TREATMENT AND CARE
Have you or your loved one experienced significant traumatic events in the past? Do you believe that working through these experiences may be an important aspect of your overall recovery? These themes are all-too-common and an important area for holistic recovery. Effective treatment will emphasize trauma recovery concurrently with healing from addiction. The clinical question we ask in our assessment at CeDAR is not “should” we provide recovery from trauma, but rather “how” to do it. This article reviews trauma-informed care within addiction treatment and looks at the different stages of healing for someone.
Single-Episode versus Complex Trauma
We have many people who have experienced traumatic events to themselves or loved ones, and these events may be single episodes or repeat periods of harm. An example of a single episode of trauma might be a horrific car accident, sexual assault or other experience of violence. Examples of complex, repeat trauma experiences might include spending multiple years on a military tour of duty, growing up in a highly violent household, or having a troubled mother who made repeated suicide attempts when you were young. We approach these situations somewhat differently.
For people who have experienced single traumatic events, eventually, we need to get to the processing of the story itself. This person may be experiencing flashbacks or intrusive thoughts about the trauma, and we need to help them ‘disentangle’ their fearful emotions from triggers around the story. We call this ‘narrative therapy,’ in that it involves the narrative of the traumatic event, the associated emotions, and the goal of healing.
Complex trauma survivors often need more holistic and supportive forms of therapy. This would include an emphasis on boundaries in relationships, mindfulness training, and emotional regulation skills. In this way, we are helping the person be able to cope effectively with stress today and maintain their sobriety. This last part is incredibly important – if we can’t help someone stay sober in their early recovery, they will quickly fall back into destructive patterns, withdraw from treatment, and essentially end any sort of trauma-based therapy they might be doing. Another way of saying this is that we need to help the person have the basic skills to stay engaged in their healing path.
It is also common for people to have a hybrid of both single-episode and complex trauma. For these patients, we may draw from different therapy styles to help them. It is important to remember that the basic principles of good trauma-based care are really applicable to all patients, including those who haven’t really experienced severe trauma in the past. This is what we call ‘Trauma-Informed Care.’
At CeDAR, we primarily offer treatment in the framework of trauma-informed care. There are a few important ingredients in trauma-informed care. Although described in literature today, these principles have really been part of sensitive and thoughtful behavioral healthcare over many decades.
Appreciation for Limited Trust
For survivors of severe trauma, it almost a guarantee that they will have difficulties trusting others. Trauma-informed care centers understand this issue and are sensitive to it. That does not mean that we will bend or break boundaries to accommodate the desires of patients. In fact, the opposite is more often true. Through secure and consistent approaches with patients, we are able to gradually build trust. This includes paying attention to issues around self-disclosure by clinicians, authentic approaches by the clinical team, and clear expectations and strategy around what we are trying to achieve through treatment.
Appreciation for Gender Factors
Our clinical program at CeDAR is a gender-based curriculum. This means that we have two separate cottages for men and women and the bulk of therapy processing is with the same gender. Because many experiences of trauma include such events as sexual or domestic violence, the gender separation is very often welcome by our patients.
Emphasis on Autonomy and Safety
Clinical care at CeDAR involves countless numbers of decisions by our patients and their providers. Which medications will we try? What topic areas will we explore in someone’s life? Sometimes, these areas lead to difficult emotions and anxiety with our patients. It is our job as a clinical team to help patients move at an appropriate pace for their stage of healing and stage of change. For instance, if someone is very hesitant about sobriety, certain medication options may not be well-received. We often use the phrase “meet people where they’re at” to remind us of this principle.
Tailored, Patient-Centered Care
A ‘one-size-fits-all’ approach does not seem to work in trauma recovery treatment. This also does not mean something to the regard of ‘anything goes!’ We have a multitude of recovery paths and options for people. These include medication approaches, different styles of psychotherapy and flexibility for peer support avenues. This principle focuses on listening to our patients and their preferences for their healthcare. It is important to acknowledge some people take this too far, simply rejecting too many effective avenues of recovery. For these individuals, we revert back to principles of basic motivation and raising the question of where they exist on the continuum of change.
Using the Basics
Beyond the principles, trauma-informed care likely involves helping build coping skills, improve emotional awareness, practicing mindfulness and wellness techniques, and seeking to prevent relapse or ‘re-wounding.’ Because these topics are so useful to all of our patients, trauma survivors or not, we offer them as part of our core CeDAR curriculum.
Many people achieve satisfactory recovery with these approaches and do not require more advanced therapies for trauma. They are able to use basic grounding skills to work through emotional distress and their relationships are looking more and more stable. For those who do need more intensive trauma healing, we start to introduce some forms of trauma-focused care.
For patients who have some good basic stability, we may start to introduce therapy options for them which would be under the category of trauma-focused care. These involve going deeper into their story and traumatic events, in an effort to achieve a deeper sense of healing. Good treatment is somewhat cautious of these modalities, as they can actually be emotionally provocative to patients. By revisiting the details of traumatic events, some patients can unravel and feel very dysregulated. For those working to recover from substance issues, they often relapse if unprepared for the emotional experience.
Examples of trauma-focused therapies include prolonged exposure therapy, eye-movement desensitization and reprocessing (EMDR), and cognitive-processing therapy. Each requires a trained clinician who is comfortable in understanding both trauma healing and addiction healing. Too often, patients find therapists who only understand one or the other and we try to prevent this.
Each of these therapy options involves helping people to move from an abstract emotional position of ‘wounds’ towards ‘scars.’ The events and story of someone’s trauma will never change, but the emotional experience when one thinks about that past can evolve and become less triggering. We seek to help people live a healthy and balanced life today. Those who have effectively worked through areas of prior trauma seem to be more grounded, more emotionally flexible and with a greater sense of resiliency.
If you are receiving treatment for traumatic issues in your past, it can be useful to understand the underlying strategy involved in good trauma treatment. Are you more in a trauma-informed or trauma-focused track? Which is serving you better today? How do your skills in addiction recovery overlap with skills in emotional healing?
Being able to have such discussions with your clinician or team and understanding the principles of your therapy can be very helpful in building trust. This leads to good dialogues about your healthcare and you being a more sophisticated consumer of these services.
Trust. Collaboration. Patient-Centered Care. Elements of trauma-informed services through CeDAR.