Trauma & Gambling Addiction: An Overview

Workshop Objectives Have an understanding of the Adverse Childhood Experiences study Understand how the risk of poor health outcomes increases when people have experienced trauma Understand why addiction is one of the negative health outcomes associated with trauma

The ACE Study Dr. Felitti of Kaiser Permanente & Dr. Anda of Center for Disease Control A study examining the correlation between adverse childhood experiences and outcomes later in life. Initially recruited participants between 1995- 1997. Study published 1998. Ongoing date continues to be collected through CDC

Incarcerated Relative Mother Treated Violently What are the ACEs? Before the age of 18 did you experience… www.rwjf.org Abuse Neglect Household Dysfunction Physical Physical Mental Illness Incarcerated Relative Emotional Emotional Mother Treated Violently Substance Abuse Sexual Divorce www.acestudy.org

Adverse Childhood Experience (ACE) Questionnaire Finding your ACE Score While you were growing up, during your first 18 years of life: 1. Did a parent or other adult in the household often … Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? 2. Did a parent or other adult in the household often … Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? 3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you? 4. Did you often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other? 5. Did you often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? 6. Were your parents ever separated or divorced? 7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? 9. Was a household member depressed or mentally ill or did a household member attempt suicide? 10. Did a household member go to prison? Now add up your “Yes” answers: _______ This is your ACE Score

As ACEs Increase so does Risk… www.acestudy.org

A Dose-Response Relationship Response = Health, Social, Learning Issues, etc… 1 ACE 2 ACEs 3 ACEs 4 or more ACEs Dose = Accumulation of ACEs

Defining Trauma: The 3 “E”s Event: Exposure to an event or series of events that threatens the well-being of an individual or group Experience: Respond to the event with intense fear, helplessness and/or horror Event: Shakes our basic beliefs about safety, predictability & trust

Trauma Video

Effects of Stress Short-Term Long-Term Increased: blood flow to muscles, blood pressure, heart rate, blood sugar, muscle tension, and more Changes in emotional regulation and reactivity Trouble accessing our “thinking brain” Lowered ability to empathize High likelihood of negative perceptions of others behaviors, tone, words, and facial expressions Changes reward center of brain Inhibits development of prefrontal cortex May increase size of amygdala Changes development of immune system Changes DNA transcription Changes development of hormonal systems

Prefrontal Cortex is the brain’s center for executive control Amygdala is the threat detection center Hippocampus controls memory processing www.recovery.org

Brain Chemistry Cortisol, “UH-OH” Stress hormone (steroid) Aids in glucose metabolism Serotonin, “Ahhh” Derived from tryptophan Regulates mood, sleep, appetite Adrenaline, “Yikes!” Stress hormone CNS excitement Fright/flight Dopamine, “YAHOO” Neurotransmitter Drugs, sex, food Antidote to cortisol Role in addiction

Dopamine Release & The Near Miss

Addictive Behaviors as Coping Mechanisms Stay safe Escape memories  Soothe pain Be in control Create a world you can tolerate Treat yourself the way you feel you deserve Redefine who you are

Creating A Foundation of Resilience

Core Values of Trauma Informed Care: Safety: Ensuring physical and emotional safety Cultural, and Gender Issues: Working to address cultural stereotypes and biases, offering gender responsive services, leveraging the healing value of traditional cultural connections Trustworthiness & Transparency: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries Empowerment, Voice & Choice: Prioritizing developmentally appropriate choice and control for the participant Peer Support and mutual self-help: Understanding peer support as integral to building trust, safety, and empowerment