While we have known for thousands of years that alcohol and drug problems were often related to past traumas, it’s only in the past few decades that treatment programs for substance use disorder (SUD) have started to take the role of trauma in these issues more holistically.
Attempts at what would be recognized as trauma-informed care go back almost as far as the modern practice of substance rehabilitation, but it was not until the 2001 publishing of Using Trauma Theory to Design Service Systems: New Directions for Mental Health Services by Harris & Fallot that a model for such care began to be more seriously considered in wider practice.
The premise, as stated by the book’s authors, changes the basic question of rehab and treatment from “What is wrong with this person?” to “What has happened to this person?”. Today, trauma-informed care approaches are common in Boston rehab centers, particularly among those that specialize in dual diagnosis cases.
Contrary to what you might expect, trauma-informed care in drug and alcohol rehab practice does not necessarily involve addressing trauma, PTS, or PTSD. The idea is simply for the people involved in an individual’s treatment and rehab to be aware of how trauma has or might have affected them. This is meant to prevent worsening the patient’s condition by unintentionally touching off their emotional triggers.
In the aftermath of the Vietnam War, it became clear that veterans of the conflict were far more likely to have problems with drugs and alcohol compared to the general population. Later, it was found that many other people with drug and alcohol problems also had traumatic experiences and shared much the same patterns, leading to studies that ultimately linked a large proportion of substance use disorders with emotional trauma.
The numbers vary depending on the study, but anywhere from a third to two-thirds of people diagnosed with an SUD also have post-traumatic stress (PTS) or post-traumatic stress disorder (PTSD). Other mental health issues have also been linked to both SUD and trauma, including depression and anxiety.
Given that even the most conservative estimates of co-occurring trauma and SUD are still quite significant, there should be a theoretical benefit to approaching all SUD cases with the assumption trauma may be involved. This way, therapists and other clinicians can develop a pattern of care that avoids “re-traumatizing” individuals and helps with their long-term recovery.
While the existence of a link between trauma and SUD is no longer disputed, as of now, there is no wider consensus on why this link exists. In the United States, there are four leading hypotheses on the trauma-SUD connection. These are, in order of popularity, the self-medication hypothesis, the shared vulnerability hypothesis, the susceptibility hypothesis, and the high-risk hypothesis.
Trauma-informed care is associated with a number of approaches and treatments, a few of which we’ll explain below. Please note that facilities and programs that do not specifically offer trauma-informed care may offer these as well.
1.) Eye Movement Desensitization and Reprocessing (EMDR)
This type of psychotherapy was developed specifically to help people with PTSD. In cases where the patient has trauma linked to their SUD, the application of this therapy may be used to address both issues.
In EMDR sessions, therapists will ask patients to focus on or track objects with their eyes. During this time, the therapist will try to elicit traumatic memories and their associated emotions. They may then guide the patient towards more pleasant thoughts. When done right over multiple sessions, this can lessen the negative effects of the traumatic experience.
2.) Dialectical-Behavior Therapy
This approach uses meditation and mindfulness techniques to help the patient achieve better emotional regulation. This is often done to prepare them for other types of therapy that they may not be emotionally prepared to go through.
3.) Exposure Therapy
The idea of this approach is to acclimate the patient to experiences they find stressful by allowing them to reexperience the trauma in a milder form within a safe and controlled space. This may help them tolerate and eventually accept situations that would normally cause them to experience unbearable stress.
Trauma-informed care is fast becoming one of the most used general approaches in rehabs today. Even if you don’t believe that trauma has a connection with your SUD, it may be worthwhile to try out these programs, as the existence of trauma may not be immediately apparent to affected individuals.
For a listing of treatment programs in New England that offer a trauma-informed approach, you can contact our team at Boston Drug Treatment Centers. Good luck, and be well!