Becoming a Trauma Informed Addiction Counselor GACA 2015

Denice Colson, PhD, LPC, MAC. CPCS
Trauma Education & Consultation
Services, Inc.

NOTE: WE WILL BE DOING SOME LIVE POLLING DURING THIS
CLASS!
TO PARTICIPATE, TEXT DENICECOLSON831 TO 37607. YOU
WILL RECEIVE A RESPONSE.
WHEN THE POLL IS POSTED ON THE SCREEN DURING THE
TRAINING, YOU WILL THEN TEXT A, B, C, OR D BASED ON
YOUR RESPONSE TO THE STATEMENT.
GO AHEAD AND TEXT NOW BEFORE WE START SO THAT YOU
ARE PREPARED TO PARTICIPATE.

“
”
65% of Alcoholism is
attributable to
unhealed,
unaddressed
childhood trauma.
(Anda, ACE Interface, 2013)

“
”
78% of IV drug use
is attributable to
unhealed,
unaddressed
childhood trauma.

“
”
58% of suicide
attempts are
attributable to
unhealed,
unaddressed
childhood trauma.

“
”
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
one trauma in their
lifetime.
(SAMHSA, TIP 57)

“
”
Approximately 8.4
million adults have
co-occuring
mental health and
addiction disorders.
(www.nimh.nih.gov)

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

What percentage of people in substance
abuse treatment are working with trauma
informed counselors, and more
importantly, receiving trauma specific
treatment?

Addiction, depression and anxiety, are
frequently the fruit of unaddressed,
unresolved childhood abuse and trauma,
most programs continue to focus mainly
on picking the fruit, cutting the limbs,
and trimming the tree, making it prettier,
better trained; but the roots remain
intact, protected and covered up only to
produce more fruit in the future.
Trauma

Goals and Objectives
 Identify the research which indicates links between
childhood trauma and adult/adolescent addiction.
 Identify the differences between source-focused thinking
and symptom focused-thinking.
 Identify the 6 progressive stages for developing a trauma
survivor.
 Identify the 3-phases of trauma recovery.
 MOST Important Goal: To increase your hope that
survivors can heal, to increase your confidence in trauma-
informed treatment, to empower you to work more
confidently with your clients—90% of whom probably
have childhood and adult onset trauma.
http://www.slideshare.net/DeniceColson/becoming-a-trauma-
informed-addictions-counselor-using-a-sourcefocused-model-
adacbga-2015-2

Levels of Development in
Trauma-Care
Trauma
Specific
Treatment
DENICECOLSON831 to
Text #: 37607

Level 1: Being “Trauma
Informed”
 Simply means internally acknowledging
the impact that trauma has on your
clients, your treatment, and your self.
 It’s a broad stroke.
 It’s the “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)
 You recognize that many, if not most, of
your clients have a history of trauma.

Level 2: Adopting a Trauma-
Informed Approach
 Goes beyond recognizing the
presence of trauma symptoms and
acknowledging the role that trauma
has played in their lives, and
actively seeks to change your
treatment approach from one that
asks, "What's wrong with you?" to
one that asks, "What has happened
to you?” (SAMHSA)
 Actively shifting your own
perspective.

Change takes place slowly and
over time. To start…
 Stop trying to fix the behavior, and see
the behavior as a symptom of a wound.
…there’s fire!
 Make the assumption that, where
there’s smoke…

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.

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.

adopts the 4 R’s
1. Realizes
2. Recognizes
3. Resists
4. Responds

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

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

ACEs and Population Attributable Risks
Anda, ACE Interface© 2013

ACE and Adult Alcoholism
 A 500% increase in adult
alcoholism is directly related to
adverse childhood experiences.

ACE and Adult Alcoholism
0
2
4
6
8
10
12
14
16
18%Alcoholic
ACE Score0
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).

 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

 86% report physical abuse histories,
 69% sexual abuse histories.
 Of those with sexual abuse histories
 96.7% physically abused .
 96% of both (sa, pa) emotionally abused.
(Saylors, 2003; 2004)
Of American Indian/American
Native women in SA treatment

ACE and Obesity
 66% reported one or more type of abuse.
 Physical abuse and verbal abuse were most
strongly associated with body weight and
obesity. (the abuse types strongly co-
occurred)
International Journal of Obesity (2002) 26, 1075 – 1082. doi:10.1038=sj.ijo.0802038

ACE and Smoking
 A child with 6 or more categories of
adverse childhood experiences is 250%
more likely to become an adult smoker

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

ACEs and Relationship Problems
(Divorce, Family Problems, Sexual
Dissatisfaction)
Percent
with
Problems
ACE Score
Anda, ACE
Interface, 2013

ACEs and Adult History of
Homelessness Washington State, BRFSS
Percent
Homeless
ACE Score
Anda, ACE
Interface, 2013

ACEs and Unemployment
Percent
Unemploye
d
ACE Score
Anda, ACE
Interface, 2013
Source: Soc Psychiatry & Epidemiology; Liu, et al.,
(2013)

Chronic Depression
 Adults with an ACE score of 4 or more were 460%
more likely to be suffering from depression .

Suicide
The likelihood of adult
suicide attempts increased
30-fold, or 3,000%, with an
ACE score of 7 or more.

Suicide
Childhood and adolescent
suicide attempts increased
51-fold, or 5,100% with an
ACE score of 7 or more.

Suicide
0
5
10
15
20
25
%AttemptingSuicide
ACE Score
1
2
0
3
4+

ACEs increase the risk
of:
 Heart disease
 Chronic lung disease
 Stroke
 Diabetes
 Cancer
 Lung cancer
 Liver disease
 Suicide
 Injuries
 HIV and STDs

Poor Life Expectancy: ACE
score of 4 or more reduces
life expectancy by 20
years!

ACE and Neurological
development

Stressful experiences disengage the
frontal lobes, which, over time can lead
to: Impulsivity
 Short-sightedness
 Aggressive behavior
 Increased anxiety
 Depression
 Alcohol and drug abuse
 Learning disorders
 Stress-related diseases

High Health and Mental
Health Care Costs

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.

Social, emotional,
and cognitive impairment
Adoption of
health risk behaviors
Disability,
Diseases,
social problems
Early
Death
ACEConversion
59
ACE Pyramid

How Strong is the Study?
 Replicated in 20 US states and Puerto Rico as well as
China, Macedonia, Philippines, Saudi Arabia, South
Africa, Thailand, and Viet Nam
 ACE surveys had been completed in Albania,
Latvia, Lithuania, and Macedonia, with further
studies underway in Montenegro, Romania, Russian
Federation and Turkey
 61 Publications by principles and their associations
on CDC.gov
 Same results.

Not Yet Replicated in
Georgia!
 Visit my Facebook page:
https://www.facebook.com/pages/The-Georgia-
Adverse-Childhood-Experiences-ACE-Awareness-
Project/327902950723640
 LIKE

Social, emotional,
and cognitive impairment
Adoption of
health risk behaviors
Disability,
Diseases,
social problems
Early
Death
ACEConversion
62
ACE Pyramid
Research gaps

1. Realizes the widespread impact of trauma and understands potential paths for
recovery.
2. Recognizes the signs and symptoms of trauma in clients,
families, staff, and others involved with the system.
Symptoms and diagnosis associated with trauma:
Addiction
PTSD
Depression
Anxiety
Being “Source-Focused” means that we move beyond symptoms to
sources.

 …it hurts emotionally and/or physically. The brain
doesn’t really know the difference. Pain is pain.
 Universal belief: it SHOULDN’T happen.
 An experience that causes psychological injury or
pain.
64
Psychological trauma

Events that Cause Trauma
 Physical abuse
 Physical neglect
 Emotional abuse
 Emotional neglect
 Sexual abuse
 Death of a loved one
 Domestic violence
 Living with an alcoholic
or drug addict/abuse
 Living with someone
with a mental illness.
 Having a mental illness.
 Growing up poor and hungry.
 Rape
 A parent never telling you they love you.
 Death of a pet.
 Threatened killing of a pet.
 Family member in prison.
 Family member in combat.
 Being in combat.
 Abandoned by a parent or a spouse.
 Screamed at.
 Called names.
 Watching someone else be abused.

Events that Cause Trauma for
Addiction Counselors
 Hearing horrific stories
about: Physical abuse,
Physical neglect,
Emotional abuse,
Emotional neglect,
Sexual abuse, Domestic
violence
 Experiencing physical
abuse on the job
 Watching recidivism
 Being attacked verbally
or physically by a client
or other staff member
 What word do we use to refer to the
experience of a traumatized counselor?
Burn-Out!

3. Resists re-traumatization by instituting policies that promote
the Six Key Principles.

SAMHSA’s Six Key Principles :
1. Safety: avoid activities that may reenact traumatic
experiences.
What are some activities that may inadvertently reenact
traumatic experiences?
What activities might we avoid?
What type of environment promotes a sense of safety?

SAMHSA’s Six Key Principles Promote:
2. Trustworthiness and Transparency- be honest about what
you are doing and why you are doing it.
What are some things that we as counselors might do that
would sabotage trust?
What does it mean to be “transparent”?
How transparent should a counselor be?

3. Opportunities for peer support
How can you offer opportunities for peer support?
In a residential center?
In an outpatient center?
In individual counseling?

4. Treatment approaches which offer collaboration and
mutuality.
What makes a counseling session “collaborative”?
What is “mutuality”?
How can we move forward and be collaborative?

5. Empowerment by giving clients a voice and giving them
choices about their treatment.
How can we help traumatized clients find their voice?
In a structured treatment program, how can we give choices,
within limits?

6. Sensitivity to Cultural, Historical, and Gender Issues
recognizing generational and historical trauma.
What is “generational” or “historical” trauma?
How does this get passed down?
What impact does it have?

3. Resists re-traumatization by instituting policies that promote
the Six Key Principles.
4. Responds by fully integrating knowledge about trauma into
policies, procedures, and practices.

Integration:
 When does the therapeutic relationship begin?
 When do we start applying a trauma-informed
approach?

Rather than only
evaluating the
surface…
Begin by:
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 Informed 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).

Adverse Childhood
Experiences screening
 Finding Your ACE Score

The Impact of Childhood
Trauma and Abuse Matrix
 Handout

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.

Use Other Handouts
 Develop your own.
 Visit ACESConnection.com for more
help.

“Important Souls”
THE STORY OF ANNA CAROLINE JENNINGS- A TRAUMA
SURVIVOR WHO DIDN’T GET TRAUMA INFORMED CARE AND
WHOSE STORY HELPED TO LAUNCH THE CURRENT TRAUMA
INFORMED CARE MOVEMENT

Breath…
 What are your feelings and thoughts about this
video?
 Perhaps you have responded in a like minded
manner as a treatment provider in the past. What
can you do about that now?
 Forgive yourself, and move forward to change
your approach.
 You can’t know what you don’t know.
 You can’t treat what you don’t understand.
 You can move up the pyramid!

As you Consider Shifting
Your Paradigm…
 Where are you coming from?
Preferred model of treatment, how does
this strike you?
 What is your history with addiction
treatment?
Training, experience, personal recovery
experience
 What is your personal trauma history?
Personal trauma Treatment, family trauma
treatment, etc.
 How ready are you to make this shift?
 Consider the Stages of Change.

Stages of Change
 Pre-contemplative: I didn’t know there was a paradigm to shift!
I am happy with the way I do treatment now and don’t see
any reason to change.
 Contemplative: I’m considering the idea that trauma might be
beneath some of my client’s SUD, but I’m not convinced yet.
I’m considering it and weighing the research.
 Preparing: I’m convinced that I need to make some changes,
but I’m not sure which way to go. Where do I begin? I’m
gathering my resources today.
 Action: I’ve made the paradigm shift internally and am
applying the shift in my practice and looking for more ways to
make the application.
 Maintenance: I’m maintaining the paradigm shift and looking
to add skills and move up to the expert level of trauma care.

Wherever you are now…
 Think about where you want to be a year from
now
 5 years from now
 10 years form now
 What kind of treatment do you want to provide
for your clients?
 What kind of supervision do you want to provide
for your staff?
 How willing are you to deal with the trauma in
your own history?

Level 3: SAMHSA Guidelines for
Trauma-Specific Interventions
Any trauma specific intervention that you learn
and adopt should meet the following guidelines:
 Survivor's need to be respected, informed,
connected, and hopeful regarding their own
recovery.
 The interrelation between trauma and
symptoms of trauma such as substance abuse,
eating disorders, depression, and anxiety need
to be understood, anticipated, and addressed
through education and information.
 Providers need to work in a collaborative way
with survivors, family and friends of the
survivor, and other human services agencies in
a manner that will empower survivors and
consumers

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.

Evidence-Based Therapies
(EBTs)
 2002, 49 state mental health agencies in the US had
already implemented one or more EBTs (Ganju,
2003),
 inextricably entwining mental health treatment and
evidence-based theory.
 continues to be much debate over the accuracy of
the science behind EBTs and EBP (Littell, 2009).
 Wampold states, “The notion of requiring clinicians
to use empirically supported treatments or
evidence-based treatments is simply not supported
by the research evidence” (2009, location 2097).

The Dodo Verdict
 originally introduced in 1936 by Saul Rosenzwieg
(Duncan, Miller, Wampold, and Hubble, 2009).
 The dodo verdict is in reference to the story of Alice
in Wonderland.
 Some Implicit Common Factors in Diverse Methods
of Psychotherapy and commented that, “no form
of psychotherapy or healing is without cures to its
credit” and “success is therefore not a reliable
guide to the validity of a theory” (Duncan, et al,
2009, location 442).
 in this article that he laid the foundation for
assessment that focused on the common factors
(Duncan, et al, 2009).
 This approach to assessing the effectiveness of
psychotherapy is gaining in acceptance and has a
strong influence in the treatment approach
proposed by this dissertation.

The common factors
approach
 references the components or fundamentals that
are present in all forms of psychotherapy
(Duncan, et al, 2009).
 Rosenzweig is given credit for initiating the
common-factors movement based on his article
originally published in 1936,
 he suggested that there may be three common
factors which contribute to effectiveness in
psychotherapy.

 Contemporary research seems to support
this original hypothesis that the therapist is
key and that all psychotherapy
methodologies tend to be equally
successful, (Kim, Wampold, and Bolt, 2006;
Okiishi, Lambert, Nielson, and Ogles, 2003;
Wampold and Brown, 2005; and Wampold,
Mondin, Moody, Stich, Benson, and Ahn,
1997),
 even treatments designed to specifically
deal with PTSD, (Taylor, Thordarson, Maxfield,
Fedoroff, Lovell, and Ogrodniczuk, 2003;
Stapleton, Taylor, and Asmundson, 2006;
Seligman, 1995).

Client/Extratherapeutic
Relationship
Placebo/hope/expectancy
Models/Techniques
Client/Extra-therapeutic 40%
Relationship 30%
Placebo/hope/expectancy 15%
Models/Techniques 15%
99
Factors Accounting for Successful
Outcomes in Psychotherapy
Lambert, M. (1986). Implications of
Psychotherapy Outcome Research for
Eclectic Psychotherapy.
In J. Norcross (Ed.) Handbook of Eclectic
Psychotherapy. New York: Brunner/Mazel.

 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)

Key Thought from the Trauma-
Informed movement: 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.

“Trauma”
 Derived from the Greek
word that means an injury
or wound.

 Wound to the identity rather than a wound to the body.
 Creates contradictions to expectations which results in tangible
and intangible losses.
 Creates a demand for action.
 An experience that causes psychological injury or wound. Pain
is pain.
106
Psychological trauma

Personal
experiences
107
Personal Identity
Personal
expectations,
values, beliefs,
and needs.
Genetics

How the Damage to Identity
Happens: The Still-Face Experiment
 https://www.youtube.com/watch?v=apzXGEbZht0

109
REBT Basic Human Behavior
A. Activating
Event
Emotions
C. Behavior
B. Beliefs, values,
expectations,
needs
Information passes
through the brain.

Blueprint for building
a Trauma Survivor©
Theory: Six Stages in
Development of a Trauma
Survivor Identity

2. You
experience
Losses.
Triggers Limbic
System
(Fight/Flight) of
the Brain.
1. Event Outside of
conscious control
contradicts
expectations/
beliefs.
3.Grief
Response
begins and
is resolved.
Stops here.
3. Grief
Response begins
and is NOT
resolved;
information is
stored, and the
cycle moves
forward.
Trauma Survivor
Blueprint©
(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,
experience more loss and
triggers 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!

Example of Development
in a Family
 You are treating a new client, Sue Crenshaw. She is 35
years old, divorced twice, and has 3 children who don’t
live with her. She has come to you for… a drug and
alcohol evaluation for a DUI, or for ASAM I treatment, or
because she has sever anxiety,
 Her history reveals that she started drinking when she
was 13. Started using pot at 15. Has tried various drugs
including cocaine, ecstasy, and meth, but has an
aversion to needles so assures you she has never used
heroin or “hard drugs”. Currently she mostly drinks
alcohol and smokes pot.

Treatment Approach
 Typical symptom focused treatment would
involve what steps?

Trauma-Informed 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.
 Assumes that the SUD developed because of resiliency.
 So, how did Sue Crenshaw get here? How did this
“Substance Use Disorder” develop and what are the
roots?

 Sue Crenshaw is
10 years old
and in the 5th
grade. She has
been an A/B
student since
she started
school.
 John is 8 years
old and in the
3rd grade. He
has been an
A/B student
since he started
school.
Meet the Crenshaws: A typical family
Bob Crenshaw:
•35 Years old
•Father
•Manager in an
oil company
•Drinking beer
since 18 years
old
•Never
addicted.
Mary Crenshaw
•33 years old
•Mother
•Works part time
from home as a
computer
programmer.
•Drinking beer since
she was 18 years
old
•Never been
addicted.
For the sake of the role-play, no
previous trauma of any kind.
Copyright Denice Colson, PhD, LPC, MAC, CPCS ©2014

 Choose which family member you want to represent
in this discussion based role-play.
 Choose between mom and one of the two children.
 Dad will be role-played by the trainer.
 As we walk through this role-play, you will be asked to
respond, putting yourself in this person’s place.
 We will be demonstrating the 6 stages in the
development of a trauma survivor but in a family
system.
121
Instructions

 The family is at a restaurant with two other neighborhood
families celebrating New Year’s Eve. Sue is sitting with her
friends all together at a separate, but nearby table, while the
adults are sitting men with men and women with women at
their table. Dad had a couple of beers at home before coming
to the restaurant and has had several more while at the
restaurant. Sue notices that Dad seems to be laughing louder
and louder. She hears a loud crash and turns to see her father
covered with spaghetti sauce and his plate on the floor.
Apparently he has dumped his entire plate on himself. As mom
jumps up to help him he growls at her, “I can take care of
myself, bitch!” He stands, very wobbly, and heads to the men’s
room. As everyone watches, he walks toward the door,
showing uncertainty in his steps. He is obviously drunk and not
walking straight.
122
Incident #1:

 Stage 1: Event
outside of your
control contradicts
expectations,
values, beliefs.
What did you feel
when it
happened? Does
it contradict your
expectations?
Incident #1: The first incident.
(Adapted from Collins & Carson., 1989. The Integrated Trauma
Management System)
Mom
JohnSue

Stage 2: You
experience Losses.
Triggers Limbic System
(Fight/Flight) of the
Brain.
What did you
lose?
Management System)
Mom
JohnSue

 Stage 3: Grief
Response begins
and is resolved.
Stops here or Grief
Response begins
and is NOT resolved;
information is
stored, and the
cycle moves
forward.
You attempt to
resolve it with
dad, but he
refuses. The
cycle moves
forward if it isn’t.
Management System)
Mom
JohnSue

Stage 4: Brain rallies
to survive: activating
(new) survival
responses
What might you do in
response?
Management System)
Mom
JohnSue

 Stage 5: Own
responses are
compared to
expectations/belie
fs.
As you think about
your responses, do
any of them
contradict your
expectations of your
own behavior,
thoughts, or
attitudes? What might
you feel?
Management System)
Mom
JohnSue

 Stage 6: If they
contradict, creates
more losses
triggers Limbic
system again, and
more emotion
associated with
loss.
What might you lose
Management System)
Mom
JohnSue

 The individuals are
beginning to
develop “masks”
over their true
identities. Sue is
developing a mask
over her true
identity.
Incident #1: After the first incident.
Management System)
Mom
JohnSue

 The individuals are
beginning to
develop “masks”
over their true
identities. Sue is
developing a mask
over her true
identity.
Incident #1: What about father?
Management System)
Mom
JohnSue
1. What might he feel
when it happened?
Does his drunk
behavior contradict
his own expectations?
2. What will he lose?
3. Is it resolved? Does it
move forward if it
isn’t?
4. What might he do in
response?
5. Do any of them
contradict his
expectations of his
own behavior,
thoughts, or attitudes?
What might he feel?
6. What might he lose?

Incident #1:
After the first
incident…the
father.
Management System)
Mom
JohnSue

 Its been 4 years and there have been at least 7 more
incidents. Sue is now 14 and has heard her mom and dad
fight many times. This time, she’s in her room and she hears
dad come home. He’s loud when he comes in the door
and she peeks out to see what he’s doing. He looks
obviously drunk and appears to have been in a fight.
Shortly after he gets into the house, police pull up into the
driveway with sirens blaring and lights flashing. Mom runs
up to dad and asks what happened. Sue and John come
out to see but then run and hide in their rooms. The police
knock on the door and announce themselves. They arrest
Dad for driving drunk and leaving the scene of an
accident. Mom starts crying and yelling. Dad throws up in
the front room while handcuffed.
132
Incident #9:

 Stage 1: Event
outside of your
control
contradicts
expectations,
values, beliefs.
 What did you
feel when it
happened?
Does it
contradict your
expectations?
Incident #9
Management System)
Mom
JohnSue

 Stage 2: You
experience
Losses.
Triggers
Limbic
System
(Fight/Flight)
of the Brain.
 What did you
lose?
Incident #9
Management System)
Mom
JohnSue

 Stage 3: Grief
Response begins
and is resolved.
Stops here or Grief
Response begins
and is NOT
resolved;
information is
stored, and the
cycle moves
forward.
You attempt to
resolve it with dad,
but he refuses. The
cycle moves forward
if it isn’t.
Incident #9
Management System)
Mom
JohnSue

 Stage 4: Brain
rallies to
survive:
activating
(new) survival
responses
 What might you do
in response now?
Incident #9
Management System)
Mom
JohnSue

 Stage 5: Own
responses are
compared to
expectations/
beliefs.
 As you think
about your
responses, do
any of them
contradict
your
expectations
of your own
behavior,
thoughts, or
attitudes?
Incident #9
Management System)
Mom
JohnSue

 Stage 6: If they
contradict,
creates more
losses, triggers
Limbic system
again, and
more emotion
associated
with loss.
 What might
you lose?
Incident #9
Management System)
Mom
JohnSue

 Incident #9:
…the
individuals
have
continued to
develop
“masks” over
their true
identities.
Incident #9
Management System)
Mom
JohnSue

Incident #9: Father
Management System)
Mom
JohnSue
1. What might he feel
when it happened?
Does his drunk behavior
contradict his own
expectations?
2. What will he lose?
3. Is it resolved? Does it
move forward if it isn’t?
4. What might he do in
response?
5. Do any of them
contradict his
expectations of his own
behavior, thoughts, or
attitudes?
6. What might he lose?

Incident #9: The Father
Management System)
Mom
JohnSue

 Boundary Erosion
and
Enmeshment:.
Eventually…
Family
Identit
y
Family
Identity
Management System)

Our Client-Sue Crenshaw
What She Presents Her TRUE Identity

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

 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.
145
Treatment

Dr. Felitti’s redefinition of
addiction informed by the ACE
Study:
 Addiction is the unconscious, compulsive use of
psychoactive materials or agents in an attempt to
deal with a problem.
 “It’s hard to get enough of something that almost
works.”
 Considers addiction (SUD) as evidence of another
problem.
Felitti, V. (2011) Adverse Childhood Experiences and The Origins of Addiction. Neuroscience of Addiction. Presentation to the
Alberta Family Wellness Center. Retrieved from http://www.albertafamilywellness.org/resources/video/origins-addiction

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

Its this paradox that we as
addiction counselors have
to try to overcome.
 Being source-focused helps us to be able to go
around the paradox. Avoiding it and not taking it
on directly.

Source Focused means:
 Each stage of The Trauma Survivor Blueprint is
addressed in order.
 Evaluation, testing, and treatment are all focused
on the source of the problem, not just the
symptoms.
 Symptoms are bypassed when at all possible and
allowed to resolve on their own as the “wound” is
healing.

Why is bypassing symptoms
important?
• Asking a person to let go of their survival
responses before the pain heals for which
they are using the survival responses is like
asking someone to let go of the ledge
they are holding on to so that they can
float in mid air until the rescue helicopter
gets to them!

Let’s launch you in to the air!

153
How do we fight this
paradox?
We don’t!
We give people something to
hold on to.

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

3 Progressive Phases of Trauma
and Abuse Recovery
1. Establishing Safety
and Stabilization
3. Reconnecting
and Integrating
2.
Reprocessing
and Grieving

Phases
 Very broad and undefined.
 The heart of recovery is Reprocessing and Grieving.
 Remaining in Establishing Safety and Stabilization won’t
complete the healing- this is like cutting off the limbs of
the tree down to a stump and hoping it doesn’t grow
back.
 Have to get to the Reprocessing phase.

In order to navigate these three very
broad phases, I’ve broken them
down into 12 Strategic Stages*
 Safety and Stabilization: 4 stages
 Reprocessing and Grieving: 6 stages
 Reconnecting and Reintegrating: 2 stages
*While the 12 numbered sentences, identified as “Healing for
Trauma and Abuse in 12 Progressive Stages,” were inspired by the
Twelve Steps of A.A., they are not really an adaptation. Rather, they
were created specifically for this program, and should not be
construed otherwise. A.A., which is a program concerned only with
recovery from alcoholism, is not in any way affiliated with this
program.

Phase One-Safety and Stabilization:
Characterized by Feeding Your FAITH
1. I admit that I am wounded and I am accepting that I am powerless over the
wound, the wounding, and the one creating the wound.
2. I have decided to give up trying to fix myself and will humbly seek healing
through a Higher Power, fully understanding that healing will require my
participation.
3. I am accepting that I have to grieve in order to heal and I’m determined to
give up any substance use that results in numbing my grief and I will allow
myself to feel as I move through the healing process even though it will be
painful and scary at times.
4. I am forming a partnership with at least one other person (counselor or
recovery coach) as I prepare to boldly identify in a focused and structured
manner the people or events that wounded me.

Phase Two- Reprocessing and Grieving:
Characterized by Snowballing your HOPE
1. I am courageously choosing to tell my story using structure
and detail to my counselor/recovery coach, and, when
possible my fellow burden bearers.
2. I am identifying the beliefs that have grown out of the hurtful
events; beliefs about me, life, others, and God (spirituality,
religion, or church) along with my initial responses.
3. I am humbly identifying and admitting to myself, my partner
or group, my own survival responses even when they
contradict my own expectations of myself.

Phase Two- Reprocessing and Grieving:
(Con’t)
4. I am embracing and grieving all of the losses I experienced during this
source of trauma; those the offender caused me, and those caused by
my own survival responses.
5. After completing this thorough inventory of my experiences,
contradicted expectations, losses, survival behaviors and the losses
these caused me, I humbly and courageously choose forgiveness;
forgiving my perpetrator for robbing me and forgiving myself (as I have
been forgiven) for my responses.
6. I understand that healing is an ongoing process from the inside-out, and
I humbly acknowledge where I’ve come from and those who have
contributed (including my Higher Power) to my healing and will make a
spiritual or personal marker to represent where I have traveled on my
path of healing with this source of trauma.

Phase Three: Reconnecting and Integrating:
Characterized by Activating Your LOVE
1. I am remaining open to identifying other wounds in my
life that need to be healed, without attempting to heal
them myself, while maintaining a willing attitude to work
through these steps again if necessary, or to assist
someone else who needs to work through these steps to
healing.
2. I am beginning to intentionally move toward reconnecting
with myself, with my Higher Power (God as I understand
Him), and with others.

THE TWELVE STEPS OF ALCOHOLICS
ANONYMOUS
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood
Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them
all.
9. Made direct amends to such people wherever possible, except when to do so would injure
them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we
understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this
message to alcoholics, and to practice these principles in all our affairs.
Copyright 1952, 1953, 1981 by Alcoholics Anonymous Publishing (now known as Alcoholics Anonymous World Services, Inc.) All rights reserved.
Rev. 6/14 SM F-121

How S.T.A.R. Works Phase 1
 This can be done in individual or group/class
setting of as many people as you like.
 Phase 1 can be done using “Inside-Out
Trauma and Abuse Recovery: Let the Healing
Begin!” a specifically Christian-integrated
class that can be lengthened or shortened as
needed. Psychoeducational in nature, open to
public, has a starting and stopping point.
 Clients can work the stages using text and
discussion.
 They can go back through as many times as
they like until they are ready to move on to
Phase 2.
 If you don’t want a specifically Christian
program, you can modify it and remove the
parts that are too much.

 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).
 Each stage is different and goes from telling the story, to
identifying the impact of the trauma on current life in a
strategic and measured manner.

 One source of trauma is addressed at a time-not one
incident—one source. Most sources are people or
relationships. For example, Sue Crenshaw has at least 3
sources, probably. Her father, her mother, and alcohol.
 Treats addiction as a source of trauma. “Trauma is the
problem and substance use is the solution; until the
solution becomes the problem.”
 She would move through the 6 stages on alcohol, then her
father, and then her mother.
 Then she would go on to Phase 3.
 Video

 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.
 Identifies areas that have been strengthened, healed, or
restored.
 Completes a “Relationship Map” and a “Life Map”
 Ending point is determined by participant and
Counselor/Recovery Coach.

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!

Summary and Conclusion
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)

“
”
65% of Alcoholism is
attributable to
unhealed, unaddressed
childhood trauma. (Anda, ACE Interface, 2013)

“
”
78% of IV drug use is
attributable to
childhood trauma. (Anda, ACE Interface, 2013)

“
”
58% of suicide
attempts are
attributable to
childhood trauma.(Anda, ACE Interface, 2013)

“
”
Of self-reporting
addicts, 71% report
one trauma in their
lifetime. (SAMHSA, TIP 57)

What percentage of counselors are
providing trauma informed treatment, and
more importantly, trauma specific
treatment?
 My hope is, that after today, you will make it one more.

Trauma wounds, but
people can heal.
I BELIEVE THIS IS ONE OF THE MOST IMPORTANT
THINGS WE CAN DO. WE CAN BEGIN TO ADDRESS
THIS GENERATIONAL TRANSFERENCE OF TRAUMA
AND THE IMPACT OF TRAUMA IN PEOPLE’S LIVES.

Thanks for coming!
Denice Colson, PhD, LPC, MAC, CPCS
www.TraumaEducation.com
Be sure you have signed up to receive the
assessments and tools by email!
Like the illustrations on my slides?
Follow this link to the company and sign up to get
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http://www.presentermedia.com/CXATNDAISWG

Becoming a Trauma Informed Addiction Counselor GACA 2015

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