Aacc 2017 become a more trauma informed addiction counselor
- 1. Denice Colson, PhD, LPC, MAC, CPCS, CCS Eagle’s Landing Christian Counseling Center, Inc. Trauma Education & Consultation Services, Inc.
- 5. “ ” 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)
- 6. “ ” But of self-reporting addicts, 71% report experiencing at least one trauma in their lifetime. (SAMHSA, TIP 57)
- 7. “ ” 90% of people receiving services from behavioral health organizations have experienced trauma. (National Council for Behavioral Health)
- 9. 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!
- 10. Jesus Christ– Living Water, Bread of Life (Colossians 2:6-7)
- 11. 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.
- 12. Links between childhood trauma and adult/adolescent addiction. THE ACE STUDY AND BEYOND
- 13. 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.
- 14. Dose-Response Relationship Higher ACE Score Reliably Predicts Prevalence of Disease, Addiction, Death Higher ACE Score Responsegetsbigger The size of the “dose”— the number of ACE categories Drives the “response”— the occurrence of disease, addiction, and death.
- 15. The ACE Study and Addiction Outcomes studied 4 different types of addiction
- 16. 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
- 17. ACE and Adult Alcoholism 0 2 4 6 8 10 12 14 16 18%Alcoholic ACE Score 0 1 2 3 4+
- 18. 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).
- 19. 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.
- 20. ACE and Current Smoking 0 2 4 6 8 10 12 14 16 18 20 0 1 2 3 4-5 6 or more ACE 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
- 21. 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
- 22. 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…
- 23. 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
- 24. 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.
- 25. 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.
- 26. 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).
- 27. Questions and Discussion Based on the research coming from the ACE study and others, how important is addressing trauma when doing addiction treatment?
- 28. A TREATMENT IMPROVEMENT PROTOCOL Trauma-Informed Care in Behavioral Health Services First Printed 2014
- 29. 4 Levels of Development in Trauma Care Trauma- Informed 1 Adopt a Trauma Informed approach2 Adopt/Practice Trauma-specific Intervention 3 Trauma Expert4
- 30. 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)
- 31. 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
- 32. 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…
- 33. 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.
- 34. View symptoms through the lens of trauma.
- 35. …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.
- 36. Rather than only evaluating the surface… Begin with evaluation: Assume there is a root, and make an attempt to evaluate for the root.
- 37. 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?
- 38. 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?
- 39. 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)
- 40. 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).
- 41. Screening Tools ACE Score http://acestudy.org/yahoo_site_admin/assets/docs/ACE_ Calculator-English.127143712.pdf Simple Trauma Source Assessment (by Denice Colson)
- 43. 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.
- 47. Your text goes here. This is a placeholder to display what the text will look like in application. 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
- 48. 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.
- 51. 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.
- 52. Key Thought: a trauma-specific intervention will focus on the source, not just the symptoms.
- 53. 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.
- 54. 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
- 55. 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.
- 56. How the Damage to Identity Happens: The Still-Face Experiment https://www.youtube.com/watch?v=apzXGEbZht0
- 57. 57 REBT Basic Human Behavior A. Activating Event Emotions C. Behavior B. Beliefs, values, expectations, needs Information passes through the brain.
- 58. Personal experiences Personal Identity/Mind 58 Expectations, values, beliefs, and needs. Genetics
- 59. Blueprint for building a Trauma Survivor Theory: Six Stages in Development of a Trauma Survivor Identity
- 61. Trauma Survivor Blueprint© (Part 1) 61 (Adapted from Collins & Carson, 1989. The Integrated Trauma Management System)
- 62. 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)
- 63. 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
- 64. 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)
- 65. 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”.
- 66. Self-Perception= I’m a tough guy! Perception by others= He’s an angry violent person!
- 67. 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
- 68. Paradoxical Relationship with the Substance Adapted from Collins, J., (1990) Presenters Handbook, TRT Institute, Angel Fire, New Mexico Flip-side of the same coin. Professional Trauma Survivor
- 69. 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.
- 70. 3 Widely Accepted Phases of Trauma Recovery Safety, Grieving, Reconnecting
- 71. 3 Progressive Phases of Trauma and Abuse Recovery
- 73. 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!
- 74. How S.T.A.R. Works Phase 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
- 75. 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
- 76. 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)
- 77. Thanks for coming! Denice Colson, PhD, LPC, MAC, CPCS, CCS www.TraumaEducation.com Be sure you have signed up to be able to download the assessments and tools! Like the illustrations on my slides? Follow this link to the company and sign up to get your own membership! http://www.presentermedia.com/CXATNDAISWG