This is part three of the three-part series, Trauma-Informed Addiction Treatment and Research-Based Interventions. Read part two, The Relationship Between Trauma and Substance Abuse
A trauma-informed approach to treatment, according to the Substance Abuse and Mental Health Services Administration, is one that:
- Realizes the widespread impact of trauma and understands multiple pathways for recovery
- Recognizes the signs and symptoms of trauma in clients and families
- Responds to trauma by fully integrating knowledge about it into practices, procedures and policies
- Actively works to prevent re-traumatization
A successful trauma-informed approach will include interventions that are based on trauma research and the psychosocial, educational and empowerment principles that have long been used in public system settings. Following are some of the most commonly used and successful research-based interventions for trauma-informed treatment:
Seeking Safety is an evidence-based counseling model that focuses on the present rather than the past and is designed to help individuals regain a sense of safety from trauma and substance abuse. While it addresses both trauma and addiction, it doesn’t delve into detailed accounts of the trauma. The twenty-five topics covered under this model can be addressed in any order.
The topics include:
- PTSD: Taking Back Your Power
- When Substances Control You
- Setting Boundaries in Relationships
- Creating Meaning
- Integrating the Split Self
- Taking Good Care of Yourself
- Detaching from Emotional Pain (Grounding)
This model operates on several key principles:
- Safety as the priority of treatment
- Integrated treatment
- A focus on ideals
- Four content areas: cognitive, behavioral, interpersonal and case management
Seeking Safety is very flexible. It can be presented in group or individual settings, and it works well for men and women, adults and adolescents and people in all levels of care.
Risking Connection is a trauma-informed model for various levels of mental health, public health and substance abuse staff. It emphasizes relationships as central to the healing process as well as the importance of self-care for providers.
This model is based on RICH relationships—those characterized by respect, information sharing, connection and hope. It focuses on the concepts of empowerment and collaboration to help caregivers understand how trauma causes pain, how connection and relationships can be used as treatment tools, and the importance of maintaining a trauma framework when responding to crises and working with dissociation and self-awareness.
Acceptance and Commitment Therapy
Mindfulness interventions are intentional, non-judgmental and accepting practices that focus on teaching people how to pay attention to their thoughts and feelings in the moment.
Acceptance and commitment therapy is a mindfulness intervention that helps individuals think and act in ways that support their personal values while developing psychological flexibility. Through ACT, clients recognize the challenges of their attempts to suppress, control and manage negative emotional experiences. In doing so, they become more adept at making healthy decisions that promote well-being.
The six core processes of ACT are:
- Acceptance over avoidance
- Cognitive diffusion techniques that help individuals change the way they interact with their thoughts
- Being present in a non-judgmental way
- Self as context, or being aware of one’s own experiences without attachment
- Values, or one’s judgments of what is important in life
- Committed action, or developing larger patterns of healthy behaviors linked to chosen values
Dialectical Behavior Therapy
Dialectical behavior therapy is another mindfulness-based intervention designed to help clients develop skills for managing difficult emotions and reducing conflict in their relationships. Problematic behaviors evolve as coping mechanisms, and while they may offer short-term relief, these behaviors lead to more problems in the long-term.
DBT helps clients learn new behaviors and enhance their capabilities by learning new coping skills in a variety of areas, including:
- Distress tolerance
- Regulating emotions
- Interpersonal relationships
DBT is divided into four treatment stages:
Stage 1 moves the client from being and feeling out of control to achieving control over their behaviors.
Stage 2 moves the client from feelings of quiet desperation to full emotional experiencing. This is the stage where PTSD is treated.
Stage 3 is all about learning to live. The client defines life goals, builds self-respect and finds peace and happiness.
Stage 4 is for clients who wish to find deeper meaning through spirituality and helps them move from a feeling of incompleteness toward feelings of joy and freedom.
DBT is an evidence-based therapy that’s been shown to reduce suicidal behaviors, self-injury, substance abuse and anger resulting from past trauma.
Mindfulness-Based Relapse Prevention
Relapse prevention is central to successful addiction recovery. Mindfulness-based relapse prevention is a model that eschews the common belief that relapse is a “sleeping tiger” ready to pounce when least expected.
The primary goals of MBRP are to:
- Develop awareness of one’s habitual reactions and personal triggers for relapse and learn how to pause these automatic processes for closer inspection
- Learn how to be okay with being uncomfortable
- Recognize challenging emotional and physical experiences and develop skills to respond to them in healthy ways
- Develop self-compassion and a nonjudgmental approach toward oneself and one’s experiences
- Build a healthy lifestyle that supports mindfulness and a life of recovery from trauma and substance abuse
Mindfulness meditation is a meditation technique that can help individuals manage distracting thoughts and feelings by staying aware of the thoughts, feelings and sensations in the present moment. A growing body of research shows that mindfulness meditation is an effective treatment for a wide range of physical and psychological ailments and has been associated with decreased stress, depression, anxiety, pain and insomnia.
Recent research by neuroscientists at Harvard Medical School and Massachusetts General Hospital found that regular meditation practice actually changes the brain, increasing the amount of gray matter in the auditory and sensory cortex and in the frontal cortex, which is associated with executive decision making and working memory. The study also found that following four regions of the brain thickened after just eight weeks of meditating:
- The posterior cingulate, which is involved in self-relevance and mind wandering
- The left hippocampus, which is involved in learning, cognition, memory and regulating emotions
- The temporoparietal junction, which is associated with perspective, empathy and compassion
- The pons, which is where many regulatory neurotransmitters are produced
Additionally, the amygdala, which is involved in anxiety, stress and fear, experienced a reduction in size after eight weeks of mindfulness meditation.
SAMHSA’s Six Key Principles of a Trauma-Informed Approach
According to the Substance Abuse and Mental Health Services Administration, a trauma-informed approach adheres to six key principles rather than a pre-ordained set of procedures and practices.
These principles are:
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice, and choice
- Cultural, historical and gender issues
Trauma permeates all areas of an individual’s life, and when it co-occurs with a substance use disorder, the result is often devastating to their relationships, physical and mental health, finances, quality of life and sense of well-being.
Through a trauma-informed approach to addiction treatment using research-based interventions, individuals can safely and effectively restore their lives after trauma and end an addiction for the long-term.
Download this entire series as a beautifully designed eBook, Trauma-Informed Addiction Treatment and Research-Based Interventions