing empathy tend to be more at risk of compassion stress…’ 

Are our inner reserve infinite?Slide57

Occupational Risks

Empirical research attests to the negative toll exacted by being a caregiver.

The literature points to

Depression

Mild anxiety

Emotional exhaustion

Disrupted relationshipsSlide58

The ABC’s of Prevention of

Compassion

Fatique

A = Awareness

B = Balance

C = ConnectionsSlide59

Even Mother Teresa Understood Compassion

Fatique

She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.Slide60

B = Balance In Your Life

Emotions are a signal that tell us when something is wrong or we are out of balance

We all need meaning and purpose in our life

We all need autonomy and freedom to make choices that bring us balance and happiness

We all have hidden sources of energy and healing power. Slide61

C = Connections

Talk out your stress- process your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family, supervisor)

Build a positive support system that supports you, not fuels your stressSlide62

Self-Compassion QuizSlide63

“Hope does not take away your problems. It can lift you above them.”

--Maya Angelou