Trauma, Chemical Use and Addiction - January 2013

Tana Bridge, PhD, LMSWAssociate Professor ~ Eastern Michigan University Supervisor/Consultant: National Institute for Trauma & Loss

A lot is Known About Trauma Unattended Trauma leads to self-defeating, self-destructive, pathological behavior Most will need external support to move beyond trauma Additive Nature of Trauma Steele (1992), Terr (1979), Pynoos(1988)

Substance Use/Trauma  Ability to escape from trauma memory/symptoms may be accomplished through drug use  Drug use can perpetuate feelings of powerlessness, fear, etc. brought about by trauma  Drug culture can expose/create victims of trauma

Trauma Defined Acute Stress Disorder Post Traumatic Stress Disorder Disorder of Extreme Stress Not Otherwise Specified ~ Complex Trauma

Differences in Trauma &Grief Grief  Trauma  Sadness  Terror  stands alone  Include grief  Reactions are known to  Reactions unknown, held public within  Can usually talk about loss  Can’t or don’t want to talk  Pain is acknowledgement of  Pain triggers terror, loss powerlessness, loss of safety

 Anger is non-destructive,  Anger- can become non-assaultive assaultive Grief does not disfigure self  Attacks, distorts self image image  Guilt says ”It was my fault, I could have prevented it Guilt says ”I wish I would/would not have”  Dreams of self as potential victims -dreams of deceased  Grief reaction and trauma No trauma specific reactions specific reactions. W. Steele

Complex/Chronic PTSD~DESNOS Prolonged and Repeated Trauma  DV woman and children  Victims of ongoing child abuse  Prisoners  Hostages  People held under the control of their perpetrator  Also known as DESNOS-Disorder of Extreme Stress/Not otherwise specified.

Trauma is a SensoryExperience Enters via the 5 senses What are some events/situations that might bring about a trauma specific response?

Traumatic SituationsWarViolenceRapeMurderBeatings/AssaultsDomestic ViolenceFires

SuicidesCar Accidents/Plane CrashesDisasters - earthquake, floods, fires, etc.Injuries or life threatening illnessDog BitesDrowning

Exposure to Trauma Surviving Victim/Survivor Witness to the Event Related or Connected to the Victim Hearing the Details

Symptoms….What are common symptoms of trauma or PTSD?

SymptomsPhysical symptoms: hypervigalence, startle response, sleep difficulties, concentration or memory problems, mood problems such as anger or depression Intrusive symptoms: recurrent recollections (thoughts, memories, dreams, nightmares or flashbacks), re-enactment (behavior or re-telling) distress at symbolic events, survivor guilt or grief

Symptoms - continuedAvoidant symptoms: avoiding specific thoughts, feelings, activities or situations, diminished interest, emotional numbness, inability to connect with future (feel they will die at young age)Special forms of avoidant symptoms: dissociation, helplessness, loss of fear

 Cognitive Struggles: 2+2 ??? 4, MagicalThinking (E.G. if I touch him he will die),concentration , recall and problem solving.Rumination or preoccupation: Continuousconscious awareness about the event andassociations that go beyond ordinary thinking.Characterized by a sense of uncontrolledrepetition.

How the brain receives and processes trauma….

2 Component of BrainResponse1. Reaction – “auto” responses2. Memory

 Development: The brain develops sequentially, with “lower” systems developing first and “higher” systems developing later. There are several areas of the brain that are impacted by trauma.

Brain ~ parts impacted by trauma Cortex: reasoning, problem solving, cognitive memory, planning, recognition Limbic: emotions, survival related emotions/pleasure, emotional memory Diencephalon: (includes thalamus and hypothalamus) “fight, flight or freeze,” stress response, receives, filters and relays sensory inputs – NOT cognitive Brainstem: heart rate, body temperature, respiration. The brainstem also stores anxiety or arousal states associated with a traumatic event

Neurochemical basis of PTSDTrauma changes the levels of 5 major neurotransmitters: epinephrine, cortisol, norepinephrine, serotonin and endorphinsThe limbic system (involved in strong emotion) can be changed by the presence of excess norepinephrine and produces:

Neurochemical basis of PTSD - continued Continual presence of symptoms/reactions to trauma Kindling effect - when small amounts of norepinephrine cause a cascade effect - the person reacts to a small stressor as if a true emergency has occurred Prolonged stress creates a dependency on the analgesic effect - the person seeks intensity to achieve overload and then the calming effects of endorphin release

National Institutefor Trauma & Loss in Children

This audio section is included with the permission ofThe National Institute for Trauma andLoss in Children (TLC) www.tlcinst.org .- William Steele, PsyD, MSWA Program of Starr Institute for Training- 48255 Garfield Road, Suite. 111, Clinton Twp. MI48038- Phone: 313-885-0390. Toll-Free: 877-306-5256 .- On the web: http://www.starrtraining.org/tlc- On Twitter : http://twitter.com/TLCchildtrauma- On Facebook:http://www.facebook.com/pages/The-National-Institute

Putting together thepieces… What is needed for ‘resolution’ or successful process in working through a traumatic situation….

The Process of Working throughTrauma  Safety –Seeking Safety  Attachment /Connection  Connect with trusted adults  Elicit support of others  Educate about possible reactions  Gives meaning  Normalizes

 Connect with Details – Nonverbal into Verbal  It gives the “why”s  Allows for mastery over content  Allows for experience outside of self  Removes negative image  Challenge distorted thinking LEARN HEALTHY coping and thinking!

Trauma and the Cognitive Triangle:Traumatic Event (TF-CBT: Tassell & Schmidt)

Promises of Healing Reduced frequency of symptoms Reduced fear of the symptoms Reduced fear of insanity Opportunity to grieve Change from victim to survivor

Promises of Healing...continued Opportunity to begin enjoying life Sense of humor Profound empathy for others who suffer

Questions???

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Trauma, Chemical Use and Addiction - January 2013

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Trauma, Chemical Use and Addiction - January 2013 Webinar Transcript