Trauma and Substance Abuse An Introduction to Trauma-Informed Care

1. Trauma and Substance Abuse An Introduction to Trauma-Informed Care Hoyt Roberson, MC, MS Licensed Marriage and Family Therapist Presbyterian Medical Services 505-962-6642 (O) 505-321-5115 (C) hoyt_roberson@pmsnet.org

2. Trauma is…. • Extreme stress that overwhelms a person’s ability to cope. • Develops intra-personally. • May result in feelings or thoughts of • Vulnerability • Helplessness • Fear • Self-blame • Grief • Re-experiencing, Avoidance/Numbing, Hyperarousal, Negative Cognitions

3. Trauma does not necessarily result in PTSD • A minority of survivors develop clinically diagnosable PTSD • Being below clinical thresholds • Does not mean the absence of significant symptoms • May result in reduced services • May result in greater stigma

4. Indicators of greater risk for PTSD • Multiple traumas • Little or no social/familial support • Type of trauma • Accidental or intentional • Childhood abuse • Female • Presence of other mental health issues • Individual’s interpretation of the event

5. An experience of significant trauma or multiple experiences of trauma, may affect the individual’s view of, and understanding of • Themselves • The “world” • The reliability or safety of others • Their religious beliefs

6. Adverse Childhood Experiences Study • Childhood abuse and neglect are intimately correlated with adult mental and physical health issues. • The affects of childhood abuse and neglect continue through generations unless interdicted.

7. Neurosequential Development Theory • Dr. Bruce Perry • The brain develops in stages which create vulnerable or critical windows of development • Interference with brain development within those time windows adversely affects functional development of the brain • Abilities and functions are diminished • Will affect the person across their lifetime • Results in behavioral, cognitive, and emotional impairments

8. Prevalence of Trauma • 25% of children and adolescents experience at least one potentially traumatic event before the age of 16. • 13% of 17 year olds have experienced PTSD at some point in their lives. • Up to 59% of young people with PTSD develop substance abuse problems • 75% of Americans will experience a traumatic event in their lifetime • 25% of women in NM sexually assaulted • Trauma is ubiquitous in the United States

9. Results of Trauma • Emotional difficulties • Cognitive difficulties and distortions • Social impairments and difficulties • Ability to handle transitions and change • Interference with developmental momentum

10. Results of Trauma • Trauma memories and negative self-talk/image are often key in maintaining symptoms. • Avoidance of memories and self image issues results in continued symptoms and lack of treatment. • Instead of treatment, self-medication with substance is often the coping strategy selected.

11. Results of Trauma • 20% of veterans with PTSD also have SUD • 30% of veterans with SUD also have PTSD • 48% rates in some studies of SUD have PTSD • SUD + PTSD have higher comorbid mental health issues

13. We Used to Think Substance Abuse Mental Illness Trauma

14. Now We Know Trauma Substance Abuse Mental Illness

15. Recovery From Trauma • Judith Herman • Safety • Mourning • Reconnecting • Neurosequential Development Theory • Re-form or repair lost abilities • In the order of natural development • Treat both trauma and substance use • Address behavioral, cognitive, and interpersonal deficits

16. Treating Trauma • Front line or evidence-based treatments • Prolonged Exposure • Cognitive Processing Therapy • EMDR • Seeking Safety • Various forms of CBT for adults • Trauma-focused CBT • Medication • Alternative or complementary treatments • Accupuncture, massage, biofeedback, Yoga • Pastoral counseling

17. Trauma-Informed Care • Moved from “what’s wrong with you?” to “what happened to you?” • Involves an entire agency and systems of care. • Integrated treatment • Behavioral Health/Substance Abuse • Behavioral Health/Primary Care • Both trauma-informed and trauma-competent

18. What Can You Do? • Identify an agency champion for trauma-informed care • Use a consultant • Complete an agency assessment • Develop a plan to train, orient, and update • Know what works • Insist on competence and follow-through • Care for staff • Celebrate successes

19. What Can You Do? • Get trained in trauma-informed care • Get trained in trauma interventions • Join a learning team or community

20. What Can We Do? • Make trauma-informed care a priority throughout our systems • Develop networks for warm hand-offs and treatment of clients • Implement programs to intercept and eliminate generational transmission of trauma and substance abuse • Use programs that work • Expect staff to be informed and competent

21. What Can We Do? • Provide training • Motivational Interviewing • Seeking Safety • Prolonged Exposure • Cognitive Processing Therapy • Trauma-focused CBT • Support and encourage learning teams and communities

22. Veteran and Family Support Services • Originally a veteran and family program • Developed a trauma-competent staff • Behavioral health, substance abuse, case management, and medication management • Trauma-informed lagged

23. Veteran and Family Support Services • Clients (VFSS, Jail Diversion, Mental Health Court, and Drug Court) are provided the full range of services we provide. • Assessments and therapeutic interventions ensure the whole person is treated. • Facilitate a Veterans Advisory Council • Provide community education and engagement