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The Complex Nature of Trauma Treatment

January 31, 2018 Trauma and PTSD
woman therapist counseling with teenage boy in office

By Deborah V. Gross, MD, Psychiatrist at The Ranch Mississippi

What we experience early in life can influence our future responses. A psychologically traumatic event from your past may impact how you think, feel and behave today. That’s how post-traumatic stress disorder (PTSD) develops. While addiction is an illness of the brain, PTSD is more of an injury to the brain—something from the outside that happened to the person. In fact, we have evidence from the research of psychiatrists, like Bessel van der Kolk, that psychological trauma actually damages the anatomy of the brain. Some behavioral health professionals even prefer the term post-traumatic stress injury (PTSI) over PTSD.

How Past Trauma Gets Activated in the Present

Our brains are wired to do whatever they can to help us survive. When you experience trauma, you may feel helpless and in danger. Your brain activates survival mechanisms to help you cope at the time of the traumatic event. Some people develop PTSD or another trauma disorder after facing these situations. For these people, the same survival mechanisms get reactivated in the present day when they feel threatened, afraid or reminded of the original traumatic experience. The problem is that in the here and now, those tactics may not work, and may even be harmful.

Treating Trauma and Addiction

Many people with addictive disorders have experienced psychological trauma. Until recently, these problems were typically treated separately—you would get treated for one, then get treated for the other. Neither of these approaches work very well. If you treat addiction and don’t pay attention to the trauma, the trauma may activate under the strain and mess up the addiction treatment. Similarly, you can’t treat trauma effectively while people are actively abusing drugs or alcohol. This is because there’s still abuse and trauma present in the form of self-abuse. The individual is abusing themselves by misusing substances and often by the things they’re doing to get the substances as well.

In order to heal from a physical wound, you don’t tell your blood cells and skin cells how to do what they do. The body is wise—it knows. However, you do need to create the conditions that allow it to heal. You keep the area clean and maybe put on a bandage. In some cases, you might need stitches. In the same way, certain conditions must exist in order to heal from emotional trauma.

The Most Important Aspect of Trauma Treatment

Before people who have experienced psychological trauma can recover, they must achieve physical and emotional safety. If you have a cut on your arm, it will never heal if you keep banging on it. Likewise, you can’t recover from PTSD or trauma if you’re hurting yourself by continuing to engage in self-destructive behaviors that accompany a substance use disorder. You can’t get well while still experiencing active trauma or neglect, including the self-inflicted abuse and neglect that are so much a part of addiction. You must create and sustain psychologically safe conditions.

One important way to establish safety is to start with the basics: stop unsafe behaviors (e.g., drug and alcohol use) and replace them with safe ones—healthy routines, regular wake and sleep times, decent meals, etc. For some, this is their trauma work because they have literally never taken good care of themselves.

Some people may be able to identify triggers, others—especially those who can stay in treatment longer—can go further. It’s helpful to pinpoint and name the trauma and learn some basic grounding skills, like meditation and breathing. Almost everyone who attends addiction treatment with a history of psychological trauma benefits from learning something about it and how it affects the brain and behavior.

Treating the Person, Not the Problem

People come to drug and alcohol rehab with addictions of higher and lower severity and with psychiatric troubles of higher and lower severity. They’re also at different levels of readiness for making change, and their change readiness may be different for different aspects of their lives and behaviors. There are also factors outside the person to consider. These include several variables, like how long they can attend treatment, what kind of outside support is in place, as well as the severity of recent stress and loss—and if it’s still going on.

Effective addiction treatment isn’t just about eliminating the substance use or trauma. It’s about treating the person—assessing each individual one by one and considering all of the variables I mentioned and more. The next step is building a treatment plan that matches what they need and can accomplish at the single moment in time they are with us. It’s also about creating a comprehensive continuing care plan that provides the support clients need after they leave treatment.

Early sobriety is hard and so is establishing conditions for healing. The most effective addiction and trauma treatment is highly personalized and carefully paced for the needs of each individual and where they’re at on their recovery journey.

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