Complex Trauma Treatment and Trauma-Informed Addiction Therapy at Promises
Many people with alcohol or drug addiction have a history of trauma. Whether it was a single event or occurred repeatedly over an extended period of time – either recently or in the more distant past – trauma can have a severe impact on the primary victim and on family members, friends and co-workers, and helpers as well. The trauma-informed addiction treatment program at Promises was developed to address the cross-effects of trauma, addictions, and other co-occurring conditions.
How Does Promises Approach Complex Trauma Treatment with Addiction?
Trauma-informed addiction treatment at Promises integrates a variety of strategies in order to provide a powerful treatment experience that can be individually tailored according to the needs and values of the client. Treatment begins with a specialized assessment that includes attention to possible trauma in the client’s history and to trauma-related symptoms. Repeat assessments are used to track the client’s progress and to adjust interventions. A trauma-informed and problem-solving approach assures that all clients are treated with respect and with attention to their strengths. Attention to emotional regulation and other skills, to self-esteem and relationship issues, to the resolution of trauma symptoms and to sober living offers a comprehensive approach to complex trauma and its many manifestations.
What Is Trauma?
Trauma is defined as any event or experience (including witnessing) that is physically and psychologically overwhelming. It can include exposures and incidents that anyone would identify as trauma, such as physical or sexual assault, combat, major accidents and near-death experiences, rape, and community violence, as well as those that are less easily identified, such as rejection, neglect, abandonment and emotional abuse. Either type can occur on a one-time basis or repeatedly to the point of becoming chronic.
Several main types of trauma have been identified, including those that are:
- Impersonal, occurring on a random basis due to an “act of God” or “being in the wrong place at the wrong time.” This type includes natural disasters, accidents, and such personal misfortunes as chronic illness and disability;
- Interpersonal, those deliberately committed by other people. This type includes all forms of victimization including abuse and neglect, assault, and violence;
- Identity, due to the individual’s personal characteristics such as gender, sexual identity or orientation, race, and ethnicity;
- Community, due to membership in a particular group such as a family, tribe, community, or one with a specific set of religious or political beliefs; and
- Complex trauma, occurring repeatedly and, in many cases, becoming chronic, cumulative and even continuous.
Traumatic events and experiences have both objective and subjective elements. Objectively, they range from those that are relatively mild (identified as “small t”) to those that are horrific (“large T”). Subjectively, some individuals are more vulnerable or susceptible to stress than others who are more resilient or resistant. Other factors, such as whether the trauma is public versus private and the degree of support available to the victim, determine the response. Thus, the impact of the very same traumatic experience can be a highly individual experience that can differ substantially. These individual differences are important to appreciate and understand as they undergird the healing process.
What Is Complex Trauma?
Complex trauma is a relatively new term that was developed to refer to traumatic events or experiences that are particularly complicated by the fact that they are interpersonal in causation and usually committed by someone related or known to the victim. Thus, they involve betrayal of the relationship, which is part of what makes them traumatic. Additionally, trauma of this sort most often begins in childhood, occurs repeatedly, progresses in severity over time, and is a set-up for additional revictimization over the entire lifespan. This, in turn, results in compounded and cumulative (rather than single-event) trauma that profoundly affects the victim’s identity and ability to trust others. While complex trauma usually begins childhood, it can also originate in adulthood.
Reactions to Trauma
The effects of trauma are wide-ranging and can emerge at the time of its occurrence or later. Several emergence patterns and timeframes have been identified. In adults with a time-limited traumatic exposure, the majority (approximately 75%) experience posttraumatic reactions that resolve quickly and permanently after a relatively short period of time. The remainder either have posttraumatic reactions that emerge on occasion or in delayed form (usually due to life events or incidents that serve as reminders of the trauma and trigger the posttraumatic response) or that persist, emerge as symptoms and become chronic. All of these reactions can range in severity from those that are relatively mild annoyances to those that are very severe to the point of being agonizing and life-threatening.
When posttraumatic effects become severe enough to cause debilitating symptoms, they often meet criteria for the diagnosis of Posttraumatic Stress Disorder (PTSD). PTSD includes four primary sets of symptoms that occur in the aftermath of a traumatic circumstance that has been experienced or witnessed:
- re-experiencing the trauma through dreams, memories and flashbacks,
- avoiding reminders of the trauma,
- engaging in numbing strategies to deal with painful emotions and related cognitive changes, and
- experiencing hyper-arousal and hyper-vigilance.
PTSD is a disorder of mind-body dysregulation caused by an acute psycho-physiological response to traumatic stress. The normal stress response is exceeded and individuals who develop PTSD are easily triggered into uncomfortable physical and psychological states by reminders of the trauma. They often have associated depression, anxiety, dissociation and medical conditions and may turn to alcohol or drugs or other addictive/compulsive behaviors to cope with their painful psychological and physiological reactions. Although these strategies may be effective initially and on a short-term basis, they may become additional problems in their own right over time.
Complex PTSD (colloquially known as “PTSD, plus”) refers to a set of symptoms that are in addition to the four primary symptom clusters of PTSD listed above. These additional symptoms are most often due to the impact of prolonged and pervasive trauma on physical and emotional development. Traumatic experiences are particularly overwhelming for children and adolescents who do not have the maturity or size to be able to withstand, understand or cope with them. The chronically traumatized child’s development becomes organized around fear of others and defensive responses, or what has been called “survival brain.” In contrast, children whose upbringing is not bound up in fear and insecurity are free to have a “learning brain,” one that is not on high alert and is free to engage in exploration of self and the world.
These differences in brain development carry forward and impact the child’s (and later the adolescent’s and adult’s) identity, self-esteem, personal coherence, ability to regulate feelings, and ability to have safe and trusting relationships with others, interfering with spirituality, life meaning and life satisfaction. Complex PTSD also has a physical impact, resulting in medical and somatic symptoms that lessen quality of life. Most often, and especially when the trauma occurred in the past, these additional symptoms do not get recognized as trauma-related, get misunderstood and are left untreated. Like individuals with more straightforward PTSD symptoms, those with complex PTSD may resort to behaviors and the use of substances to self-medicate. Too often, these attempts result in addictions and compulsions that then create more exposure to traumatization and a vicious cycle. As a result, individuals who enter recovery need attention to both the untreated trauma and the addictions resulting from their attempts to cope.
Integrated Trauma-Informed Addiction Treatment at Promises
Promises recognizes the interconnections between addictions and unresolved trauma and how they can have a negative synergistic impact on each other. In response, Promises has developed an integrative therapeutic program that specializes in the treatment of individuals with complex trauma and PTSD, addictions, and other co-occurring conditions. The treatment program is based on the principles of sequenced and relationship-based trauma-informed care and offers trauma-focused strategies as appropriate or as needed, according to each individual’s treatment plan. This program is designed to help you in your healing efforts and in reducing the possibility of relapse.
What Is Trauma-Informed Care?
Trauma-informed care (TIC) has to do with a philosophy and an approach to treatment that is based on an understanding that many (if not most) individuals receiving services in the mental health/addiction services system have a history of trauma that is related to their past and present distress. Thus, it is necessary to attend to the possibility of a trauma history in clients’ backgrounds. For this reason, TIC includes an emphasis on universal screening for trauma at the start of treatment and an interweaving of information about trauma and its impact throughout the treatment program.
Rather than a more traditional model that primarily focuses on symptoms, TIC approaches clients from a position of respect for them as individuals, for their survivor skills and for their resilience. Promises utilizes a strength-based and problem-solving treatment approach that emphasizes client control and empowerment to contradict the lack of control that accompanies traumatization. Clients are encouraged to actively collaborate on and participate in their treatment to break the stereotype of being “done to” to re-establish a sense of accomplishment and personal pride. Trauma-informed care also attends to the client’s context and environment as part of his or her individualized needs and offers hope for healing and recovery.
Promises’ staff has received specialized training in understanding the role that trauma may play in addictions and compulsions and in the full range of mental health and medical conditions. Our team has also been trained in understanding the original effects of trauma and how those might become compounded over time, presenting as personality issues or other symptoms. They have learned how to ask about and discuss trauma as part of the treatment program and how to determine when specialized trauma-focused approaches are needed. Speak Confidentially with a Promises Recovery Advisor at 844-876-5568.
What Is Trauma-Focused Treatment?
Trauma-focused treatment (TFT) is specifically directed at the resolution of trauma in order to alleviate its symptoms. Yet, at Promises, the focus is not narrowly on trauma symptoms alone. Here, “trauma is not viewed as a discrete event but rather as a defining and organizing experience that forms the core of an individual’s identity.” (Harris & Fallot, 2001, pp. 11 & 12).
Promises’ integrated treatment includes a focus on personal and interpersonal issues (i.e., shame, self-blame, personal meaning-making and spirituality, inability to trust others, etc.) that have been impacted and distorted by trauma and seeks to address them in a progressive way throughout the program. In their individual, group and family therapy, clients are encouraged to take a “whole person” approach to their trauma history and its repercussions and to approach themselves and their peers with compassion.
Trauma-focused treatment also encompasses strategies and approaches, many of which are evidence-based such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and Emotion Focused Treatment for Complex Trauma (EFFT), which have been specifically developed for the treatment of trauma symptoms and are individually applied once the client has been stabilized in early addiction recovery. These are combined with many other contemporary treatment approaches that are available at Promises, such as Acceptance and Commitment Therapy (ACT), mindfulness and meditation, psychodrama and other expressive therapy, Dialectic Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Somatic Experiencing (SE) and Somatosensory Psychotherapy (SP), interpersonal neurobiology and attachment-based approaches, psychopharmacology, nutrition, yoga, massage, acupuncture, neurofeedback, and equine therapy.
What Is Sequenced, Relationship-Based Treatment?
The Treatment Sequence
The model has three main stages and a pre-treatment stage for assessment and motivation enhancement/treatment planning. The first stage is devoted to detox (if needed) and issues of early sobriety. The initial emphasis is on safety and crisis management; education about addiction, trauma, their interaction and numerous other mental health topics; stabilization through skill-building; and development of a treatment alliance with the primary therapist, the treatment team and other clients in treatment. Once clients have stabilized, they are assessed as to their need for specialized trauma-focused treatment. They select the approach based on their values and the input of their therapist.
The second stage is focused on the processing of trauma and its impact using specialized evidence-based techniques. Once processing has occurred to the point of some resolution, symptoms usually begin to diminish, in turn, making it easier to maintain sobriety and to enjoy a more stable and satisfying life.
The third stage usually occurs after the first 30 or 60 days of treatment and is focused on present and future life choices that are less encumbered by trauma symptoms and by addictions. Clients are encouraged to apply their newly developed knowledge and skills to maintain a life of sobriety and safety from additional abuse and trauma.
Each stage builds upon the previous one, with the client acquiring growing control and mastery. Throughout the stages, there is overlap in therapeutic work and planning for expectable relapses. The process of change is both progressive and recursive and clients are taught to expect setbacks and to problem solve and apply newly developed skills. Most clients continue their outpatient treatment after their discharge from Promises and primary staff maintains contact with the outpatient therapist throughout the client’s stay.
Trauma-informed care is founded on interpersonal safety and the significance of a treatment relationship based on the trustworthiness and consistent attunement of the helper. Promises staff has been trained in attachment-based treatment and interpersonal neurobiology. Clients can take risks with self-exploration, the development of new behavioral patterns and personal change in the context of a relationship that is respectful, compassionate, supportive and that promotes hope.