Addictions and Trauma


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Relationship between addictions and trauma as well as re-victimization that occurs in these populations.

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Addictions and Trauma

  2. 2. What does this describe? <ul><li>Cravings </li></ul><ul><li>Chemicals in the body/brain respond differently to substances </li></ul><ul><li>Denial  Acceptance </li></ul><ul><li>Lifelong management </li></ul><ul><li>Change in lifestyles </li></ul><ul><li>Monitor what is ingested into the body </li></ul><ul><li>Genetic link </li></ul><ul><li>Behaviors </li></ul><ul><li>Often fatal if not treated </li></ul>Copyright Carol D. Miller
  3. 3. Substance Abuse is a Medical Illness <ul><li>We do not hold people who have diabetes responsible for their disease, so why do we hold people with alcohol and drug addictions responsible for having a disease by labeling them as “lazy,” “not ready to grow up,” “bad,” “just wanting to have a good time,” “not loving their children/family?” (6, 12) </li></ul>Copyright Carol D. Miller
  4. 4. Substance Abuse is a Medical Illness <ul><li>The American Medical Association formally recognized alcoholism as a disease in 1956 (14) </li></ul><ul><ul><li>Characteristic set of signs and symptoms </li></ul></ul><ul><ul><li>Progressive course </li></ul></ul><ul><li>Prior to this recognition, was considered as a person with a moral problem or a willpower issue </li></ul>Copyright Carol D. Miller
  5. 5. Substance Abuse (1) <ul><li>One of the following must be present within a 12 month period: </li></ul><ul><ul><li>(1) recurrent use resulting in a failure to fulfill major obligations at work, school, or home; </li></ul></ul><ul><ul><li>(2) recurrent use in situations which are physically hazardous (e.g., driving while intoxicated); </li></ul></ul><ul><ul><li>(3) legal problems resulting from recurrent use; or </li></ul></ul><ul><ul><li>(4) continued use despite significant social or interpersonal problems caused by the substance use (e.g., arguments about consequences of intoxication, physical fights). </li></ul></ul><ul><li>The symptoms do not meet the criteria for substance dependence. </li></ul>Copyright Carol D. Miller
  6. 6. Substance Dependence (1) <ul><li>Three or more of the following, occurring at any time in the same 12-month period: </li></ul><ul><ul><li>(1) Tolerance, as defined by either of the following: </li></ul></ul><ul><ul><ul><li>A need for markedly increased amounts of the substance to achieve intoxication or desired effect </li></ul></ul></ul><ul><ul><ul><li>Markedly diminished effect with continued use of the same amount of the substance </li></ul></ul></ul><ul><ul><li>(2) Withdrawal, as manifested by either of the following: </li></ul></ul><ul><ul><ul><li>The characteristic withdrawal syndrome for the substance </li></ul></ul></ul><ul><ul><ul><li>The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms </li></ul></ul></ul><ul><ul><li>(3) The substance is often taken in larger amounts or over a longer period than was intended </li></ul></ul><ul><ul><li>(4) There is a persistent desire or unsuccessful efforts to cut down or control the substance </li></ul></ul>Copyright Carol D. Miller
  7. 7. Substance Dependence (1) <ul><ul><li>(5) A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects </li></ul></ul><ul><ul><li>(6) Important social, occupational, or recreational activities are given up or reduced because of substance use </li></ul></ul><ul><ul><li>(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). </li></ul></ul>Copyright Carol D. Miller
  8. 8. Biochemical Response to Traumatic Experiences <ul><li>Negative excitement functions as connection in traumatic experiences (e.g., intimate partner violence = abuse followed by passionate reconciliation: infusion of adrenaline “fight-or-flight” followed by endorphins “natural high”) (10, 13) </li></ul><ul><li>Frequent arousal created by chronic trauma permanently changes person’s biochemistry and it becomes difficult to return to baseline levels biochemically (10) </li></ul><ul><li>Natural biochemicals become the addictive substance (2, 8, 13, 16) </li></ul>Copyright Carol D. Miller
  9. 9. Cycle of Addiction & Trauma (9, 12, 13) <ul><li>Experience of trauma increases likelihood of turning to substances to cope </li></ul><ul><li>Use of substances decreases use of self-protecting mechanisms and increases participation in illegal activities </li></ul><ul><li>Failure to self-protect and participation in illegal activities increases likelihood of further trauma (re-victimization) </li></ul><ul><li>And so on… </li></ul><ul><li>Some research reports “more than 70% of women with drug or alcohol abuse problems were victims of violence” (9) </li></ul><ul><ul><li>Accuracy of data? </li></ul></ul>Copyright Carol D. Miller
  10. 10. Why Do Survivors of Trauma Use Substances? <ul><li>Self-medication (9,10) </li></ul><ul><li>Escape painful emotions (2) and therefore control them (17) </li></ul><ul><li>Regulate and relieve intense feelings (10) </li></ul><ul><li>Suppress painful memories (2) </li></ul><ul><li>Numb out (2, 10) </li></ul><ul><li>Feel alive (2, 17) </li></ul><ul><li>Find relief (2, 15) </li></ul><ul><li>Gain a sense of control (2) </li></ul><ul><li>Express painful emotions by doing something concrete and active (12, 17) or to communicate the secret of the trauma (10) </li></ul>Copyright Carol D. Miller
  11. 11. Why do Survivors of Trauma Use Substances? <ul><li>Reenactment of trauma (11,17) </li></ul><ul><li>Expression of self-blame, self-hate (17) </li></ul><ul><li>Self-soothe (17) </li></ul><ul><li>Maintain sense of self if feeling threatened with loss of identity (17) </li></ul><ul><li>Escape perceived rejection – substance becomes a loyal friend (10, 17) </li></ul><ul><li>Express ownership over one’s own body – “It’s my body” (10, 17) </li></ul><ul><li>Asking for help (17) </li></ul><ul><li>Access feelings or memories (12) </li></ul><ul><li>To connect with others (12) </li></ul>Copyright Carol D. Miller
  12. 12. What Functions do Substances Serve for the Trauma Survivor? <ul><li>Initial impulse to self-medicate appears to help in the beginning (12, 13) </li></ul><ul><li>Stability – the expectations from substances can appear reliable to the survivor compared to human relationships (5) </li></ul><ul><li>Alcohol – lowers agitation, initially can sedate a spiking cortisol reaction from the traumatic event, sleep disturbances, nightmares, and other intrusive symptoms (13) </li></ul><ul><li>Heroin – calm feelings of rage and aggression (13) </li></ul><ul><li>Cocaine – anti-depressant impact (13) </li></ul>Copyright Carol D. Miller
  13. 13. REAL IMPACTS of Substance Use on the Trauma Survivor <ul><li>Compound original symptoms (5, 12, 13) </li></ul><ul><li>Exacerbate discomfort (13) </li></ul><ul><li>Increases alienation from others (13) and self (12) </li></ul><ul><li>Promotes greater dysfunction (13) </li></ul><ul><li>Keeps the survivor from finding healthy ways to feel good (12) </li></ul><ul><li>Prevents the survivor from getting needs met (12) </li></ul><ul><li>Takes away control – trauma was an experience beyond the survivor’s control and substance use leads to a loss of control (12) </li></ul><ul><li>Prevents healing (15) </li></ul>Copyright Carol D. Miller
  14. 14. How Re-Victimization Occurs <ul><li>Re-Victimization can occur on many levels: </li></ul><ul><ul><li>Individuals </li></ul></ul><ul><ul><li>Groups </li></ul></ul><ul><ul><li>Institutional </li></ul></ul><ul><ul><li>Societal </li></ul></ul>Copyright Carol D. Miller
  15. 15. Individual and Group Re-Victimization <ul><li>Prostitution – further perpetuation of abuse of body; risk of being beaten or raped </li></ul><ul><li>Rejection by family and friends – lack of understanding of the disease of addiction </li></ul><ul><li>Repeating dysfunctional familial and parenting patterns </li></ul><ul><li>Self-injurious behaviors </li></ul>Copyright Carol D. Miller
  16. 16. Individual and Group Re-Victimization <ul><li>Domestic violence – being blamed by family/friends for the abuse or perceived as the aggressor if under the influence of substances (3) </li></ul><ul><li>Labels (e.g., “crack-head”) </li></ul><ul><li>Social situations – refusing substances/alcohol at social events and fear of rejection </li></ul>Copyright Carol D. Miller
  17. 17. Institutional Re-Victimization <ul><li>Treatment </li></ul><ul><ul><li>Treating addiction and trauma as separate disorders (9) </li></ul></ul><ul><ul><li>Treating persons with trauma and/or addictions as though they are “cute little children” or “annoying adolescents” in adult bodies because of their symptoms </li></ul></ul><ul><ul><li>Lack of belief for capacity for change – “She’s always going to be like that” or “I know her from ___ and that’s the way she is” </li></ul></ul>Copyright Carol D. Miller
  18. 18. Institutional Re-Victimization <ul><li>Court Ordered for Treatment </li></ul><ul><ul><li>Disclosure of vulnerable information – fears of whether it might be used against them when there are releases of information to monitoring agencies </li></ul></ul><ul><ul><li>Might be perceived as patronizing – an authoritative agency ordering treatment, rather than self-electing to attend treatment (7) </li></ul></ul>Copyright Carol D. Miller
  19. 19. Institutional Re-Victimization <ul><li>Legal System </li></ul><ul><ul><li>Criminal charges associated with substance abuse becomes a part of permanent record </li></ul></ul><ul><ul><li>Majority of crimes committed by persons with substance dependence disorders would not have occurred if not under the influence or drug seeking </li></ul></ul>Copyright Carol D. Miller
  20. 20. Institutional Re-Victimization <ul><li>Legal System Continued </li></ul><ul><ul><li>Decreases likelihood of contacting law enforcement if victim of crime during act of prostitution and substance use out of fears of being arrested and threats to her credibility </li></ul></ul><ul><ul><li>Legal monitoring agencies may impose sanctions on persons for use of substances or relapses – decreases likelihood the person will ask for help when struggling with addiction and suffers in silence “secrecy” </li></ul></ul>Copyright Carol D. Miller
  21. 21. Institutional Re-Victimization <ul><li>Legal System Continued </li></ul><ul><ul><li>Domestic violence – may be charged as the aggressor if under the influence of substances at time of law enforcement involvement (3) </li></ul></ul><ul><ul><li>Loss of custody of children and risk of termination of parental rights </li></ul></ul>Copyright Carol D. Miller
  22. 22. Institutional Re-Victimization <ul><li>Employment </li></ul><ul><ul><li>Criminal charges on record leads to difficulty obtaining employment or continuing education </li></ul></ul><ul><ul><li>Struggles with maintaining employment if relapse occurs </li></ul></ul>Copyright Carol D. Miller
  23. 23. Societal Re-Victimization <ul><li>Attitudes toward substance abuse disorders (“just lazy” “doesn’t love her children” “doesn’t want to stop using”) </li></ul><ul><li>Low level of societal acceptance of substance abuse disorders as a disease </li></ul>Copyright Carol D. Miller
  24. 24. Treatable and Manageable <ul><li>Like persons with other diseases, “Addicts are not responsible for their disease, but they are responsible for what they do about their disease” and “…they are fully responsible for their behaviors during every stage of the disease.” (4) </li></ul><ul><li>Women tend to get better if treatment addresses both addiction and trauma (12) </li></ul>Copyright Carol D. Miller
  25. 25. Why? <ul><li>“ The CARE Program has help me find peace in my life. It is a safe environment for a group of women with substance abuse issues find new ways to cope. We come from diverse places but there seems to be a commonality among us….We were never given good coping skills and we have self-medicated our pain. Carol’s program helps us work through our pain and trauma in an environment of supportive, caring women.” </li></ul><ul><li>“ I came into CARE believing that I had no choices in life, that I was simply living the hand of cards that I have been dealt. How untrue, I have a choice in everything I do, I just have to be brave enough to make it. CARE has taught me to believe in myself, to live for me and my children, to make goals for my life and to strive to accomplish those. CARE has taught me to thrive even with the traumatic and substance abuse issues that I have. In short, CARE has taught me how to live a safer life, a more caring and productive life; a happy life.” </li></ul><ul><ul><li>Client statements used with written permission </li></ul></ul>Copyright Carol D. Miller
  26. 26. Resources <ul><li>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. </li></ul><ul><li>Bass, Ellen and Laura Davis. The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse 4 th Edition. New York: HarperCollins, 2008. </li></ul><ul><li>Bancroft, Lundy. Why Does He Do That? Inside the Minds of Angry and Controlling Men. New York: Berkley Books, 2002. </li></ul><ul><li>Cain, Tonier. Healing Neen. Maryland Disability Law Center: In the Hollow Films, 2010. </li></ul><ul><li>Courtois, Christine A. Healing the Incest Wound: Adult Survivors in Therapy. New York: W.W. Norton & Company, 1988. </li></ul>Copyright Carol D. Miller
  27. 27. Resources Continued <ul><li>Dupont, Robert L. The Selfish Brain: Learning from Addiction. Center City, MN: Hazelden, 2000. </li></ul><ul><li>Haddock, Deborah B. The Dissociative Identity Disorder Sourcebook. New York: Contemporary Books, 2001. </li></ul><ul><li>Herman, Judith. Trauma and Recovery. New York: Basic Books, 1997. </li></ul><ul><li>Miller, Dusty and Laurie Guidry. Addictions and Trauma Recovery: Healing the Body, Mind & Spirit. New York: W.W. Norton & Company, 2001. </li></ul><ul><li>Miller, Dusty. Women Who Hurt Themselves: A Book of Hope and Understanding. New York: Basic Books, 2005. </li></ul><ul><li>Miller, Dusty. Your Surviving Spirit: A Spiritual Workbook for Coping with Trauma. Oakland, CA: New Harbinger Publications, Inc., 2003. </li></ul><ul><li>Najavits, Lisa M. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press, 2002. </li></ul>Copyright Carol D. Miller
  28. 28. Resources Continued <ul><li>Naparstek, Belleruth. Invisible Heroes: Survivors of Trauma and How They Heal. New York: Bantam Books, 2004. </li></ul><ul><li>Perkinson, Robert R. Chemical Dependency Counseling: A Practical Guide. Second Edition. Thousand Oaks, CA: Sage Publications, Inc., 2002. </li></ul><ul><li>Schiraldi, Glenn R. The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth. New York: McGraw-Hill, 2000. </li></ul><ul><li>Vermilyea, Elizabeth G. Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress. Baltimore: The Sidran Press, 2000. </li></ul><ul><li>Williams, Mary Beth and Soili Poijula. The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms. Oakland, CA: New Harbinger Publications, Inc., 2002. </li></ul>Copyright Carol D. Miller
  29. 29. Contact Information for Carol D. Miller <ul><li>Private Practice </li></ul><ul><ul><li>4131 NW 28 th Lane, Suite 6 </li></ul></ul><ul><ul><li>Gainesville, FL 32606 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>(352) 514-1794 </li></ul></ul><ul><li>Meridian Behavioral Healthcare, Inc. </li></ul><ul><ul><li>4400 SW 13 th Street </li></ul></ul><ul><ul><li>Gainesville, FL 32608 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>(352) 374-5600 ext. 8224 </li></ul></ul>Copyright Carol D. Miller