Trauma and Substance AbuseAn Introduction to Trauma-Informed Care

Hoyt Roberson, MC, MSLicensed Marriage and Family Therapist

Presbyterian Medical Services505-962-6642 (O)505-321-5115 (C)

hoyt_roberson@pmsnet.org

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

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

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

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

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.

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

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

Results of Trauma

Emotional difficulties Cognitive difficulties and distortions Social impairments and difficulties Ability to handle transitions and change Interference with developmental momentum

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.

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

Mental Illness

Substance Abuse

Trauma

We Used to Think

Mental IllnessSubstance

Abuse

Trauma

Now We Know

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

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

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

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

What Can You Do?

Get trained in trauma-informed care Get trained in trauma interventions Join a learning team or community

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

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

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

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