Substance Abuse and Trauma

Substance Abuse Treatment as it Is Related to Trauma

Research indicates that there is a strong correlation between people who have experienced trauma (whether in childhood or in adulthood) and substance abuse or dependency. Because patients who suffer from substance abuse are also highly likely to have experienced trauma in their lives, a trauma-focused care approach can be the best method of treating substance abuse patients because it emphasizes the underlying cause of the patient's stress, depression, and compulsion to abuse or develop a dependency upon harmful substances. Since attempting to treat patients with a substance use dependency can be include a range of interventions, it depends upon the therapist or counselor's training and preferred approach to counseling as to whether or not the patient receives the appropriate or most effective care. This study examines the research related to the issue of trauma and substance abuse treatment and concludes that trauma-focused care can help to address the underlying issue for patients who suffer from substance abuse.

Introduction

The topic of this research is the relationship between trauma and substance abuse treatment. Correlation has been noted between substance abuse and trauma victims: the relationship is one that has been studied by researchers seeking to understand what this connection means and how it can be treated (Ekinci, Kandemir, 2015). From children who experience trauma at a young age and grow up to abuse drugs or alcohol to adults who are traumatized from war or from abusive relationships, the theme is the same: people who have suffered a trauma in life tend to try to cope by self-medicating, a process which leads to substance abuse (Boden, Kimerling, Jacobs-Lentz, et al., 2011; Witkiewitz, Estrada, 2011; McDowell, Rodriguez, 2013; Ekinci, Kandemir, 2015). By understanding how trauma leads victims to abuse substances, therapists can better develop and implement appropriate treatments and interventions to mitigate the risk of substance abuse setting in.

Treatments for substance abuse range from pharmacotherapy to (Gifford, Tavakoli, Wang et al., 2013) to post-deployment education (for servicemen so that they can be better prepared to identify and seek treatment for PTSD) (Witkiewitz, Estrada, 2011). For substance abusers who have suffered trauma as children, psychiatric and psychological interventions are used (Ekinci, Kandemir, 2014).

The purpose of this paper will be to show how trauma-focused treatment can be applied to help address the underlying issue of trauma for substance abusers who have been impacted by it. This study will be useful for all stakeholders in substance abuse treatment and/or prevention programs -- from researchers to therapists to clinicians to patients, family members, and organizations (particularly military) that are at risk for seeing members develop substance abuse problems.

Ideas and Themes

The main idea that emerges from the research available on the subject of the relationship between substance abuse treatments and trauma is that the traumatized patient typically feels compelled to bury, hide or deal with the depression and mood swings that stem from the trauma by turning to substances such as alcohol, narcotics or tobacco (Gifford, Tavakoli, Wang et al., 2013; Boden, Kimerling, Jacobs-Lentz, et al., 2011; Witkiewitz, Estrada, 2011; McDowell, Rodriguez, 2013; Ekinci, Kandemir, 2015). Treating substance abuse when it exists within comorbidity that includes trauma, the theme that emerges from the relevant research is that interventions which focus on the cognitive issues of the patient are most effective in addressing the problems of substance use dependency, as they seek to penetrate, understand, and orient the patient to the underlying causes while highlighting positive cognitive processes that can be utilized by the patient to help him or her overcome the obstacles preventing them from moving forward in a positive degree.

Research

McDowell and Rodriguez (2013) show that the relationship between trauma and substance abuse is such that one cannot effectively be treated without providing some form of intervention to address the other. For instance in patients being treated for trauma, substance abuse is a common problem that also needs to be addressed because otherwise it prevents positive outcomes from being obtained over the course of the trauma-focused treatment. The researchers found the cognitive processing therapy (CPT) worked effectively in both treatment of substance abuse and of trauma because it enabled the therapist and the patient to focus mindfully on the issues negatively impacting their lives: "Comorbid conditions are often believed to be harder to treat in terms of lower treatment response, attrition, or relapse of SUD [substance use disorders]. In this study, these problems were not observed, suggesting that trauma-focused treatment is effective and indicated for treatment of PTSD with comorbid SUD" (McDowell, Rodriguez, 2013, p. 362). By focusing on the trauma of the patient, the comorbid substance use dependency was also able to be treated effectively.

The study by Ekinci and Kandemir (2015) found that "childhood traumatic experiences increase the likelihood of psychiatric disorders like substance dependence" (p. 251) and that substance abuse patients "should routinely be examined" for evidence off childhood trauma. Their study supports the findings of the study by McDowell and Rodriguez in that finding the underlying causes of the substance abuse problem could provide a better understanding of the patient's issues and allow both patient and therapist to engage with a more appropriate intervention.

Giordano, Prosek, Stamman et al. (2016) note that in their study of 121 adult outpatients of a substance abuse treatment facility, 85.12% of them had experienced at least one traumatic event over the course of their lives (p. 55). Their study showed that trauma plays a major role in the lives of substance abusers and can be a viable focus for counselors tasked with treating patients with substance use dependency. As Giordano, Prosek, Stamman et al. (2016) state, "it seems imperative, therefore, that addictions counselors are sufficiently trained in trauma approaches" (p. 61). The problem they find, however, is that other researchers identify a lack of adequate trauma-focused therapy training among counselors and therapists working with substance abuse patients. The researchers conclude that "trauma-informed care" needs to be promoted among counselors and therapists who are treating substance abuse users, as trauma is so commonly found in the lives of these users.

These same themes are found again in the studies by Witkiewitz, Estrada (2011), Gifford, Tavakoli, Wang et al. (2013), and Boden, Kimerling, Jacobs-Lentz et al. (2011). In each study, trauma emerges as a dominant theme in the lives of patients seeking treatment for substance abuse. As Boden, Kimerling, Jacobs-Lentz et al. (2011) state, "post-traumatic stress disorder (PTSD) interacts directly with substance use disorders (SUD) to worsen SUD symptoms and make recovery less likely" (p. 578). The key to helping patients overcome the comorbidity of trauma and substance use dependency, training in trauma-focused care is very important (Giordano, Prosek, Stamman et al. (2016).

Analysis

Treating patients with substance used dependency should be a comprehensive exercise that addresses causes and not just symptoms of the problem. In the light of findings by McDowell and Rodriguez (2013), Ekinci and Kandemir (2015) and Giordano, Prosek, Stamman et al. (2016), as well as other researchers, it is evident that substance abuse commonly correlates with traumatic experience. That traumatic experience can range from early childhood trauma to adult trauma (such as PTSD for soldiers serving overseas). The patient's experience with trauma causes a repression of feelings, as a result of the individual's inability to confront the issue of trauma directly (Wietkiwitz, Estrada, 2011). A coping mechanism is used by the patient through the use of substances that become addictive for the individual (Boden, Kimerling, Jacobs-Lentz et al., 2011). This causes the individual's problems to worsen as now it is not just a matter of addressing the issue of trauma but also of addressing the issue of substance abuse, which can further aggravate the individual's mood, outlook, behavior, and ability to function with any degree of stability or consistency (Gifford, Tavakoli, Wang et al., 2013).

A counselor or therapist responsible for treating the patient suffering from substance abuse does not always address issues of trauma, yet this is one of the most common themes found by researchers among substance abuse patients (Gifford, Tavakoli, Wang et al., 2013). Moreover, treating substance abuse patients who suffer from depression, anxiety, stress, or mood disorders can cause lead to pharmacotherapy being utilized when this method of intervention does not provide the in-depth analysis that such patients need as a result of their trauma. In order for counselors or therapists to most effectively provide treatment for substance abuse, utilizing a trauma-focused care method can be highly impactful in a positive manner.

Therapists must be trained in providing trauma-focused care because currently there is little evidence found in the relevant research to indicate that therapists understand or practice a trauma-focused care treatment (Giordano, Prosek, Stamman et al., 2016).