aacc 2017 become a more trauma informed addiction counselor

Denice Colson, PhD, LPC, MAC, CPCS, CCS Eagle’s Landing Christian Counseling Center, Inc.Trauma Education & Consultation Services, Inc.

Introduce Yourself 3

“”

Overall, 61% of men and 51% of women surveyed in the general population report experiencing at least one trauma in their lifetime. (SAMHSA, TIP 57)

“”

But of self-reporting addicts, 71% report experiencing at least one trauma in their lifetime.

(SAMHSA, TIP 57)

“”

90% of people receiving services from behavioral health organizations have experienced trauma.

(National Council for Behavioral Health)

Reconsidering the roots…

Father gets drunk in restaurant

Dad gets DUI

Parents argue louder

Mom starts talking about dad

Mother slaps father

Mother hiding from father

Yells at mom in front of friends

Dad gets drunk more often

Dad withdraws further

Mom shouts at kids

Father curses at mother

Dad gets arrested at home

GOING FROM ROOT TO FRUIT

Full-blown Substance use Disorder!

Jesus Christ– Living Water, Bread of Life (Colossians 2:6-7)

Goals and Objectives

Identify the six progressive stages for developing a trauma survivor and addict

Discuss the research that demonstrates links between childhood trauma and adult/adolescent addiction

Explore strategies for introducing trauma-informed care into addiction treatment using assessment and education

MOST Important Goal: Pour into you HOPE for healing, CONFIDENCE in change, and IDEAS for implementing trauma-specific interventions in your ministry.

Links between childhood trauma and adult/adolescent addiction.THE ACE STUDY AND BEYOND

Largest scientific research study

of it’s kind.

17,000 middle-class American adults in 2 waves.

Initiated in 1995 and 1997

Analyzes the relationship between 10 categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.

Replicated in multiple states and countries with same outcomes. Some stronger.

Dose-Response RelationshipHigher ACE Score Reliably Predicts Prevalence of

Disease, Addiction, Death

Higher ACE Score

Resp

onse

gets

big

ger

The size of the “dose”—the number of ACE categories

Drives the “response”—the occurrence of disease, addiction, and death.

The ACE Study and Addiction

Outcomes studied 4 different types of addiction

ACE and Adult Alcoholism

A 500% increase in adult alcoholism is directly related to adverse childhood experiences.

2/3rds of all alcoholism can be attributed to adverse childhood experiences

ACE and Adult Alcoholism

0

2

4

6

8

10

12

14

16

18%

A

lco

ho

lic

ACE Score

0 1 2 3 4+

ACE Leads to Early Alcohol Initiation

•As the number of ACE increase, the more likely a person is to begin drinking before 14, or between 15-17 and the less likely they are to begin drinking at 18 or at 21 (the legal age).

ACE and Obesity

BMI > 30 White bars BMI >40 Gray bars

Williamson, DF, Thompson, TJ, Anda, RF, Dietz, WH, and Felitti, V. (2002). Body weight and obesity in adults and self-reported abuse in childhood. International Journal of Obesity. 26, 1075–1082.

ACE and Current Smoking

0

2

4

6

8

10

12

14

16

18

20

0 1 2 3 4-5 6 or moreACE Score

%

A stepwise 250% increase in the likelihood of an ACE Score 6 child being a current smoker, compared to an ACE Score 0 child

ACE and IV Drug Use

A male child with an ACE score of 6 has a 4,600% increase in the likelihood that he will become an IV drug user later in life

2/3rds experienced physical and/or sexual abuse

75% of the women - sexually abused. (SAMHSA/CSAT, 2000; SAMHSA, 1994 )

Men and women in SA treatment…

6 to 12 times more likely to have been physically abused.

18 to 21 times more likely to have been sexually abused. (Clark et al, 1997)

Teenagers with alcohol and drug problems

Summary Findings of ACE Study…

Risk for intimate partner violence

Multiple sexual partners (54+)

Sexually transmitted diseases (STDs)

Suicide attempts

Unintended pregnancies

Depression

Anxiety

Difficulty keeping a job.

Summary Findings of ACE Study…

ACE is associated in a strong and graded fashion with:Chronic obstructive pulmonary disease

(COPD) Depression Fetal death Health-related quality of life Ischemic heart disease (IHD) Liver disease

ACE score of 6…

Strongly correlated with a 20 year shortening of life-expectancy.

Spiritual Impact

Physical, emotional, and spiritual abuse increases insecurity in attachment to God

Leads to God concepts which are less loving and more controlling and distant (Reinert and Edwards, 2009).

Psychological distress (depression, anxiety, etc) is the BEST independent predictor of negative feelings towards God (Eurelings-Bontekoe, Hekman-Van Steeg, & Verschuur, 2005).

Questions and Discussion

Based on the research coming from the ACE study and others, how important is addressing trauma when doing addiction treatment?

A TREATMENT IMPROVEMENT PROTOCOL Trauma-Informed Care in Behavioral Health Services

First Printed 2014

4 Levels of Development in Trauma Care

Trauma-Informed

1

Adopt a Trauma Informed approach2

Adopt/Practice Trauma-specific

Intervention

3

Trauma Expert4

Trauma-Informed

1st Level of Development in Trauma Care

“recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well-being of those seeking healing and recovery with the support of mental health

and human services.” (SAMHSA)

1

Simply means internally acknowledging the impact that trauma has on your clients, your treatment, and your self.

It’s a broad stroke.

You recognize that many, if not most, of your clients have a history of trauma.

90% of people receiving services from behavioral health organizations have experienced trauma. (National Council for Behavioral Health)

Your text goes here. This is a placeholder to display what the text will look like in application.

Trauma-Informed

2nd Level of Development in Trauma Care

Adopt a Trauma Informed approach

“recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well-being of those seeking healing and recovery with the support of mental health

and human services.” (SAMHSA)

1

Actively shifting your own perspective and approach to assessment and treatment from one that asks, "What's wrong

with you?" to one that asks, "What has happened to you?” (SAMHSA)

2

A Trauma-Informed Approach

Can be implemented in any type of service setting or organization: Private practice office, group practice, treatment center; church, synagogue, temple or mosque; day-care, elementary, middle or high school.

Realizes the widespread impact of trauma and understands potential paths for recovery;

Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

Resists re-traumatization. Meaning, institute policies that promote…

When implementing a trauma-informed approach, consider SAMHSA’s Six Key Principles Safety

Trustworthiness and Transparency

Peer support

Collaboration and mutuality

Empowerment

Sensitivity to Cultural, Historical, and Gender Issues recognizing generational and historical trauma.

View symptoms through the lens of trauma.

…and consider the context…

Raised by a single mother

Arrested for DUI at 23

Mother was verbally and physically abusive.

Bullied in School

Started drinking at 13 to feel like he fit in at school, smoking pot at 14 to deal with anxiety.

Abandoned by father at 5.

Rather than only evaluating the surface…

Begin with evaluation:

Assume there is a root, and make an attempt to evaluate for the root.

Typical Evaluation…

What brought you here today?

What symptoms are you having?

What changes do you want to make?

What diagnosis will I give?

…What’s wrong with you?

Trauma Specific Evaluation…

Also ask questions like,

When did this start?

What was going on in your life that led you to make this decision?

What kinds of stress did you have?

…What happened to you?

EFFECT OF Trauma-Oriented Evaluations on Doctor Office Visits

Benefits of Incorporating a Trauma-oriented Approach

Biomedical evaluation: 11% reduction in DOVs

(Control group) in subsequent year. (700 patient sample)

Biopsychosocial evaluation: 35% reduction in DOVs

(Trauma-oriented approach) in subsequent year.

(>120,000 patient sample)

Use Screening Instruments

Family Health History Questionnaire

Health Appraisal Questionnaire (http://www.cdc.gov/ace/questionnaires.htm)

Also:

Trauma Symptom Inventory (Briere, 1995)

PTSD-8 (Hansen, et al., 2010)

Primary Care PTSD Screen (PC-PTSD) (Prins, et al.,

2003).

Screening Tools

ACE Score

http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf

Simple Trauma Source Assessment (by Denice Colson)

Simple Trauma-Source Assessment©

2 sections: child/adult.

Simple questions.

Check-list.

A few scaling questions.

Provides for discussion, not “diagnosis”.

Sign-up for my newsletter and receive this by email to use in your center. You can put your own heading on it as long as you keep it like it is written (don’t add or take anything out without contacting me and getting written permission) and keep my copyright on the bottom.

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Trauma-Informed

Adopt/Practice a Trauma-Specific

Intervention

3rd Level of Development in Trauma Care

Adopt a T.I. approach

“recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well-being of those seeking healing and recovery with the support of mental health

and human services.” (SAMHSA)

1

Actively shifting your own perspective and approach to assessment and treatment from one that asks, "What's wrong

with you?" to one that asks, "What has happened to you?” (SAMHSA)

2

Any trauma specific intervention that you learn should understand, anticipate, and address through education the

interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety.

3

Use Educational Handouts

Impact of Trauma Handout

ACE Pyramid Handout

Develop your own.

Visit ACESConnection.com for more help.

Sign-up on our email list (agree to copyright) for links to these.

Listed “Evidence Based” Psychotherapy Models for Adults with ACEs-related Disorders

Brief Psychodynamic Therapy

Cognitive Processing Therapy

Emotion Focused Therapy for Trauma

Eye Movement Desensitization and Reprocessing

Imagery Rehearsal/Rescripting Therapy

Narrative Exposure Therapy

Phased Model for Treatment of Dissociation

Prolonged Exposure Therapy

Present Centered Therapy

Present Focused Group Therapy

Seeking Safety

Skills Training in Affect and Interpersonal Regulation

Trauma Affect Regulation: Guide for Education and Therapy.

Key Thought: a trauma-specific intervention will focus on the source, not just the symptoms.

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Trauma

Source-focused thinking means that I begin to look past the fruit, past the surface, and attempt to identify and address the roots of addiction, depression and anxiety.

Source-focused thinking vs. Symptom-focused-thinking

I don’t want to just remove the part of the tree I can see, I want to dig deeper, do the best I can to get to the roots.

Strategic Trauma and Abuse Recovery©: A Source-Focused Model for Healing DISSERTATION: TOWARD A MORE COMPREHENSIVE, BIBLICALLY-INTEGRATED, THEORY AND TREATMENT OF PTSD, SUBSTANCE ABUSE, AND OTHER TRAUMA RELATED DISORDERS

The 6 progressive stages for developing a trauma survivor.

If you are a horticulturist, a person who studies the science and art of growing fruits, vegetables, flowers, and ornamental plants, it’s important to know the plant stages of development.

If you are going to be a trauma-informed or addictions counselor, it’s important to know the stages of development for a trauma survivor.

How the Damage to Identity Happens: The Still-Face Experiment

https://www.youtube.com/watch?v=apzXGEbZht0

57

REBT Basic Human Behavior

A. Activating

Event

EmotionsC. Behavior

B. Beliefs, values,

expectations, needs

Information passes

through the brain.

Personal experiences

Personal Identity/Mind

58

Expectations, values, beliefs,

and needs.

Genetics

Blueprint for building a Trauma Survivor

Theory: Six Stages in Development of a Trauma Survivor Identity

Trauma Survivor Blueprint© (Part 1)

61

(Adapted from Collins & Carson, 1989. The Integrated Trauma Management System)

Trauma Survivor Blueprint© Part 2

4. Brain rallies to survive: activating (new) survival

responses

5. Own responses are compared to

expectations/beliefs.

6. If they contradict, Limbic system again

creating more emotion associated with loss.

(Adapted from Collins & Carson, 1989. The Integrated Trauma Management System)

Ongoing, unresolved trauma: Survivors keep cycling through this loop, developing more

survival responses.

As the cycle moves the person further away from awareness of this connection

4. Brain rallies to survive: activating (new) survival

responses

5. Own responses are compared to

expectations/beliefs.

6. If they contradict, triggers Limbic system again creating

more emotion associated with loss.

(Adapted from Collins & Carson., 1989. The Integrated Trauma Management System)

As the cycle moves the person further away from awareness of this connection…

Perception of self and others changes.

Personal identity changes.

People adopt a “survivor identity”.

Self-Perception= I’m a tough guy!

Perception by others= He’s an angry violent person!

Unfortunately, many of these symptoms are viewed by the survivor-brain as solutions.

They temporarily work to reduce the pain and/or internal conflict and safeguard the personal identity.

Meaning, the brain doesn’t want to let go of them!

Most treatment is symptom focused—focus on

reducing unwanted or risky symptoms.

67

Treatment

Paradoxical Relationship with the Substance

Adapted from Collins, J., (1990) Presenters Handbook, TRT Institute, Angel Fire, New Mexico

Flip-side of the same coin.

ProfessionalTrauma Survivor

Trauma-Specific Treatment Approach

Trauma informed interventions look beneath the surface to ask, “What has happened to you?” and attempts to address not only the fruit (addiction/substance use disorder) but also the roots.

In fact, source-focused treatment assumes that something did happen and assumes that there is a root beyond self-destructive behavior; we just have to find it.

Assumes the person is trying to solve a problem, not make one.

3 Widely Accepted Phases of Trauma Recovery Safety, Grieving, Reconnecting

3 Progressive Phases of Traumaand Abuse Recovery

How S.T.A.R. Works

Elements of STAR are evidence informed, and strategically arranged and integrated in a uniquely structured way, building a pathway through the healing process.

STAR assumes resiliency in people. People are resilient and surviving the best they can. Many of the behaviors like addiction, depression, and anxiety, are adaptations intended for survival. To the survivor, they almost work.

STAR assumes the resiliency of the brain. Neuroplasticity-based treatment is gaining momentum in behavioral health care. Trauma impacts and changes the brain. Treatment using the STAR modalities intends to impact and rewire the brain naturally. The brain can heal!

How S.T.A.R. WorksPhase 1

Uses “Break EVERY Stinking Chain! Healing for Hidden Wounds” curriculum.

Class, individual, small “step-study” group.

Can be done by lay-leader at church.

Mostly educational.

Available at Amazon.com.

Phase 2

Can be done individually or in a group of up to 8 people.

Each stage has a set of handouts and involves structured writing and structured processing (reading out loud and processing feelings).

One source of trauma is addressed at a time.

Treats addiction as a source of trauma. “Trauma is the problem and substance use is the solution; until the solution becomes the problem.”

Phase 3

Can be done individually, in marriage counseling or family counseling, and, optionally the participant returns to a Phase 1 group to help with others and provide encouragement and give back.

Ending point is determined by participant and Counselor/Recovery Coach.

Focus on last 2 stages.

Next Training: February 1-3, 2018– McDonough, GA—678-289-6981 or TraumaEducation.com

Your text goes here. This is a placeholder to display what the text will look like in application.

Trauma-Informed

Adopt/Practice Trauma-specific

Intervention

Trauma Expert

4th Level of Development in Trauma Care

Adopt a Trauma Informed approach

“recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well-being of those seeking healing and recovery with the support of mental health

and human services.” (SAMHSA)

1

Actively shifting your own perspective and approach to assessment and treatment from one that asks, "What's wrong

with you?" to one that asks, "What has happened to you?” (SAMHSA)

2

Any trauma specific intervention that you learn should understand, anticipate, and address through education the

interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety.

3

Continue to use trauma-specific treatment models. Seek certification in different models or a general certification organization such as

International Association of Trauma Professionals or American Academy of Experts in Traumatic Stress

4

Summary and Conclusion

TRAUMA IS THE PROBLEM, ADDICTION IS THE SOLUTION, UNTIL THE SOLUTION BECOMES THE PROBLEM.

A SUCCESSFUL TRAUMA THERAPY IS ABOUT MORE THAN JUST NOT HAVING SYMPTOMS. IT’S REALLY ABOUT HAVING A LIFE…A LIFE THAT’S ABOUT PURSUING DREAMS, PURSUING HAPPINESS. BUT ESPECIALLY IT’S ABOUT THE RIGHT TO HAVE A PRESENT AND A FUTURE THAT ARE NOT COMPLETELY DOMINATED AND DICTATED BY THE PAST. (SAAKVITNE, 2000)

Thanks for coming!

Denice Colson, PhD, LPC, MAC, CPCS, CCSwww.TraumaEducation.com

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