Trauma-Informed Care in Addiction Treatment

Trauma can play a major role in the development of mental health issues, from depression and anxiety to substance use disorders.

Successfully treating such problems can often require focusing on this trauma and untangling its role in an individual’s difficulties.

Engaging with trauma through targeted care and treatments requires both sensitivity and patience.

Supporting individuals in engaging with and working through their trauma to relieve an addiction is best done by adhering to a number of key principles and ideas.

The connection between trauma and addiction

There are a lot of studies which indicate a significant connection between trauma and addiction, especially when it comes to maltreatment as a young person and the development of substance abuse in middle age [1].

This trauma can take many forms. These include:

Bereavement
Abuse, either physical or emotional
Life-altering accidents
Witnessing abuse or violence
Traumatic childbirth
Crime

Not only does trauma increase the risk of developing an addiction, but those who are trying to work through their addiction are less likely to see long-term improvement if they have experienced trauma [2].

As a result, optimising the effectiveness of addiction treatment for these individuals requires trauma-informed care.

Defining trauma-informed care

Before trauma-informed care can be identified and pursued in order to effectively treat addiction, it must first be defined and distinguished from alternative methods of recovery.

As its name suggests, trauma-informed care is addiction treatment which pays appropriate attention to the incidents and violence an individual has been through as part of its system of healing and recovery [3].

For those recovering from addiction, this care considers the role that trauma has played in the development of a substance use disorder as well as the ongoing impact it has on reinforcing and perpetuating addictive behaviours.

For example, an individual who has been through a traumatic road accident will have their treatment focus on the initial impact of the accident – alcohol being used a temporary physical and psychological anaesthetic – and its ongoing impact – drinking to forget or function normally.

The principles of effective trauma-informed care

Identifying the link between trauma and addiction is only the first stage of trauma-informed care. Throughout treatment, an individual is supported and guided by a number of core principles which make the treatment truly unique.

1. Trauma as an active influence on behaviour

First and foremost, this form of addiction treatment focuses heavily on the impact of trauma. An accident or history of abuse can not only determine an individual perception of substance use, but also that of their self-worth, relationships with other people, and the world as a whole.

Individuals are supported in identifying the ways in which trauma has both influenced past behaviour and continues the influence present actions and decisions. Trauma is an active influencer, not merely a scar from the distant past.

2. Creating a space for cooperation and communication

Within treatment, a safe space is created which fosters open and honest communication between patients and treatment support staff.

The purpose of this space is to facilitate communication about an individual’s trauma and how they can engage with it in a healthier way. Talking about such things can be emotionally demanding, so this arena of confidentiality and trust is essential.

Balancing an individual’s experiences of control, choice and safety is also pivotal to ensuring that they do not feel victimised by what the treatment is talking about and instead remain focused on the purposes and desired outcomes of each discussion.

3. Recognising complexity through education

The relationship between trauma and addiction is never a simple one, and this treatment keeps this idea firmly in mind throughout an individual’s sessions.

The link between an individual’s experience and their addiction may not be clear, and a number of unconscious feelings and perceptions may well be at play. Effective treatment is all about exercising patience and remaining focused on the long-term goals of recovery.

4. A constant dual focus

Whereas alternative methods of support may focus on either an individual’s trauma or their substance abuse, trauma-informed care maintains a constant duality, looking at both things and how they affect one another.

This means that while unpacking trauma in a safe and productive way is important, talking through addictive behaviours and the impacts of substance abuse on health are equally so.

5. Prioritising safety through empowerment

As with all addiction treatment methods, safety is the top priority during trauma-informed care. An individual’s experience is considered with the utmost care and compassion, ensuring they not only recovery from addiction but do so in a controlled and long-lasting manner.

But in addition to this physical sense of safety, treatment that focuses on trauma also concerns itself with the emotional and mental safety of an individual as they closely consider the events that have shaped their life so drastically.

Sessions also prioritise an individual’s right to progress at a speed with which they are comfortable. Discussions always proceed with compassion and consideration of how they are feeling, and the goals of treatment are approached with this forethought throughout.

6. Looking to the future

Dealing with trauma involves a great deal of looking back to an individual’s past and how it impacts their present behaviours. However, trauma-informed care also looks to the future.

Not only does the treatment look to help individuals develop techniques and coping mechanisms for handling their trauma in a way that prevents substance misuse from reoccurring, but it also identifies other forms of support that can be used in the future.

Common methods of trauma-informed care

Although the principles of effective trauma-informed care are consistent, the means through which this treatment can be provided varies. Individuals can undergo the treatment through a number of different methods, each with its own perks and opportunities.

1. Dialectical Behavioural Therapy (DBT)

Derived from Cognitive Behavioural Therapy (CBT), DBT encourages individuals to work through difficult and problematic thoughts and feelings through guided and supported discussions.

Designed to help individuals both cope with their trauma and understand it better, DBT helps them work through their experiences in order to identify the impacts it has on current behaviour and the ways in which these influences can be reduced or negated.

2. Eye movement desensitization and reprocessing (EMDR)

Combining emotional treatment with an element of physical activity, EMDR sees individuals engage with their traumatic experiences while also being tasked with a small motion or task.

This could see them talking about their experiences while simultaneously engaging with several directed eye movements, following an audio recording’s instructions, or using a small instrument like a bell.

By engaging with something practical, individuals working through EMDR can experience a smoother route to their more sensitive and traumatic memories and feelings.

3. Seeking Safety

An evidence-based treatment specifically designed for the dual diagnosis of post-traumatic stress disorder (PTSD) and substance abuse, Seeking Safety helps both individuals and groups work to develop effective coping mechanisms.

With a slightly greater focus on the PTSD/trauma side of this comorbidity [4], Seeking Safety is flexible and adaptive in order to help everyone develop techniques and strategies that work for them.

A closer look at trauma and how addiction treatment engages with it

As a blanket term, trauma can be used to describe a wide range of experiences and feelings. However, by breaking it down into its significant components and looking at them individually, it becomes easier to see how trauma-informed care supports individuals in the long-term.

In order to better understand trauma, it’s best to divide it into the three Es: events, experiences, and effects.

1. Events

Perhaps the simplest component of trauma to identify is the event or events that have caused it. Individuals who experience trauma will have undergone a single or a sequence of events that have physically and emotionally impacted them.

For many, the traumatic event in question will become a pivotal turning point in their development as a person, and they will often be able to recall it in excruciating detail.

In trauma-informed care, the first milestone of treatment will be to identify the event or events in question. For some, this can be difficult as they may instead have repressed the details of a traumatic experience and not be able to address it with any sufficient detail when asked.

2. Experience

What many don’t think about when they consider trauma are the different ways individuals can experience the same trauma events. A car accident could happen to three people, but each individual will think and feel differently about it based on a variety of factors.

Such factors might include:

Age
Occupation
Upbringing
Religious beliefs
Worldview
Self-worth
Previous traumatic experiences

A good example might be a police officer. They may have seen a number of traffic accidents before as part of their job and so react to themselves being in an accident differently to someone who has never witnessed a crash or its aftermath before.

These different experiences of the same event can manifest in a spectrum of emotions. Individuals can feel shame, guilt, anger, fear, as well as any other emotion, and this response will strongly determine how they recall the event and how it influences their future behaviour.

In trauma-informed care, identifying the relationship between an event and addiction will concern itself with understand how an individual has experienced a traumatic event and how they felt/continue to feel about it.

The same event may occur to two people, but they can have different perspectives and emotional responses to it. As a result, they can develop different subsequential relationships with drugs and alcohol which will need to be understood in order to provide effective treatment.

3. Effects

Following a traumatic event, an individual will have a trauma response. The graphic, frightening, or emotionally momentous nature of the event they have experienced will take a toll on how they act and feel, but this doesn’t necessarily happen immediately or in a single breakdown.

Some individuals may take years to experience the effects of their trauma, and they can often not be aware that there is a connection between the effects they are feeling and the experience they went through.

As a knock-on effect of the variety of ways individuals can perceive and respond to traumatic events, the effects that they experience in the years after an event can also be wide-ranging and complex:

An inability to handle stress: Following a traumatic experience, individuals can develop a heightened sensitivity to situations or activities which prompt a stress response. The situation doesn’t have to be similar to the traumatic experience in nature, but it often applies pressure onto an individual which they are uncertain about being able to navigate or handle effectively without an influx of negative thoughts and emotions. In some cases, the traumatic experience causes individuals to anticipate similar levels of distress on a regular basis going forward, so they expect much more stress to result from situations that are only slightly stressful in reality.
Strained interpersonal skills: Trauma can have subtle impacts on the ways in which individuals perceive and interact with other people. They can sometimes lose their knack for speaking with and being comfortable around others, or they can lose sight of them as important parts of their life. This can result for a number of reasons. Individuals can become so concerned with avoiding traumatic experiences that they become insular and antisocial, or they can become uncomfortable sharing personal experiences with others and so avoid getting close.
Cognitive difficulties: Individuals who have undergone a traumatic experience can find themselves developing complications with their brain development and faculty functionality. Specifically, they can often experience problems with memory, concentration, and learning.
Paranoia and hypervigilance: Undergoing a traumatic experience can often make individuals more wary of the situations they get into and the people they interact with. This is a reasonable response in principle, but the power of trauma can often make individuals paranoid beyond reasonable standards. Exhaustive research, checking foods and drinks before consuming, developing suspicions about people – individuals can become hyperaware of the smallest details concerning their day-to-day life, so much so that it takes away from their consideration of important things. As noted above, this hypervigilance can detract from the upkeep of personal relationships, career progression, and physical health/hygiene.
Risk avoidance: In order to avoid experiencing trauma again, individuals can eliminate all degrees of risk from their life. This can be physical risk – such as not engaging in thrilling or exhilarating activities – as well as emotional and interpersonal. This approach to life can be pursued to such as an extent that individuals don’t do anything they haven’t done before or push themselves to better their lives in any way.
Repression/obsession: An individual’s reaction to the traumatic stimulus in their life can also follow one of two extremes. They can completely neglect and ignore their experience, or they can put it on a pedestal and think about it constantly. With repression, individuals push their experiences so far from their conscious mind that they behave as though it never happened. This creates problems where they have unconscious outlets to deal with their trauma, resulting in emotional and mental pain. With obsession, individuals consider their traumatic experience in everything they do, thinking about it and acting in accordance with it at every opportunity. This means they don’t consider things based on merit, but exclusively on how it relates to their trauma.