Trauma and its Links to Mental Health

Traumatic experiences and substance abuse often go hand-in-hand. People have a tendency to directly associate the two together, as trauma often triggers alcohol or drug dependency. This is a commonly known connection, but treatment and therapy has historically failed to understand the theories behind this close-knit relationship. This is an evident trend in the context of sexual assault. History tells us that sexual assault is associated with a higher risk of problem drinking and drug use in women. But little is known about the mechanisms linking trauma histories in general to women’s drinking or drug use problems.[1] We all know there is a link, but the real question is: why?

Trauma can be defined as experiencing, witnessing, or being threatened with an event that involves actual serious injury, a threat to physical integrity, or possible death. The responses to these events may include intense fear, helplessness, or horror.[2] This events may involve military combat, sexual assault, physical attacks, robbery, mugging, being kidnapped or taken hostage, torture, natural or manmade disasters, automobile incidents and life-threatening disease.[3]

All in all, these events can be incredibly damaging. The effects are long-lasting, and painful memories can be initiated at any time. This prolonged effect is why people turn to drugs or alcohol. These substances offer a temporary fix – a chance to mask the true emotions.

This is a significant and complex connection.[4] But addictions councillors’ trauma approaches are limited.[5] Until recently, the two issues were treated separately. Therapy institutes were aware of the link but did not see overlapping treatment programmes as effective means to solve both issues. The link is being reported and understood now more than ever. Clinicians have noted that many patients describe a pattern of alcohol and other drug use as motivated by a desire to obscure or escape uncomfortable experiences.[6] And in one study, out of 121 adults in outpatient substance abuse therapy, 85% claimed to have experienced at least one traumatic event in their life. [7]

If therapists or clinicians fail to understand this link, then the entire treatment programme can be jeopardised. For example, patients with post-traumatic stress disorder (PTSD) often use alcohol and/or drugs in a problematic way. Failure to recognise this connection between symptoms has seen providers frequently misdiagnose and mistreat many cases.[8] Even when the link is recognised, there are still a number of different approaches – many miss the point and are ineffective. This can be seen in sequential approaches, where substance abuse problems have to be addressed before turning to trauma-related difficulties.[9] So, it begs the question: how should we treat these two issues?

To start, therapists must make the link; accept that these are connected and can both have a lasting impact on the outcome of treatment. This is a good starting point. From here, there are two approaches that can be adopted: trauma-informed programmes or trauma-specific interventions. At Ishmail and Associates, we believe a combination of the two is most effective, and here’s why.

Trauma-informed services consider knowledge about the trauma – its impact, interpersonal dynamics, and paths to recovery – and incorporate this knowledge thoroughly in all aspects of service delivery. These services understand that problem behaviours originate as attempts to cope with abusive experiences.[10] On the other hand, trauma-specific services are more focused. They try to directly address the impact of trauma on lives and to facilitate recovery and healing.[11] In our professional opinion, the ideal substance abuse treatment programme is a well-balanced combination of the two. This would mean creating a sensitive and stable, trauma-informed environment, and offering additional trauma-specific interventions.[12]

An integrated approach is key here. If therapy is approached with both issues in mind, then dealing with both will be far more successful. As mentioned earlier, we believe addressing both simultaneously is the best option. Many therapists do become confused when trying to do this. Because they do not understand the link, they prioritise their tasks and approaches incorrectly.[13] If treatment plans address these issues independently, then they are only undermining the close relationship between trauma and substance abuse.

Within substance abuse recovery, the task of addressing traumatic experiences is emerging as one of the most important clinical challenges today. Despite this, more and more practitioners are seeing it as a core element in improving outcomes in treatment settings.[14] If therapists fail to address trauma as part of the treatment, it can have an adverse effect on proceedings. Trauma can be triggered at any time and can be crippling for that person. If therapists do not understand or appreciate this, the entire therapy risks being undermined. Misidentified or misdiagnosed trauma-related symptoms interfere. They can hamper engagement from that particular client, cause early dropout and significantly increase the chances of relapse.[15] Getting this right is, therefore, critical to ensure long-term and effective recovery.

 


 
Sources:

[1] Ullman, S. E., Relyea, M., Peter-Hagene, L. and Vasquez, A. L. 2013. Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims in Addictive Behaviours. [online[, available at: https://www.sciencedirect.com/science/article/pii/S0306460313000397 [accessed 7 July 2020].
[2] Vandemar N., Brown, V., and Fallot, R. D., 2004. Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment, [online], available at: https://www.researchgate.net/profile/Vivian_Brown2/publication/264839544_Enhancing_Substance_Abuse_Recovery_Through_Integrated_Trauma_Treatment/links/53f607e20cf2888a749243db.pdf [accessed 7 July 2020].
[3] Zweben, J. E., Clark H. W. & Smith, D. E. 1994. Traumatic Experiences and Substance Abuse: Mapping the Territory, Journal of Psychoactive Drugs, 26:4, DOI: 10.1080/02791072.1994.10472453 [accessed 7 July 2020].
[4] Vandemar N., Brown, V., and Fallot, R. D., 2004. Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment, [accessed 7 July 2020].
[5] Giordano, A. L., Prosek, E. A., Stamman, J., Callahan, M. M., Loseu, S., Bevly, C. M., . . . Chadwell, K. 2016. Addressing trauma in substance abuse treatment in Journal of Alcohol and Drug Education, 60(2), available at: https://search.proquest.com/docview/1826099279?accountid=14511 [accessed 7 July 2020].
[6] Zweben, J. E., Clark H. W. & Smith, D. E. 1994. Traumatic Experiences and Substance Abuse: Mapping the Territory, Journal of Psychoactive Drugs, [accessed 7 July 2020].
[7] Giordano, A. L., Prosek, E. A., Stamman, J., Callahan, M. M., Loseu, S., Bevly, C. M., . . . Chadwell, K. 2016. Addressing trauma in substance abuse treatment in Journal of Alcohol and Drug Education, [accessed 7 July 2020].
[8] Ouimette, P., & Brown, P. J. (Eds.). 2003. Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. American Psychological Association. https://doi.org/10.1037/10460-000 [accessed 7 July 2020].
[9] Vandemar N., Brown, V., and Fallot, R. D., 2004. Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment, [accessed 7 July 2020].
[10] ibid.
[11] ibid.
[12] ibid.
[13] Zweben, J. E., Clark H. W. & Smith, D. E. 1994. Traumatic Experiences and Substance Abuse: Mapping the Territory, Journal of Psychoactive Drugs, [accessed 7 July 2020].
[14] ibid.
[15] Vandemar N., Brown, V., and Fallot, R. D., 2004. Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment, [accessed 7 July 2020].

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