Meet Emily, a 30-year old woman struggling with addiction. As a young girl, Emily often witnessed her parents arguing. The arguments involved a lot of shouting and pushing. If her parents had been drinking, then the arguments were especially violent: Emily witnessed her father beat her mother on multiple occasions. Emily was afraid of her parents when they drank because they would become physically rough with her, grabbing her by the arms and pushing her around.
When she was four years old, her parents divorced and her father moved to a neighboring town. After the divorce, Emily rarely saw or spoke with her father. Her mother had a string of boyfriends who abused alcohol and drugs, often in front of Emily. Many of the boyfriends were physically abusive towards Emily’s mother. The police were often at Emily’s house in response to domestic violence complaints.
When Emily was 12 years old, her mother moved out of state with a boyfriend and Emily was sent to live with her grandmother in another town. At her new school, Emily became friends with kids who used alcohol and drugs. Emily became sexually active at the age of 13. She did poorly in school, so she dropped out when she turned 16. Angry that she had dropped out of school, Emily’s grandmother kicked her out of the house and Emily moved in with her boyfriend.
Emily and her boyfriend both used meth, and they sold drugs to support their habits. Emily was arrested numerous times before she turned 21. She was in and out of jail for a variety of offenses. At the age of 25, Emily attended her first treatment program, but she felt isolated from the other clients. She did not share stories about her childhood in groups or with her counselor. Subsequent attempts at treatment over the next 5 years had similar results.
At the age of 30, after another drug-related charge, Emily was court ordered to attend drug treatment at Vinland Center. This time, treatment was different for Emily. During her treatment at Vinland, Emily’s counselor encouraged her to talk about her childhood and helped her process her feelings of shame and resentment surrounding her childhood trauma. For the first time ever, Emily felt comfortable sharing her story with other people.
Emily is a fictional person, but her story is a compilation of multiple clients at Vinland Center. Stories like Emily’s are the expectation when counseling individuals with substance abuse issues and co-occurring mental health issues.
What Causes Trauma?
Trauma occurs when someone’s response to an external event overwhelms their coping skills. What does this mean? A child who is physically abused by a parent does not understand why the abuse is happening and does not know how to escape the situation, so their coping skills are overwhelmed. The child might act out in a variety of ways (poor attention at school, running away from home, etc.) because they don’t know what else to do.
The more times an individual is exposed to traumatic events, the greater the impact on their mental and physical health. The types of traumatic experiences that lead to long-term mental health issues are usually caused by prolonged and repeated experiences that occurred before adulthood. These experiences can include sexual abuse, physical abuse, severe neglect, repeated abandonment, and psychological abuse. People who repeatedly witnessed these experiences are also victims of trauma. The long-term effects of trauma are disempowerment and disconnection from others.
Pervasive in Society
The Adverse Childhood Experiences (ACE) Study is a collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. Between 1995 and 1997, more than 17,000 individuals provided detailed information about their childhood experiences of abuse and neglect. Researchers compared the incidence of childhood trauma to adult health and well-being.
Roughly one in five respondents to the ACE Study reported three or more traumatic childhood experiences. Researchers discovered that these individuals had higher rates of alcohol and drug abuse, depression, domestic violence, sexually transmitted diseases, and heart disease.
Post-Traumatic Stress Disorder
Among the general public, post-traumatic stress disorder (PTSD) is most commonly associated with combat war veterans, but it can develop in any individual who has survived a traumatic event. In fact, PTSD rates are highest among women who experienced childhood trauma. Over the course of their lifetimes, 10% of women and 5% of men will experience symptoms of PTSD.
One-third of people exposed to trauma develop PTSD. Men report higher incidences of trauma, but women are more likely to develop PTSD if exposed to trauma.
Symptoms of PTSD include re-living or re-experiencing an event, avoiding situations that remind a person of an event, feeling numb, and feeling anxious.
Common in Treatment
Research conducted in the past ten years has dramatically increased awareness about the prevalence of trauma among people seeking treatment for alcohol and drug abuse.
People dealing with the life-long effects of trauma are no longer seen as a subgroup. As the following statistics reflect, trauma is pervasive in the treatment setting. According to the Substance Abuse and Mental Health Services Administration (SAMHSA):
- 75% of women and men in substance abuse treatment report histories of abuse and trauma.
- 97% of homeless women with mental illness report severe physical and/or sexual abuse.
- 12%-34% of individuals in substance abuse treatment have PTSD.
Every individual seeking treatment for substance abuse, even those not showing symptoms of PTSD, should be asked about past trauma.
There is some evidence that patients with PTSD fare worse in traditional substance abuse treatment than patients with other types of co-occurring disorders. PTSD does not go away with abstinence from substances. In fact, symptoms are widely reported to become worse with initial abstinence.
For an organization to become a trauma-informed service provider, staff members must change their approach to interacting with clients. A common example is a shift from “What is wrong with you?” to “What happened to you?”
Dr. Roger Fallot, a clinical psychologist and a well-known developer of trauma services, identified the following core principles of a trauma-informed system of care:
- Safety: Ensuring physical and emotional safety.
- Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries.
- Choice: Prioritizing consumer choice and control.
- Collaboration: Maximizing collaboration and sharing of power with consumers.
- Empowerment: Prioritizing consumer empowerment and skill-building.
Sources: Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Council for Community Behavioral Healthcare.