9/12/2015 Phoenix Arizona

Understanding Trauma in Addiction Treatment

Presented by, Noé Vargas, DBH, LPC, FT

At the Association for Addiction Professionals (NAADAC) Annual

Conference Washington D.C. October 11, 1025

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Welcome!

Introductions

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Outline • Terminology • Trauma and SUD/Addiction

• Assessment & Treatment

What is your understanding of psychological

trauma?

Why is it important to understand the impact SUD/Addiction has in individuals suffering

with psychological trauma?

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Terminology

• Subjective • Could threaten the life, or physical integrity of an individual • Brain response (triune brain)

• Emotional response

• Physiological response

• Trauma overwhelms the individual window of tolerance or coping response

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What Is Trauma?

•Acute trauma or type I trauma •Chronic trauma or type II trauma

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Types of Trauma

Prenatal Postnatal

When Does Trauma Begin?

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•The Triune Brain: https://www.youtube.com/watch?v=eZJaQPHL764

•Reptile Brain

•Limbic System •Neo-cortex

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Trauma & the Brain

8 & 9

• Abuse •Sexual, Physical & Neglect

• Domestic violence •Trafficked children •Witnessing or exposure to violence •Natural disaster survivor •Substance Abuse/Addiction exposure

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Childhood Experiences Leading to Trauma

2 & 7

Overlapping of SUD & Trauma/PTSD

Substance usages predisposes individuals to a higher rate of traumas.

The combination of SUD/Addiction & Trauma increases the changes for other mental health problems.

Substance usage can interfere with treatment outcomes.

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Overlapping of SUD & Trauma/PTSD

Usage of substances to self-medicate. Heavy substance usage

increases victimization. Substance usage increases

trauma symptomatology.

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•Protective mechanism •Coping mechanism •Stressful or high emotional event

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Dissociation Overview

7, 8, & 2

What is resilience?

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Role of Resiliency

•Ability to recover from traumatic events

•Safety •Capable & Lovable

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The Resilient Person

2

• Perspective on disorders https://www.youtube.com/watch?v=BR6m7FL1Dko

• Consider client’s cultural background when screening and assessing.

• Cultural behavioral accepted practices

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The Impact of Culture on the Healing Process

1, 3, & 4.

• Ethno-cultural, beliefs and values (trauma & substance usage)

• Community practices, norms and resources

• Family heritage and dynamics

• Understand acculturation levels • Individual bio-psychosocial resources and vulnerabilities

• Prior exposure to traumatic experiences

• Previously established patters of coping (Substance usage) • Language preference

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Cultural Aspects When Assessing Trauma &

SUD/Addiction

1 & 11

• Substance Use itself does not constitute a trauma.

• Screen/Assess for Trauma and SUD/Addiction both.

• Assessing for trauma can be done

even if a client continues to use.

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Central Issues to Trauma Assessment

6 & 11

• Assess psychological symptoms that may be associated to trauma.

• Assess for mental and SUD/addiction,, as well for trauma related symptoms.

• Know the differences between a screening and an assessment instrument.

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Awareness of Co-0curring Diagnosis

6

• Physical safety • DTS/DTO • Psychosis • Other Psychological Debilitation • Mental functioning • Support Systems • Trauma status

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Critical Issues when Assessing Co-occurring

6

• PC-PTSD • LCE-5 Part I and/or II • PCL-5 (different versions) • DAST (different versions) • The AUDIT • The CAGE • WHO- ASSIST V3.0

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Few Practical Screening & Assessment Tools

Partially 6

•Identification of trauma •Assessment of trauma •Building safety •Psych-education •Processing (an integrated approach) •Closure

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Overview of the Trauma Healing

Process

6

•Realizing

•Recognizing •Responding

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Trauma Informed

Approach

6

•Respect •Positive regard •Compassion •Installing hope •Form a therapeutic relationship with your client

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Central Issues Trauma

Informed Care

2, 6, & 4.

•Re-Traumatization

•Vicarious Trauma

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Clinical Aspects to

Consider

http://www.ptsd.va.gov/professional/assessment/ncptsd-instrument-request-form.asp http://www.psychiatry.org/psychiatrists/practice/dsm/dsm-5/online-assessment-measures#Disorder http://www.nctsn.org/ http://www.samhsa.gov/

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Resources for

Counselors

Any questions?

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Q & A

1 . A g a t h o n o s - G e o r g o p o u l o u , H . ( 1 9 9 2 ) . C r o s s - c u l t u r a l p e r s p e c t i v e i n c h i l d a b u s e a n d n e g l e c t . C h i l d A b u s e R e v i e w , 1 , 8 0 - 8 2 . 2 . B r i e r e N . J . , & S c o t t C . ( 2 0 1 5 ) . P r i n c i p l e s o f T r a u m a T h e r a p y : A g u i d e t o s y m p t o m s , e v a l u a t i o n , a n d t r e a t m e n t . T h o u s a n d O a k s , C A : S a g e 3 . C o r e y , G . , C o r e y S . M . , C o r e y C . , & C a l l a n a n , P . ( 2 0 1 5 ) . I s s u e s a n d e t h i c s i n t h e h e l p i n g p r o f e s s i o n s . S t a m f o r d , C T : C e n g a g e L e a r n i n g . 4 . I v e y , E . A . , I v e y , B . M . , & Z a l a q u e t t , P . C . ( 2 0 1 6 ) . E s s e n t i a l s o f i n t e n t i o n a l i n t e r v i e w i n g . C o u n s e l i n g i n a m u l t i c u l t u r a l w o r l d : B o s t o n , M A : C e n g a g e L e a r n i n g . 5 . O k l a h o m a T r a u m a t o l o g y I n s t i t u t e . ( 2 0 0 6 , J u n e ) . F i e l d T r a u m a t o l o g y T r a i n i n g . P h o e n i x , A Z : A u t h o r . 6 . S u b s t a n c e A b u s e a n d M e n t a l H e a l t h S e r v i c e s A d m i n i s t r a t i o n . T r a u m a - I n f o r m e d C a r e i n B e h a v i o r a l H e a l t h S e r v i c e s : T r e a t m e n t I m p r o v e m e n t P r o t o c o l ( T I P ) S e r i e s 5 7 . H H S P u b l i c a t i o n N o . ( S M A ) 1 4 - 4 8 1 6 . R o c k v i l l e , M D : S u b s t a n c e A b u s e a n d M e n t a l H e a l t h S e r v i c e s A d m i n i s t r a t i o n , 2 0 1 4 . 9/12/2015

References

7 . T h e N a t i o n a l C h i l d T r a u m a t i c S t r e s s N e t w o r k ( 2 0 1 0 ) . R e s o u r c e p a r e n t w o r k s h o p s : f a c i l i t a t o r g u i d e . h t t p : / / w w w . n c t s n e t . o r g / 8 . T h e N a t i o n a l C o u n c i l o n t h e D e v e l o p i n g C h i l d ( 2 0 0 5 ) . E x c e s s i v e s t r e s s d i s r u p t s t h e a r c h i t e c t u r e o f t h e d e v e l o p i n g b r a i n : w o r k i n g p a p e r # 3 . h t t p : / / w w w . d e v e l o p i n g c h i l d . n e t 9 . V a n d e r K o l k , B . A . ( 2 0 0 x ) . D e v e l o p m e n t a l t r a u m a d i s o r d e r . A n e w , r a t i o n a l d i a g n o s i s f o r c h i l d r e n w i t h c o m p l e x t r a u m a h i s t o r i e s . P s y c h i a t r i c A n n a l s 2 - 8 . 1 0 . V a n d e r K o l k , B . A . ( 2 0 0 5 ) . D e v e l o p m e n t a l t r a u m a d i s o r d e r . T o w a r d a r a t i o n a l d i a g n o s i s f o r c h i l d r e n w i t h c o m p l e x t r a u m a h i s t o r i e s . P s y c h i a t r i c A n n a l s , 3 5 ( 5 ) , 4 0 1 - 4 0 8 . 1 1 . W i l s o n , P . J . , & T a n g S . C . ( 2 0 0 7 ) . C r o s s - c u l t u r a l a s s e s s m e n t o f p s y c h o l o g i c a l t r a u m a a n d P T S D . N e w Y o r k : L i b r a r y o f C o n g r e s s .

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References