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Integrating Addiction Recovery and Trauma Healing

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and Trauma HealingBOB CARTY, LCSW, CADC, CCJPVANESSA LOWREY, LCPC, CADC

JIM NICHOLAS, LCPC, CRADC

Introductions

Co-Presenters from Hazelden-Chicago Bob Carty: Director of Clinical Services

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Bob Carty: Director of Clinical Services Vanessa Lowrey: Clinical Supervisor Jim Nicholas: Mental Health Specialist

Learning Objectives

Discuss importance of integrating addiction and trauma services

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Describe the impact of gender-specific groups in this work

Define “vicarious traumatization” List three benefits of a guide team Others?

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Linkage Between

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Between Addiction and Trauma

Trauma and Addiction

Familiar to addiction treatment Guilt and Shame often residue of traumatic experience

Things Done to Me

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Things Done to Me Things I’ve Done

Experience of trauma - Predisposition to addictive behavior Neurobiological Changes

Attachment Regulation of Impulses Regulation of Stress Responses

Trauma and Addiction

Experience of Trauma Precipitates Addictive Behavior Substance Use as a Coping response

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Coping in the Sense of Reducing Subjective Distress Emotional NumbingCognitive Numbing

Use Coupled with Neural Dysregulation

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Big T and Little t

Definitions / Examples Big T:

Severe

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Severe Once or Repeated May be Public

Little t: Severe Once or Repeated May be Private

Integrated

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Integrated Treatment Model

Integrated Process

Assessment of CD and MH, including trauma-related concerns MHP for individual therapy and EMDR Group therapy with masters level counselors educated on trauma

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Group therapy with masters level counselors educated on trauma Addiction Psychiatrist for psych evaluation, MAT for both CD & MH Addictionologist as PCP WHG & MRG using Covington curriculum FIT assessments Guide Team

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Integrated Process

Herman’s (1997) 3 stages of trauma treatment Establishment of Safety

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Establishment of Safety Stabilization, psych & physical safety

Remembrance and Mourning Understanding links between trauma & substance use

Reconnection with Everyday Life Utilization of coping strategies in recovery

Choosing Curriculum

Overview and Theoretical Approach Duration and Intensity of Services

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Duration and Intensity of Services Open vs. Closed Sessions Adaptations Training and Facilitator Qualifications Cost Availability, Willingness, & Education of Staff

Gender-Specific

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Gender-Specific Healing Groups

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Men’s Resilience Groups (MRG)

Participation CriteriaNormalization of Trauma Experience

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Normalization of Trauma ExperienceEducation on Big and Little t distinction

MRG

Education on trauma reactionsNeurochemical

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NeurochemicalEmotionalBehavioral

Setting Group NormsEstablishing Trust and Safety

MRG

Encountering Emotions Practicing Use of Coping Skills

Grounding

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Grounding Self-Soothing

Exploration of Interpersonal Reactions Addictive Behavior Avoidance / Isolation Maladaptive Use of Power and Control

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Women’s Healing Groups (WHG)

Approximately 65-84% of women meet criteria for PTSD before development of SUDAmong women who have experienced 3-4 forms of violence, 90%

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Among women who have experienced 3-4 forms of violence, 90% experienced a resulting mental health disorder and 47% developed a SUD

Up to 80% of women entering SUD treatment have experience physical or sexual abuse

Approximately 43-59% of women in SUD treatment meet criteria for PTSD

WHG

Healing Trauma by Covington and Russo Gender-specific curriculum for women

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Gender-specific curriculum for women designed for settings in which short-term intervention is needed

Promotes strength-based approach Seeks to empower women & increase sense of

self

WHG

Focuses on emotional development & coping strategies

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strategies Healthy expression & containment of feelings Psychoeducational & CBT techniques,

expressive arts, body-focused exercises, mindfulness, & relational therapy

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WHG

Overview of sessions Welcome and Introduction to the Subject of Trauma

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Power and Abuse The Process of Trauma and Self-Care The ACE Questionnaire and Anger Healthy Relationships Love, Endings, and Certificates

Clinical Implications & Observations

WHAT IS IT?

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Guide TeamsWHAT IS IT?ITS FUNCTIONSDEVELOPING ONE

What Is a Guide Team?

A group of 8-10 people committed to process of becoming trauma-informed and trauma-responsiveRepresents a cross-section of administration and staff

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Represents a cross-section of administration and staff Includes a senior leader, supervisory staff, support staff, and

possibly people seeking services Meets once to twice monthly Requires position of Team Leader, which can be single individual or

co-leaders, but does not have to be in a supervisory position

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Functions of Guide Team Leaders

Must be committed to trauma-responsive culture change

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Needs formal authority as leaders of the change process by organization’s leadership

Generate interest in the overall change efforts and be responsible for keeping the initiative as an important overall strategic goal

More Functions of Guide Team Leaders

Act as point persons for the Guide Team to ensure the principles are implemented across the organization

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Ensure the Guide Team has representation from various levels/departments within the organization

Monitor delivery of all trauma-informed & trauma-responsive processes in order to report to senior leadership the efficacy and work of the ongoing change initiative

Development of Guide Team

Determine Team Leader(s) Invite staff interested in promoting trauma-responsive

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Invite staff interested in promoting trauma-responsive culture

Establish Mission, Vision, and Values Incorporate new members Conduct survey regarding current culture Meet at least monthly

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Vicarious WHAT IS IT?SIGNS AND

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Vicarious Traumatization

SIGNS AND SYMPTOMSHEALING

What is Vicarious Traumatization?

A.K.A. = secondary trauma or compassion fatigue Not to be confused with professional burnout

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Not to be confused with professional burnout (deterioration in job performance due to continued involvement in high-stress work environments)

Vicarious traumatization: impact of clinicians bearing witness to the trauma of their clients

Can occur from one particularly graphic experience; more likely occurs from many experiences over time

Signs and Symptoms

May include Either emotional numbing or reactivity

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Either emotional numbing or reactivity Either interrupted or extended sleeping Either no appetite or increased appetite Other symptoms: heightened anxiety, hypervigilance,

increased startle response, and overly protective of loved ones (especially children)

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EAP and Vicarious Traumatization

EAPs frequently work with clients impacted by trauma, so there is a high risk for vicarious traumatization

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Try searching “EAP and vicarious traumatization” --what I found was how EAPs help others who experience vicarious traumatization, but nothing on how to heal from their own

Who helps the EAP professional?

Healing from Vicarious Traumatization

Recognize that you have been triggered De-brief after intense sessions involving trauma

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De-brief after intense sessions involving trauma Seek help from trusted colleagues, friends, and

therapists Practice self-compassion – enhance your self-care Identify what part of the traumatic story you have

absorbed Establish new supports to enhance your resilience

Takeaways and Next Steps

What takeaways do you have from today’s training?

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today’s training?

What can you do to apply what you have learned?

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Recommended Readings

Brown, C., PhD, LMSW, Killeen, T., PhD, & Haynes, L., MSW. (2010). Challenges of Implementing Trauma Intervention into a Clinical Treatment Program. Counselor, The Magazine for Addiction

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Program. Counselor, The Magazine for Addiction Professionals,11(September/October), 56-61.

Stephanie Covington and Eileen Russo. Healing Trauma: A Brief Intervention for Women. Hazelden Publishing, 2016.

Stephanie Covington and Roberto Rodriguez. Exploring Trauma: A Brief Intervention for Men. Hazelden Publishing, 2016.

Dimeff, L. A., & Koerner, K. (2008). Dialectical behavior therapy in clinical practice: applications across disorders and settings. New York: Guilford.

Recommended Readings

Finkelstein, N., VandeMark, N., Fallot, R., Brown, V., Cadiz, S., & Heckman, J. (2004). Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment (pp. 1-12, Publication). Sarasota, FL: National Trauma Consortium. doi:https://www.samhsa.gov/sites/default/files/wcdvs-article.pdf

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Freeman, A., Pretzer, J., Fleming, B., & Simon, K. M. (2004). Clinical applications of cognitive therapy. New York: Kluwer Academic/Plenum Publishers.

Herman, J. L. (1997). Trauma and recovery: the aftermath of violence, from domestic abuse to political terror. New York: Basic Books, a member of the Perseus Books Group.

Killeen, T. K., Back, S. E., & Brady, K. T. (2015). Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs. Drug and Alcohol Review,34(3), 234-241. doi:10.1111/dar.12229

Mate, Gabor (2010). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books.

Recommended Readings

Meichenbaum, D., PhD. (2009). Trauma and Substance Abuse: Guidelines for Treating Returning Veterans. Counselor, The Magazine for Addiction Professionals,10(August/September), 10-15.

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Professionals,10(August/September), 10-15. Stotts, A. L., & Northrup, T. F. (2015). The promise of third-wave behavioral

therapies in the treatment of substance use disorders. Current Opinion in Psychology,2, 75-81. doi:10.1016/j.copsyc.2014.12.028

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Contact Information

Bob Carty rcarty@hazeldenbettyford.org

(312)631-7952

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(312)631-7952

Vanessa Lowrey vlowrey@hazeldenbettyford.org

(312)631-7931

Jim Nicholas jnicholas@hazeldenbettyford.org

(312)631-7927

Closing Comments

For too many years, professionals failed to recognize the linkage between trauma and addictionNow, we have new approaches to treat these issues in an

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Now, we have new approaches to treat these issues in an integrated manner

We hope that you have gained new insights and tools to help you to help others