Trauma-focused care approaches for substance abuse treatment

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.

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).

Trauma-focused treatment and trauma-informed care utilizes "treatment approaches fostering safety, trustworthiness, choice, collaboration and empowerment," all of which are helpful for the patient in that they enable the patient to develop a healthy relationship with the therapist who is there to support them and they also give the patient the personal security, confidence and cognitive strength needed to overcome their substance abuse issues and address the trauma-related issues responsible for triggering the dependency upon the substances in the first place (Giordano, Prosek, Stamman et al., 2016, p. 61). This type of therapy has a stabilizing effect, enabling patients to "learn to manage emotions and identify triggers" and it also helps them to engage in "emotional processing," which is another form of treatment whereby the patient is assisted in processing "traumatic memories" and interweaving "them into their conceptualizations" (Giordano, Prosek, Stamman et al., 2016, p. 61-62). This process can be very useful in military settings, which already have a top-down-based model of authority in their organizational environment: using this model to implement the trauma-informed care approach can help soldiers returning from active duty and experiencing PTSD engage with their feelings and memories related to the trauma and reduce the risk of substance abuse worsening and trauma-related behavioral disorders manifesting in other forms (McDowell, Rodriguez, 2013). For individuals who have suffered childhood trauma and are now substance abusers, this same type trauma-informed care can be used to re-orient the patient to the underlying root causes of their problems and through the development of trust between the therapist and the patient, the latter can begin to address these issues, which are being manifested in their substance abuse.

Conclusion and Summary

Substance abuse treatment that does not take into consideration the role that trauma plays in the patient's life is a severely limited form of treatment that primarily focuses on the surface issues and does not address the causal issues for the patient's substance abuse. Trauma-informed care provides the counselor or therapist with an approach that allows him or her to engage with the patient's past history and uncover emotional memories that may have been suppressed that are related to the patient's experience of trauma. Therapists and counselors who work with substance abuse patients should be trained in trauma-informed care as this can be an effective way to help patients cope not only with their substance abuse but also with the psychological cause of their desire to abuse substances in the first place -- which is their experience of trauma. Since trauma is a very common theme found among substance abuse patients, counselors and therapists who are trained in trauma-informed care are better positioned to more fully and efficiently help their patients overcome their substance abuse.