Martina Mullin O’Hare Partnership & Community Development Officer Mental Health, Belfast Health & Social Care Trust Understanding Trauma/PTSD and the Co-existing Conditions of Alcohol and Drugs SDF Conference, Wednesday 29 October 2014,

Outline of this presentation Co-existing Conditions of Alcohol and Prescription Drug Misuse A brief overview of PTSD and research knowledge from N.Ireland The Implications and some Ways Forward

Categories of Trauma Human Caused: Trauma where acts are intentional eg, Crime Human-caused” trauma where acts are accidental (e.g. road traffic accidents) Nature-related” trauma Nature-related” trauma complicated by human actions Human-caused or complicated traumatic events are well known to have greater potential for traumatisation. Person-implicated events that are by their nature horrific, prolonged, repeated, deliberate and/or malevolent have the greatest capacity to negatively affect people.

Blocked Pain Dissociation Decreased ability to function at home/work Haunted by the past: flashbacks, nightmares, body memories Acting out in the home acting out in the street creating more pain to block

Definition of PTSD and Link with Substance Misuse “An event outside the usual realm of human experience that is markedly distressing – evoking reactions of intense fear, helplessness, terror” ( Z Solomon, 1996) It is not unusual for individuals experiencing trauma to become involved in self-destructive behaviours such as substance misuse or self harm as a way to cope and manage unbearable distress. Alcohol MisUse: This the most prevalent Co-existing condition with post- traumatic stress disorder (Kessler 1995).

What has the ETAP Research Report told us?  The onset of PTSD can typically precede the onset of substance abuse  The Legacy of the Troubles will further fuel the cycles of addiction and poor mental health  There has been a tendency to find appropriate referral difficult The coexistence of post-traumatic stress disorder and substance abuse is described in literature as a ‘downward spiral’ where trauma symptoms are common triggers of substance use, which in turn can heighten post- traumatic symptoms (Lisa Najavits, 1997) ETAP Report quote “Northern Ireland does have a higher usage of these drugs (tranquillisers and sleeping pills) which has been attributed partly to the legacy of the `troubles’.” (S. Rainey, 2011)

Co-Existing Conditions If the post-traumatic symptoms are not addressed then sufferers are in danger of descending into a spiral of disconnection with people, social isolation, loneliness, poor physical health, depression or other anxiety disorders and maladaptive coping mechanisms such as substance abuse and may eventually lead to dependence on these substances. The most common coping strategy can be, to use substances such as alcohol and prescribed drugs/medication to ease or numb the pain of the trauma and the associated symptoms

Information Leaflet for Individuals and Families Effects of Co-existing conditions Raising Awareness Moving to Action Creating a `Movement’ More Work to do

Understanding trauma, its effects and how it relates to substance use/misuse (section 1) Screening and assessment tools (section 2) Trauma Related Mental Health Disorders (section 3) Transgenerational Trauma (section 4) Negative consequences of traumatic experiences (section 5) Foundations for safe trauma treatment (section 6) A sample of interventions and tools (section 7) The importance of self-care and avoiding vicarious trauma (section 8). “It has always seemed unrealistic to expect trauma survivors to put down their coping mechanisms, even those that are unhealthy, prior to developing alternatives” (Treating Trauma, K Young 2010)

Integrated Treatment: The development of the most effective treatment responses to the needs of people with co-existing conditions rests on providing treatment of both a service user/client substance misuse and trauma. An Integrated Approach

The Silos – What can we Do The Silos of expert care create focused excellence but not commonly held standards of practice. The Resource Guide’s aim was to identify key standards of practice in co-existing conditions and make this information accessible to all The Objective is to evolve the type of service that most effectively delivers this care

To bring Trauma/PTSD into the equation with substance misuse – Other ways forward. Ultimately, resiliency provides a mandate for social change — it is a clarion call for creating these relationships and opportunities in all human systems throughout the lifespan