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How Trauma-Informed Care Is Transforming Addiction Treatment

What is trauma-informed care and why does it work so well?

Key points

  • Trauma-informed care (TIC) is based on the idea that most people have experienced trauma and that it needs to be considered when receiving care.
  • People who experience trauma during childhood are at risk for developing substance use disorder and other physical and mental health conditions.
  • TIC is based on the principles of safety and collaboration. Patients also have a voice in their care and therapy is never punitive.

First, a definition: Trauma-informed care (TIC) acknowledges the need to understand a person’s life experiences in order to deliver effective medical care. It also assumes that trauma has occurred in many of our lives, that it can continue to affect us in powerful and debilitating ways, and that it needs to be considered when we receive mental health care.

In essence, TIC shifts the focus from “What’s wrong with you?” to “What happened to you?”

The trauma-addiction connection

The Substance Abuse and Mental Health Services Association (SAMHSA) defines trauma as events or experiences that create long-lasting adverse effects for people. Trauma can occur because of physical, emotional, or sexual abuse, war or natural disasters, and many other reasons. All types of trauma increase your risk of substance use disorder (SUD).

Trauma experienced during childhood may cause especially serious long-term effects. Technically known as Adverse Childhood Experiences (ACEs), these traumas include being abused or neglected, being frequently intimidated or humiliated by adults, witnessing violence, not having enough to eat, experiencing frequent loneliness, or growing up in a household where there are serious mental health or substance use issues.

Research also shows that the more ACEs a young person experiences, the greater his or her risk of SUD and other mental and even physical health conditions. So there’s an additive effect.

How trauma-informed care can help

At the addiction treatment center where I work, around 65 percent of the women we treat have experienced some form of trauma during their lives. For our male patients, that number is lower, but still significant at around 50 percent.

Sadly, these are not outlier numbers within the addiction treatment field. Thus, there is a vital need for TIC in the addiction treatment field.

Calming the patient

Patients with SUD who are experiencing trauma symptoms often come into treatment with an internal fire alarm going off all day long. They have trouble relaxing. They have trouble trusting. They don’t sleep well. And they frequently experience panic attacks and nightmares.

Often, the first and best step for people in this state is to give them calming medication such as a selective serotonin reuptake inhibitor (SSRI), Lexapro, or Prazosin.

SSRIs enhance the brain's chemical serotonin, which can relax the patient and improve mood. (Serotonin levels are often low in people with trauma.) Lexapro is a common anti-anxiety, anti-depressant drug that causes few side effects and “plays well” with other drugs.

Prazosin was developed to lower blood pressure but was accidentally found to also stop nightmares and flashbacks. A few years ago, I was part of a research team that worked with migrant women who had experienced trauma. We used Prazosin as part of our treatment protocol for these women, and it significantly reduced the frequency of their nightmares and other trauma symptoms. We have found it does the same in the addiction treatment setting.

In a calmer state, therapy becomes possible

TIC has done so much to transform and inform addiction treatment, and patients with SUD are responding well to it. In the TIC environment, patients can feel confident that they:

  • Will be safe while in treatment.
  • Will have a voice in their care.
  • Will benefit from a TIC-trained clinical staff that is collaborating with them rather than dictating to them.
  • Will know that their therapy is always positive, never punitive.

When patients are empowered by these principles and trust that their therapist, doctor, and other providers have their best interests in mind, real progress can be made toward recovery.

EMDR for trauma treatment

At our treatment center and others, a therapy called EMDR is showing very positive results. EMDR stands for Eye Movement Desensitization and Reprocessing, and it’s a type of psychotherapy provided by a trained professional usually over six to eight sessions.

When it is successful, EMDR disrupts or disconnects the visual memory of a traumatic event from the emotional response to that memory. This means you’re not erasing the memory itself, you’re erasing the emotional wound associated with the memory.

At an addiction treatment center that practices TIC, proven trauma therapies such as EMDR are carefully integrated with the addiction therapy that patients are also receiving. This powerful combination often results in significantly better mental health outcomes and improves the chances for long-term recovery.

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