Trauma And Substance Abuse : A Literature Review

Towards the end of the 20th century, most of the studies focusing on substance abuse focused on the needs of men. This means that the percentage of women affected by substance abuse remained unknown for several decades. In the recent past, studies have been done to analyze the psychological, health, and economic challenges affecting women who abuse different substances (National Institute of Drug Abuse, 2015). This marginalized group has been selected in order to understand the major health problems and experiences affecting them. By so doing, the information obtained from the study can be used to design evidence-based care models to support the target population.

The term “Psychological trauma” refers to damage wrought from a traumatic event, which that damages one’s ability to cope with stressors. “Trauma” is commonly defined as an exposure to a situation in which a person is confronted with an event that involves actual or threatened death or serious injury, or a threat to self or others’ physical well-being (American Psychiatric Association, 2000). Specific types of client trauma frequently encountered by which therapists and other mental health workers frequently encounter in a clinical setting include sexual abuse, physical , or sexual assault, natural disasters such as earthquakes or tsunamis, domestic violence, and school or/and work related violence (James & Gilliland, 2001). Traumatic

Trauma is perceived as a physical or psychological threat or assault to a person’s physical integrity, sense of self, safety and/or survival or to the physical safety of a significant other; family member, friend, partner. (Kilpatrick, Saunders, and Smith, 2003). An adolescent may experience trauma from a variety of experiences, including but not limited to: abuse (sexual, physical, and/or emotional); neglect; abandonment; bullying; exposure to domestic violence and/ or community violence; natural disasters; medical procedures; loss/grief due to a death of a family member(s); surgery; accidents or serious illness; and war (Kilpatrick, Saunders, and Smith, 2003).

Treatment for co-ocurring disorders fall under the outpatient spectrum for addiction rehabilitation, however, it is an essential and successful form of treatment specifically for veterans. For many civilians who have not been to combat it is difficult to comprehend the toxic combination of pride, anger, duty, anguish and anxiety many veterans feel after their time in the service. Consequently, adjusting back to civilian life is a difficult task to accomplish; while some veterans sustain only minor physical and psychological wounds from combat, others aren’t as lucky. As mentioned above, for veterans, PTSD is considered a mental health condition caused by the traumatic events experienced in wartime. Thus often causing veterans to drugs or alcohol to self-medicate. If left unaddressed, PTSD and substance abuse in veterans can be

Article Citation: Bernhardt, A. (2009). Rising to the challenge of treating OEF/OIF veterans with co‐occurring PTSD and substance abuse. Smith College Studies in Social Work, 79(3-4), 344-367.

Trauma is an individual’s visceral reaction to a horrible event, events such as early childhood traumas, accidents, sexual abuse, or community violence (apa.org, 2016). An individual may react with shock and denial in the aftermath. As time continues some reactions may comprise of mood swings, intrusive memories, difficulties maintaining relationships and can manifest into physical symptoms to include headache or upset stomach. There are individuals who experience difficulties functioning in their daily lives; these observable responses are a normal response to the trauma (apa.org, 2016).

The core-concept of an individual is largely influenced by one’s ability to regulate internal emotional states and one’s behavioral reactions to external stress. Children who experience trauma have difficulty managing their emotional states thus leading to poor perceptions of themselves. A distorted sense of self can potentially lead to loss of autobiographical memories, poor body image, and disturbances in sense of separateness in which the person may appear detached and distant (Carr, 2012). It may also lead to difficulty with impulse control which includes aggression

(2012) conducted a follow-up assessment on women who survived at least one episode of sexual assault at least three months prior to receiving treatment; 86% of the sample had experienced at least one other traumatic event in addition to the index event. To be included and considered for treatment, the participants could have no current psychosis, substance dependency, or violent ideation.

“American Psychiatric Association defines trauma as an event that represents a threat to life or personal integrity. Trauma can also be experienced when children are faced with a caregiver who acts erratically, emotional and /or physical neglect, and exploitation” (Maltby, L., & Hall, T. 2012. p. 304). Trauma comes in many different forms including: war, rape, kidnapping, abuse, sudden injury, and

Trauma occurs when a child has experienced an event that threatens or causes harm to her emotional and physical well-being. Events can include war, terrorism, natural disasters, but the most common and harmful to a child’s psychosocial well-being are those such as domestic violence, neglect, physical and sexual abuse, maltreatment, and witnessing a traumatic event. While some children may experience a traumatic event and go on to develop normally, many children have long lasting implications into adulthood.

Felmingham, K. L., & Bryant, R. A. (2012). Gender differences in the maintenance of response to cognitive behavior therapy for posttraumatic stress disorder. Journal Of Consulting And Clinical Psychology, 80(2), 196-200. doi:10.1037/a0027156

The experience of trauma can bring about feelings that are difficult for anyone else to understand. The feelings become even more complicated with addiction. It is important for practitioners to first understand the relationship of trauma and addiction to one another. Once the relationship is better understood, connections can be made to possible treatments and why those treatments should be used. Research testing these treatments can give possible avenues for practitioners to venture when faced with someone who is recovering from trauma and also facing a substance use disorder. The research available is a good start when trying to define the relationship between this co-occurring disorder.

Mark Laser pointed out eight trauma reactions that people can experience that leads to painful consequences such as addictions. They are (a) trauma splitting which is basically dissociation, (b) trauma pleasure, when one lives within the adrenaline rush that they experienced during the trauma (c) trauma blocking, medicating the pain with destructive behaviors, (d) trauma reaction, when the mind and body telling is them that they are wounded inside, (e) trauma abstinence, avoiding things or situations to keep the pain away, (f) trauma shame, feeling guilt or shame because of the trauma, (g) trauma repetition, repeating the same behaviors over and over because they feel safer than new behaviors and (h) trauma bonding, finding a relationship with a person who will help them.

The current study evaluated the efficacy of a trauma-informed perspective for women attending dual diagnosis mental health and substance use treatment. Univariate analysis was conducted to help determine the efficacy of the trauma-informed perspective. Table 1 shows the results from the univariate analysis of data. The standard deviation of the entire sample was .50. From the control group who did not participate in a trauma-informed group, 50% were successfully discharged and 50% were unsuccessfully discharged. Amongst participants who received a trauma-informed group, 70% were successfully discharged from treatment where 30% were unsuccessfully discharged from treatment.

There are many types of trauma that can effect an adolescent and without the proper treatment of the traumatic event the adolescent can have difficulty adapting and developing into adulthood. Kathleen J. Moroz, of the Vermont Agency of Human Services, defines trauma as a physical or psychological threat or assault to a child’s physical integrity, sense of self, safety of survival or to the physical safety of another person significant to the child. She goes on to list the types of trauma a child may be exposed to. Abuse of every kind, domestic violence, natural disasters, abandonment, serious illness or an accident are just a few traumatic events that can effect the development of a child. (2) When these events occur as an acute event