Trauma Therapy as Part of Addiction Treatment

There is a recognized link between substance use and abuse problems and exposure to traumatic events during childhood or adulthood. This means that significant numbers of people who enter treatment for drug or alcohol addiction also have a history of serious trauma. To address this history, addiction specialists often incorporate some sort of trauma-related therapy into their treatment programs.

The Connection Between Childhood Trauma and Substance Abuse

Roughly 25 percent of all people in the U.S. will experience a traumatic event before reaching their 16^th birthday. Examples of trauma events include:

• Episodes of sexual abuse
• Episodes of physical abuse
• Exposure to a natural disaster
• Development of a life-threatening illness
• Exposure to mass violence

Not every child or teenager who lives through a traumatic situation will experience any long-term, negative consequences as a result. However, a substantial number will develop symptoms of PTSD[i] (post-traumatic stress disorder), a condition that arises soon after trauma exposure and can continue to exert its negative effects for months or years to come.

Involvement in substance use is well-known as a potential coping mechanism for people attempting to deal with the effects of serious trauma. However, as a rule, excessive substance use leads to more problems, not fewer. Among children and teenagers, drug and alcohol consumption come with a considerable risk for diagnosable substance use disorder.

No one knows for sure how many adolescents and young children with a history of trauma get involved in substance abuse. However, studies show that trauma exposure may increase risks for drug or alcohol problems by as much as 200 percent.

The Connection Between Adult Trauma and Substance Abuse

Trauma exposure can also increase the odds that an adult will develop serious substance use problems. The classic example is the connection between PTSD and drug/alcohol abuse. The U.S. Department of Veterans Affairs’ National Center for PTSD reports that over 20 percent of all military veterans who receive a post-traumatic stress disorder diagnosis also qualify for a diagnosis of substance abuse/addiction[ii]. While some veterans turn to drug or alcohol to ease their PTSD symptoms, their actions can have the opposite effect and lead to a clear worsening of those symptoms.

Underlying Guidelines for Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a four-part protocol designed to underscore the impact of trauma exposure on the course of substance use treatment[iii]. The individual steps in this protocol are:

• Realizing the extent of trauma exposure among people seeking treatment
• Increasing awareness of the signs of trauma exposure among treatment facility staff members, as well as affected people and their families
• Incorporating knowledge of the potential impacts of trauma into the core of the treatment process
• Taking active measures to prevent exposure to new traumas among people enrolled in treatment

SAMHSA also identifies six guiding principles of substance treatment for people with a history of trauma exposure:

• Creating a safe environment
• Establishing trust and creating a clear and open treatment setting
• Creating a collaborative environment that allows participants to make active contributions to their care
• Making sure that treatment participants feel that their opinions are heard and acknowledged
• Creating a treatment setting that encourages participants to support each other
• Acknowledging and honoring the unique backgrounds (e.g., gender, racial/ethnic heritage) of treatment participants

Common Characteristics of Trauma Therapy

There are some common characteristics among the therapies used to help people with substance problems who also have histories of trauma exposure. First, they tend to focus on diagnosable symptoms of PTSD. This makes sense, since post-traumatic stress disorder is the primary mental health issue associated with serious trauma.

Therapy for overlapping cases of trauma and substance abuse/addiction also typically occurs over a short span of time[iv]. At a minimum, it lasts for approximately 16 sessions and at a maximum, therapy takes about 25 sessions to complete. In addition, most of the therapies developed for people affected by trauma and substance use problems are designed to take place in one-on-one sessions, not group sessions.

Specific Treatment Options

There are a variety of treatment options available for people coping with the combined impact of substance problems and trauma. One such option is a program designed to address the effects of sexual abuse and other traumatic experiences. Treatment in this type of program typically focuses on relieving the feelings of guilt, worthlessness and shame afflicting the survivors of these experiences. Techniques used for this purpose include:

• Creation of safe spaces to discuss traumatic events
• Personal conversations with others who have survived sexual abuse and other traumas
• The use of a multi-person treatment team to address both personal and family-wide consequences of trauma exposure

Some effective programs are specifically intended to help military veterans dealing with the combined symptoms of PTSD and drug or alcohol abuse/addiction. In addition to addiction treatment, specific techniques used in veteran-oriented programs may include:

• Training in stress and anger management
• Meditation and other forms of relaxation therapy
• A form of psychotherapy called EMDR (eye movement desensitization and reprocessing)
• Loss and grief counseling

Addressing Trauma in Addiction

The need to address the symptoms of addiction should not be left out of the treatment equation. Dealing with both the impact of trauma and excessive use of drugs or alcohol are key requirements for long-term recovery. At Transformations Treatment Center, we understand the need to integrate trauma therapy with addiction treatment. Our certified programs focus on the substance side of the equation, as well as the most common causes of trauma-related symptoms.