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What is Trauma-Informed Care and Is It Important During Addiction Treatment?

“Traumatic events challenge an individual’s view of the world as a just, safe and predictable place. Traumas that are caused by human behavior commonly have more psychological impact than those caused by nature.”

~ American Psychological Association, APA Dictionary of Psychology

There is no question that traumatic experiences shape both mental processes and behavior – which is why trauma-informed care is such a crucial element of addiction treatment. However, there is often a misunderstanding regarding both what trauma looks like and how it interacts with addiction and its treatment.  In an effort to clarify these points, this post asks two key questions regarding trauma-informed care: what is it, and is it important? The short answer to these questions is that trauma-informed care for addiction treatment takes into account the traumatic effects that addiction and alcoholism can have on an individual and yes, it is very important during addiction treatment. The long answer is a little more complex, but just as clear: the trauma-informed approach to addiction treatment is crucial to overcoming the mental, behavioral, physical, and social effects of addiction. In this post, we break the topic down into three parts: the essentials of trauma-informed care, how trauma and addiction are correlated, and the role that trauma-informed care plays in addiction treatment.

What is Trauma-Informed Care?

The trauma-informed approach to addiction treatment, at its core, recognizes the consequences of trauma and addiction and uses this recognition as a means to help ease the healing process from the addiction itself. This includes both traumatic experiences that brought on addiction in the first place and the trauma caused by addiction and substance abuse behaviors. According to the Substance Abuse and Mental Health Services Administration, a trauma-informed approach in any setting has the following elements:

  • The program realizes the widespread impact of trauma and understands potential paths for recovery.
  • The program recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system.
  • The program responds by fully integrating knowledge about trauma into policies, procedures, and practices.
  • The program seeks to actively resist re-traumatization.

These four elements describe trauma-informed care more broadly. This approach can be used in nearly any mental health service setting and can be adapted to the specific program needs.

“An individual’s experience of trauma impacts every area of human functioning – physical, mental, behavioral, social, spiritual. Trauma is shrouded in secrecy and denial and is often ignored. But when we don’t ask about trauma in behavioral healthcare, harm is done or abuse is unintentionally recreated by the use of forced medication, seclusion, or restraints. The good news is that trauma is treatable – there are many evidence-based models and promising practices designed for specific populations, types of trauma, and behavioral health manifestations.”

~ The National Council for Behavioral Health

In addition to the four essential elements described above, SAMHSA provides six key principles of the trauma-informed approach:

  • Safety
  • Trustworthiness and Transparency
  • Peer support
  • Collaboration and mutuality
  • Empowerment, voice, and choice
  • Cultural, historical, and gender issues

Each of these principles builds on one another, creating a picture for mental health practitioners and addiction counselors everywhere of what a healthy approach to dealing with trauma looks like. In this way, trauma-informed care is not necessarily a specific set of interventions and program points. Instead, it is a generalized approach to mental health care and addiction treatment. Using the key principles outlined above, the core of trauma-informed care is to recognize the experiences and needs of those going through treatment. The approach aims at keeping clients connected, informed and hopeful about their recovery – from both trauma and mental disorders like an addiction.

How Does Trauma Impact Addiction and its Treatment?

There is a reciprocal, if damaging, the relationship between trauma and addiction. In fact, traumatic events can be at the heart of various types of addictions. The relationship goes both ways: sometimes traumatic events can trigger mental disorders that lead to addiction, and in other cases suffering from addiction can itself cause traumatic experiences. Traumatic events take a variety of forms, and can look like any of the following:

  • Experiencing a natural disaster
  • Undergoing physical or sexual abuse
  • Suffering bodily harm in any capacity
  • Being involved or witnessing a car accident
  • Witnessing a serious injury or fatality

Just as with addiction, processing these traumatic events can be quite difficult. But experiencing a traumatic event is not necessarily a one-way street. Dr. Tian Dayton, a psychologist, and specialist in addiction trauma writes about how trauma and addiction are interrelated, particularly when it comes to the impact of the two on relationships. The author writes that people often self-medicate the emotional pain that results from trauma with drugs, alcohol, food, sex, and many other excessive behaviors. In turn, these detrimental behaviors create subsequent trauma: relationship trauma. This is “the internal earthquake or loss of solid psychological and emotional ground that happens when people you love and need in order to feel secure in the world are lost in their own addictions, psychological illness or addictive behaviors when the relationships you depend upon for survival are ruptured.” In other words, early emotional and physical trauma can be linked to addiction, and addiction, in turn, can be linked to resulting trauma. This is why a trauma-informed approach to addiction treatment is so crucial, as we discuss in the section below.

“Trauma is subjective, meaning what matters most are the individual’s internal beliefs and their innate sensitivity to stress, not whether a family member, therapist or other outsider deems an experience traumatic. Trauma can stem from abuse or neglect as well as other painful or frightening experiences, such as a car accident, bullying, school killing, sudden life change or near-death experience, whether experienced firsthand or witnessed. It can also result from growing up in an alcoholic or addicted home or any other environment where children are taught to bury their feelings. As a result of the trauma, the individual feels intense fear or helplessness, which can lead to serious long-term struggles with depression, anxiety, and addictive or impulsive behaviors.”

~ Dr. David Sack, “Emotional Trauma: An Often Overlooked Root of Addiction”

Of course, trauma does not always lead to addiction – and even when it does, it is not necessarily an addiction to drugs or alcohol. Other addictive behaviors that can be brought on by traumatic events include anorexia and other eating disorders, gambling addiction, sex addiction, cutting and self-harm, and even something so ‘mild’ as smoking cigarettes. Every traumatic event is different, just as every addictive behavior is different. However, some of the common traits of a traumatic experience are what combine to lead an individual who experiences them to addiction:

  • The traumatic event was not anticipated.
  • The individual who experienced the traumatic event was not prepared for it.
  • The individual felt powerless to stop or address the traumatic event.
  • The individual feels responsible for the traumatic event, even though it was not their fault.

These are the themes of trauma that make them so integrated with addiction and its consequences. It is also why trauma-informed care plays such an important role in addiction treatment.

What Role Does Trauma-Informed Care Play in Addiction Treatment?

With the understanding of trauma-informed care and how trauma impacts addiction, it becomes more apparent how trauma-informed care can play a beneficial role in addiction treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA), a government entity, provides a clear understanding of both the trauma-informed approach more generally and the beneficial role it can play in addiction treatment.

A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and facilitate healing. It is critical to promote the linkage to recovery and resilience for those individuals and families impacted by trauma. Services and supports that are trauma-informed build on the best evidence available and consumer and family engagement, empowerment, and collaboration.”

~ SAMHSA, National Center for Trauma-Informed Care & Alternatives to Seclusion and Restraint

In other words, the link between trauma-informed care and addiction treatment is the same as the link between recovery and resilience: bringing the two together translates into holistic care for individuals who have experienced both trauma and addiction. Each of the six key principles of trauma-informed care identified by SAMHSA above closely mirrors the commitment to individualized care represented in most addiction treatment programs. From providing a safe environment to go through the detoxification process, to establishing a forum of trust, transparency, and collaboration, addiction treatment already has many of these principles in place. Taking a trauma-informed perspective only heightens the care for individual clients. But what does trauma-informed care actually look like when introduced into addiction treatment? One of the most relevant approaches to addiction treatment that includes the trauma-informed view is EMDR – or eye movement desensitization and reprocessing. EMDR is one form of trauma-informed care for addiction treatment and has been shown to be very effective in addressing both addictive mental disorders and the consequences of trauma. In simple terms, EMDR therapy uses rapid eye movements to desensitize patients from the stigmas, negative emotions, and detrimental behaviors that they associate with traumatic events. As the name implies, the idea behind the therapy is to not only desensitize patients from these heavy emotions but also help them reprocess their thoughts and stimulation into healthier behaviors. In this way, EMDR therapy takes on the perspective of trauma-informed care by providing a safe space for patients to be empowered in their recovery, considering the effects of trauma just as important to address as the consequences of addiction. This post regarding trauma and addiction has made at least one thing clear: a trauma-informed approach to addiction treatment can help individuals overcome the effects of both traumatic experiences and addictive behaviors. Trauma-informed care can take a variety of forms, but EMDR therapy has been shown to be particularly useful in aiding patients overcome both trauma and addiction. If you know or even believe that you have been through trauma and are suffering from addiction or alcoholism, it is time to get the help that you need. Making the decision to get treatment can be a difficult one to make, but it is certainly the first step in any successful recovery. If you have more questions regarding trauma-informed care, addiction treatment, or our treatment programs, feel free to contact us or leave a comment in the section below.