Trauma-Informed Care and Addiction Treatment

Learn how Compass Recovery uses trauma-informed care in its treatment programs in this article.

From the moment humans are born, their experiences shape how they perceive and interact with the world around them. Because our experiences impact us, severely disturbing events called trauma can have lasting adverse effects on one\'s life. Trauma can include negative experiences such as poverty, violence, separation from a loved one, neglect, or physical or sexual abuse. ¹

Trauma alters every area of a person\'s world, from their physical well-being to their mental health and behavioral choices. Everyone is susceptible to trauma, and no one is immune.

What is Trauma?

According to the American Psychological Association (APA), trauma is \"an emotional response to a terrible event like an accident, rape or natural disaster.\" ² An individual doesn\'t have to be the victim of a traumatic situation to experience trauma. Many people who are witnesses -- or even perpetrators -- can experience psychological trauma from an incident. For example, children who witness a shooting may not have been the victims, but they can still be negatively affected by the experience for years afterward.

Although the physical trauma from an event might heal, the emotional trauma can linger. Directly after a traumatic event, people typically feel denial or shock. As time progresses, one might experience flashbacks of the event, erratic mood swings, or even physical responses like nausea or high blood pressure. Although these trauma responses are typical, long-term effects can make life extremely challenging if left untreated and unresolved.

Principles of Trauma-Informed Care

Formed in 2005, National Center for Trauma-Informed Care framed the evidence-based concept of Trauma-Informed Care (TIC) to recognize that trauma can have a powerful impact across a person\'s lifetime. ³ Through a trauma-informed approach to care, organizations can potentially improve a client's health outcomes and treatment adherence. The six principles of TIC are:

1. Safety
2. Trustworthiness & transparency
3. Peer support
4. Collaboration & mutuality
5. Empowerment & choice
6. Cultural, historical & gender issues

Foundationally, adopting a trauma-informed approach isn\'t about checking through all the six principles, but rather weaving the principles throughout care for a client and through every aspect of an organization.⁴ Trauma-informed care involves a holistic approach to take into account every part of a client\'s life, including their spiritual beliefs, family history, home environment, and economic status, to name a few.

Types of Trauma

How people experience trauma and cope with it differs from person to person. Trauma can stem from any distressing event, but there are thirteen main types of trauma as defined by National Child Traumatic Stress Network:

• Bullying: Social, emotional, or physical harm by another because the victim is perceived as less powerful.
• Community Violence: Events like a robbery or violent act (shoots, stabbing, etc.) performed by someone who is not a family member.
• Complex Trauma: Complex trauma describes the exposure to prolonged traumatic events, like neglect, poverty, or domestic violence.
• Domestic Violence: Mental abuse or physical/sexual violence between two adults involved in an intimate relationship. Also known as \"domestic abuse\" or \"intimate partner\" violence.
• Early Childhood Trauma: Traumatic experiences that children aged 0-6 experience.
• Medical Trauma: Events a person or their family member may experience due to injuries or serious illness.
• Natural Disasters: Traumatic experience related to a natural or human-made catastrophe (including tornadoes, floods, fire, or flood).
• Neglect: Occurs when a parent or caregiver doesn\'t provide adequate care or safety.
• Physical Abuse: Physical trauma (pain or injury) caused by a caregiver or protector.
• Refugee and War Zone Trauma: Exposure to political violence or war, such as bombing, torture, or forced displacement.
• School Violence: Aggression against staff, students, or school property and includes school fights and shootings.
• Sexual Abuse: Any completed or attempted sexual act or exploitation of a child by a caregiver.
• Traumatic Grief: Results from the sudden or distressing loss of a parent or caregiver. ⁵

Adverse Childhood Experiences

According to the Centers for Disease Control and Prevention (CDC), Adverse Childhood Experiences (ACEs) are \"potentially traumatic events that occur in childhood (0-17 years).\" ⁶ Childhood trauma can include experiences such as physical or sexual abuse, neglect, or the sudden loss of a close family member. About 61% of adults have had at least one type of ACE, while 1 out of 6 adults has had 4 or more ACEs in their childhood.

Studies show that ACEs are connected to a child\'s future by negatively contributing to chronic illness, substance abuse, poor education, and work opportunities. Childhood trauma can also prevent children from forming healthy relationships in the future and can result in unstable work histories and financial struggles in adulthood due to their trauma response.

Trauma-Informed Care in Addiction Treatment

Consider the following statistics from the Adverse Childhood Experiences (ACEs) study and the Substance Abuse and Mental Health Services Administration (SAMHSA):

• About two-thirds of intravenous drug users experienced trauma as children.
• Individuals with an ACE score of 5 or more are 7-10 times more likely to develop substance abuse.
• About 75% of people receiving addiction treatment have a history of trauma.
• Over 30% of people receiving addiction treatment have a diagnosis of Post-Traumatic Stress Disorder, otherwise known as PTSD. ⁷

The link between psychological trauma and substance abuse runs both ways. Trauma increases the likelihood of high-risk behavior like substance use which results in substance use disorder (SUD). In short, people who have been traumatized are more likely to develop substance abuse and are less able to cope with the trauma that stems from substance abuse.

Childhood trauma, in particular, increases a person\'s risk for addiction because psychological trauma during a child\'s formative years leaves one less likely to manage challenges in the future. Because trauma is so intertwined with substance abuse disorder, addressing both simultaneously is vital to a successful recovery.

Studies on the Effectiveness of Treating Trauma While Treating SUD

Trauma-informed care is an evidenced-based concept, meaning that its guiding principles stem from research, study, and valid data. The data points to a direct connection between trauma and substance abuse. There is also evidence that shows that treating trauma also helps address substance abuse.

For example, a 2017 research review found that using treatments like trauma-focused CBT (cognitive behavioral therapy) to treat both PTSD and substance abuse in women --- at the same time -- was the most successful approach to treatment.⁸

SAMHSA has long understood the importance of treating psychological trauma and substance abuse concurrently, having released an evidence-based integrated substance abuse services guideline targeted towards women with trauma histories as far back as 2004.9 ⁹ The United States Veteran\'s Affairs (VA) also utilizes an evidence-based policy for treating clients for both PTSD and substance abuse concurrently, stating that one should not be a barrier in obtaining treatment for the other. ¹⁰

Treatment Models for SUD and Trauma

Trauma research has led to the development of trauma-informed care-focused models to treat SUD. These trauma therapy models offer multiple avenues to make the treatment of both emotional trauma and substance abuse at the same time possible. The following are a few common evidence-based models utilized in many treatment facilities.

ATRIUM

Addictions and Trauma Recovery Integration Model relies on research evidence that trauma impacts body, mind, and spirit. By integrating relational treatment and incorporating trauma-focused CBT practices, ATRIUM holistically addresses all three levels, and it can work in both peer or group settings or with therapists.

ATRIUM\'s curriculum caters to:

• Survivors of physical trauma, like sexual and physical abuse.
• People with substance abuse or addictions.
• People who are involved in destructive relationships.
• People who self-injure.
• People who are violent or abusive to others.
• People with significant psychiatric problems.

Helping Women Recover

Helping Women Recover (HWC) is based on a previous model called Women's Integrated Treatment (WIT). This trauma therapy model provides a gender-responsive and trauma approach to working with women in both group and individual settings. HWC consists of four modules, self, spirituality, relationships, and sexuality, which are each essential to growth and healing. ¹¹

Seeking Safety

Seeking Safety consists of a 25 topic format, helping both men and women develop the coping skills necessary to overcome trauma and SUD. The Seeking Safety program focuses on behavioral and thinking strategies to better manage life\'s challenges, prevent substance abuse, and recover from emotional trauma. ¹²

Trauma Recovery and Empowerment Model

Trauma Recovery and Empowerment Model (TREM) is a group-based treatment focused on trauma recovery for women with histories of sexual or physical abuse. TREM fosters the use of positive coping skills and social support. Through its emphasis on addressing the consequences of violent victimization, TREM helps trauma survivors overcome substance use disorders. ¹³

TRIADS

The TRIADS framework strongly utilizes ACES findings to develop the best practices for education, identifying strengths, screening, and trauma response. Through a holistic approach, the TRIADS framework seeks to use a deep understanding of a client\'s patient and family to manage medical conditions, mental health concerns, and substance abuse disorders. ¹⁴

Avoiding Re-Traumatization

Trauma survivors often run the risk of being retraumatized when going through therapy. Re-traumatization occurs when a victim of emotional trauma re-experiences the experience, whether they realize it or not. Triggers are a stimulus (like a scent, area, sound, or word) that might remind them of their traumatic event, causing agitation and distress. Even if the event occurred decades ago, a trigger might cause re-traumatization, leading to feelings of reliving the scene. ¹⁵

Trained counselors often know how to mitigate re-traumatization when working with trauma survivors. Providing a client with a safe and accepting environment to explore their emotions and identify potential triggers allow counselors and therapists avoid retraumatizing their clients.

How Should Addiction Treatment Address Trauma in Treatment?

There\'s no denying the links between substance abuse disorders and trauma. Rather than focusing solely on addiction, successful addiction treatment calls for trauma recovery options. Through trauma-informed care and trauma-directed interventions like ATRIUM and TRIADS, addiction treatment can hopefully evolve into a more holistic and cognitive-behavioral approach.

A trauma-informed care environment doesn\'t only extend to clients. For a treatment environment to be truly trauma-informed, a trauma-informed approach should also apply to the staff. When developing or reviewing policy, procedures, and staff training, a trauma therapy perspective in an organization ensures that the mindset is ever-present.