COLORADO SPRINGS – Trauma therapy should be an integral part of substance abuse recovery programs, because trauma is at the root of most addictions, Dolores J. Walker said at a symposium on addictive disorders sponsored by Psychotherapy Associates.
“Substance abuse comes with a package. If we want to be effective, we have to look beyond substance abuse in our therapy, and the integration of substance abuse and trauma has the best outcome,” said Ms. Walker, director of substance abuse services at Cedar Springs Behavioral Health System in Colorado Springs.
Statistics show that up to two-thirds of men and women in treatment for substance abuse report a history of trauma. Among alcoholic women, 90% report sexual abuse or violence as children, and 82% of adolescents in residential care report a history of trauma, she said.
“Clearly, these people are self-medicating. They are numbing out the trauma,” she said. “I sit with people every day who are desperate to restore their balance so they can have a life.”
Trauma can result from natural disasters, wars, near-death experiences, auto accidents, or acts of violence, but it can also result from seemingly more benign events, such as a significant relationship breakup, a medical procedure, the death of a pet, or being shunned, teased, or bullied, she said.
Addiction treatment programs that are trauma sensitive attempt to help patients address any unresolved issues regarding their traumatic history. It is the unresolved issues that will hamper addiction recovery, Ms. Walker said.
Because of the recognized risk of retraumatizing the patient, the initial phase of the program focuses on establishing trust and a feeling of safety, she said.
“Our job is to neutralize the memories and restore homeostasis, not to get them to relive the trauma. That only retraumatizes and revictimizes,” she said.
It is within this initial stage of establishing safety that patients begin their drug or alcohol detoxification program. The second stage focuses on trauma recovery, where patients “rewrite” the experience so they see themselves as a survivor rather than a victim.
“You have to enter the trauma area, not through the rational brain but through feeling,” Ms. Walker said, stressing that patients must be encouraged not to relive the trauma but to observe it from the safety of the present.
This empowers them to progress beyond victimization to survival of the experience. From this point, patients can then reconnect with the present and address their addiction, she said.
The addictive aftermath of trauma is being seen more frequently among military personnel with posttraumatic stress disorder (PTSD), according to Nancy Harrel, who is director of the Masters and Johnson Trauma-Based Disorders Program at Two Rivers Psychiatric Hospital, Kansas City, Mo.
“I think these guys are going to continue showing up in our offices, but they won't be saying they've got PTSD from their war experience,” she said in a separate presentation at the meeting. “Many … who I see have come through our dual diagnosis unit because they are using alcohol to cope.”
In the case of PTSD, alcohol is particularly effective at blocking flashbacks, she said. This makes the initial detoxification process particularly grueling. “We have to educate them that once they stop drinking, the original trauma behind their addiction will return,” Ms. Harrel said, adding that one of the first goals for these patients is to get them sleeping properly again.
Research suggests that military PTSD may be far more common among personnel deployed to Iraq than it is among those deployed to Afghanistan because of the much higher exposure to combat in Iraq, Ms. Walker said.
Up to 17% of those returning from Iraq met criteria for PTSD, compared with 11% of those returning from Afghanistan; and almost 12% of those deployed to Iraq were wounded, compared with 5% of those deployed to Afghanistan, she said at the meeting.