Last Updated on May 11, 2021 by Atif
Trauma can occur after a person experiences an event or series of event that can hurt them emotionally or physically. This takes a toll on a person’s mental, emotional and physical health. There are various types of trauma. The most common ones are:
- Domestic violence
- Physical assault
- Parental neglect
- Bullying or ongoing harrassment
- Emotional or verbal abuse
- Terminal illness
Traumatic abuse puts people at risk of developing mental health conditions. They include depression, anxiety disorders, drug abuse and alcoholism, posttraumatic stress disorders (PTSD), borderline personality disorders, eating disorders, self-injury and even suicide.
Depression can occur when a person is experiencing feelings of loss, anger, sadness that affects their day to day activities. However, feeling sad or down is a normal part of life. But when it becomes something an individual experiences daily, it is known as depression. Depression gets worse when it is not being acknowledged and treated.
Addictiveness occurs when an individual can not stop taking substances harmful to the body. A person can be addicted to drugs, alcohol and other dangerous substances.
There is a dangerous link between traumatic abuse, depression and addictiveness. The connection between these disorders is that trauma can create various long term mental health issues. These issues may lead many individuals to self-medicate, excessive drinking or drug abuse. Addiction is most likely a response to past trauma, whether the individual realizes it or not.
Here are a Few Connections that Show the Importance of Connecting Trauma and Drug/substance Abuse Treatment:
- Traumatic Induced Addiction Starts at a Young Age: Various studies have shown a connection between traumatic and drug/substance abuse in young people. A recent study showed that children that experienced trauma are five times more likely to engage in alcoholism. Another research showed that young people who have been abused at least three times are more likely to turn to drug/substance abuse than those with no past trauma. This connection is relatively straightforward. Being exposed at a young age to stress, abuse, shock, or injury can lead to different mental health issues.
- One Key in Making the Connection Between Trauma and Drug/substance Abuse is SELF MEDICATION: Self-medicating either with drugs or alcohol is the first step to drug/substance abuse. While drug/substance abuse is the step before Addiction. Some individuals who have experienced trauma believe that self-medication with drugs or alcohol helps manage traumatic abuse stress. This simply means people turn to these substances to deal with trauma’s mental, emotional and physical impact. The idea is that taking these substances help to numb the pain or feelings.
- The Connection Between Traumatic Abuse and Addiction Goes Both Ways: As stated, earlier traumatic abuse creates an environment where Addiction occurs. It is also vital to know that drug/substance abuse can also lead to secondary trauma. This simply means trauma puts individuals at risk for drug/substance abuse and drug/substance abuse put these individuals at risk for concussion. Alcohol or drug abuse tends to impair a person’s body function and brain. This ensures that individuals who are already addicted to drugs or alcohol find it difficult to deal with traumatic abuse.
- Most People Do Not Realize the Need to Account for Traumatic Abuse and Addiction Treatment: Many individuals suffering from Addiction are unaware of the reason behind their Addiction. Individuals are most likely to continue in the path of Addiction if they did not recognize past traumatic abuse. This creates a cycle of trauma and Addiction until the individual receives trauma integrated addiction treatment.
Trauma Integrated Addiction Treatment
Although research and documentation on integrated approaches are still at their initial stages, it is preferred as a mode of treatment for individuals experiencing these disorders. Integrated treatments are increasingly recognized over the sequential and parallel models. This sequential model of treatment dominated the clinical field for an extended period. It was focused on the misconception that if Addiction is simultaneously treated with trauma, it will compete and aggravate symptoms. This particular model came with a lot of problems. For example, a focus on drug/substance abuse without paying attention to the cause of the trauma can lead to a regeneration of the situation in the nearest future. Another issue was that the aggressive approach that is typically used could escalate posttraumatic stress disorders (PTSD) and anxiety disorders.
Consequently, researchers continue to understand the integrated approach for individuals. According to a recent study, The Foundations Associates, based in Nashville, Tennessee, is in the process of completing a three-year SAMHSA CSAT funded grant through the Department of Mental Health and Developmental Disabilities. The project’s objective was to evaluate an integrated residential continuum’s efficacy and define specific techniques unique to that integration. As preliminary outcomes are optimistic, This article would show the project’s effort and effectiveness. Moreover, it aims to point out parallels in key program elements as they compare to a few principles described by Minkoff1 as a necessity in an integrated model of treatment:
1. Co-Occurring Disorder/disease is an Expectation, Not an Exception
The project experienced few difficulties engaging participants throughout its duration. The population were hard to get as they were open-minded to community treatment programs. The Consumer base has primarily consisted of high severity substance/SPMI population. Most of the participants experienced various importance and psychatric episodes before they were admitted. These participants admitted, regularly failed single system treatment experiences. A favourable response to a program that combined aggressive psychopharmacologic treatment and behavioural health counselling with superimposed 12-step Dual Recovery Anonymous (DRA) tenets was expected.
2. A Successful Treatment Requires Welcoming, Hopeful and Empathetic Continuous Treatment Relationships. This Helps to Sustain Coordination and Integrated Treatment Throughout Various Treatment Programmes
In this program, there is an emphasis on an engaging staff/client relationship and conducive environment. Motivational enhancement concepts are remodelled as the core for philosophy treatment throughout all activities.
An Individual’s readiness to change is the foundation for dual recovery. When a patient relapses, it is seen as a characteristic of the pathology condition. Whenever this occurs, the patients/clients are aggressively directed to resume the treatment. These episodes are used to intensify consumer introspection regarding triggers and indications of decompensation and relapse through therapy sessions, and support groups
3. Case Management and Care-Taking Must be Balanced with Empathetic Detachment and Confrontation Within the Context of the Continuous Integrated Treatment Relationship. Following the Level of Functioning, Disability, and Capacity for An Individual’s Treatment Adherence
It was early identified that giving treatment according to the individual’s pace was efficient. The technique was also adjusted to match withdrawal, changing symptoms and level of cravings. Short sessions of daily individual and group educational components were done frequently. This helped to address the confluence of disorders throughout a person’s stay. Team members engaged in weekly treatment meetings. This helped to refocus interventions according to the needs and progress of consumers. Immediate changes in the relationship structure were made. These changes were based upon withdrawal management, improvement in the program and symptoms. There are earned system of privileges after completion of treatment goals. The consumer’s responsibilities, care-taking efforts and case management shift according to need. All relapses and infractions are addressed accordingly. Motivational techniques are used to summon a client’s insight into these experiences.
4. when Substance and Mental Illness Disorder Co-Exist, Both Conditions Should be Considered Primary, and there is a Requirement for Immediate Integrated Dual Treatment
The following are viewed as essential co-primary treatment; Aggressive psychopharmacologic monitoring and therapy applied in conjunction with recovery principles such as structured housing, DRA and sober. There is a need to extend the program’s length, depending on the severity of the treated population. The size of an individual’s stay is evaluated based on their progress in the program. Related measures and level of stability are considered before individuals are moved to less restrictive care. Medications are monitored closely even when consumers are transferred to a lower level of care. In the case of decompensation or relapse, interventions are swiftly rallied. This can be done either through relapse evaluation committees, modification to the individual’s treatment/ contract plan, intensive psychiatric evaluation or a combination. Attendant monitoring of the other globe is increased accordingly when decompensation in one sphere occurs. The aim was to recruit staff that are trained in integrated theories. Although, bias within skills sets is a natural by-product of licensing bodies and single system educational curricula. Hence workshops, conferences and staff training are accentuated. Also, staff members rotate weekly presentations on contemporary approaches to integrated care. A library serves as a national repository and is part of the dual diagnosis recovery network.
5. Psychiatric Illnesses and Substance Dependence are Examples of Chronic, Biological, Chronic Mental Health Diseases. A Disease and Recovery Model is Used to Understand them. Parallel Recovery Phases can Characterize These Disorders. These Phases Include Active Treatment, Acute Stabilization, Prolonged Stabilization and More
A hallmark of this principle is psychoeducation. This shows that education on the disease model, strategies, management, self-monitoring, and interrelatedness of conditions helps bring the element of hope. This element of hope facilitates movement through stages of change in recovery. This psychoeducation can occur through house meetings, residential therapy programs, the NAMI model, Bridges, family education programs and structured group programs. These programs offer consumer-led in-house education groups. All these psychoeducation groups mentioned above help to integrate parallels as a central theme in dual recovery, emphasizing the methodologies for maximizing the level of quality of the victim’s life.
6. There is No Absolute Correct Dual Diagnosis Intervention. Interventions Must be Individualized According to Appropriate Practice Guidelines, Following the Subtype of the Particular Dual Disorder, Specific Diagnosis and Phase of Treatment/recovery, and Functional Capability or Disability Levels
Assessment strategies include many measures and sources to assess the major life domains and placement/service needs. These consist of the administration of a variety of objective indicators to determine the individual’s preparedness for services, along with the utilization of multiple sources of information to analyze every outcome domain. The rulings of the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders (ASAM PPC-IIR) are integrated with the processes that
assist in bench-marking the levels of treatment per the patient’s needs. Hence, the population treated at Foundation Associates predominantly consists of 10% of the population utilizing the excess 70% of healthcare resources; the effects of co-occurrence further cements consumer-tailored treatment that is dynamic and permits multiple approaches. However, while early phases are aimed at stability, medium phases are more about defining personal goals and plans for attaining those goals, and later phases toward reintegration, services are continually adjusted to match the consumer’s ever-changing needs; Since multiple prior treatments are a feature of the composite pathology of treated patients.
Episodes and a typical history of only short-term sobriety and enforcement of a zero-tolerance model do not affect any meaningful progress. While abstinence is the final goal, harm reduction must be emphasized to measure progress within both staff and patients. Non-punitive reactions to lapses and relapses are crucial to real time commitment and ultimate improvement through the degrees of change.
7. Within a Managed-Care System, Any Individualized Phase-Specific Intervention can be Applied at Any Level of Care. Consequently, a Layered Approach to the Individual’s Care is Needed
Active assessment is crucial to service and intervention incorporation. While assessment yardsticks will be discussed in detail in a report that came much later, the ASAM-PPC-IIR criteria, in conjunction with a series of regulated and non-standardized actions, are applied to guide the treatment plan. The report is an essential part of those measures as, while specific faults are intertwined in the self-improvement process, the significance of client understanding cannot be overemphasized. Many practical questions require answers to create a fully functional program. At the beginning of the program, there are usually no easily accessible residential models upon which to build. Several examples of residential programs with proven effectiveness have emerged in the following years. We hope that this project’s experiences can inform other programs poised to turn principle into practice while leaving room for plans to customize treatment plans to the needs of the patients. After a 3-year longitudinal research investigation, the overall results support promising results from this modified model. The Outcome from these efforts will be reported in a subsequent article in this series, reflecting follow-up data on 86% of the study participants. Foundations Associates, located in both Nashville and
Memphis, presents a selection of outpatient plans, along with an in-patient treatment schedule posessing a 72 slot capacity that includes crisis resolution, therapeutic circles, partial or complete housing, and solo living arrangments. All programming is explicitly designed to provide integrated treatment for individuals with co-occurring disorders. For bookings and enquiries, you can reach our chief officer of operations Dick Clark, on 615/345-3214.
Types of Integrated Programs
- Cognitive Behavioural Therapy: This approach focuses on a wide range of coping strategies to avoid symptoms and reduce arousal among individuals. These individuals were maybe experiencing Post-traumatic Stress Disorder or Drug/substance abuse. An 8-12 session integrated Cognitive behavioural therapy program incorporates some techniques. These techniques include breathing retraining, psychoeducation, relapse prevention, cognitive restructuring and self-monitoring. These techniques help reduce comorbid posttraumatic stress disorder and drug/substance abuse among individuals compared to those that solely depend on individual addiction counselling.
- TARGET (Trauma Affect Regulation): This is a group intervention for posttraumatic stress disorder and substance/drug abuse. TARGET is manualized. It also provides a framework for safely processing Posttraumatic stress disorder and drug/substance abuse. With this framework, the individuals do not experience psychological symptoms of hypervigilance, dissociation, decompensation, compromising sobriety or avoidance. This curriculum can be completed in ten or fewer sessions. TARGET was found as a superior treatment in maintaining self-efficacy and sobriety.
- Seeking Safety (SS): This is a twenty-five session, present-focused, manualized intervention that addresses co-occurring posttraumatic stress disorder and drug/substance abuse. This intervention integrates behavioural, interpersonal topics cognitive, and participants receive psychoeducation about trauma consequences. This helps to develop the link between trauma and substance abuse. It also helps to develop adequate coping skills. Seeking Safety has received the most empirical attention of all the integrated psychosocial treatment designed for Posttraumatic Stress Disorder snd drug/substance abuse.
- Traumatic Recovery and Empowerment Model (TREM): This method was original created for women who struggle with trauma and substance abuse. It has recently been adapted for men, known as M-TREM. TREM incorporates CBT techniques, practical coping skills and psychoeducation. It is conducted in 24-29 sessions. This program is used in residential and non -residential correctional institutions, community mental health settings and substance abuse programs.
- Addictions and Trauma Recovery Integration (ATRIUM): This is a twelve-week integrated program. It combines the use of relational treatment and cognitive behavioural treatment. It focuses on interpersonal violence and childhood trauma. ATRIUM provides training in mindfulness and relaxation. It incorporates expressive and psychoeducational techniques. ATRIUM helps individuals to develop skills that can actively stop negative automatic thoughts. It also helps to develop coping skills and more appropriate self-care.
- Using Prolonged Exercise for the Concurrent Treatment of Post-Traumatic Stress Disorder and Drug/substance Abuse (COPE): This is a relatively new treatment that addresses PTSD and substance abuse co-morbidity disorders. This program provides more favourable results by reducing Post-traumatic stress disorder symptoms than usual treatment.
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. We are honored to have Ben writing exclusively for Dualdiagnosis.org.