1. Trauma and Substance Abuse An Introduction to Trauma-Informed Care Hoyt Roberson, MC, MS Licensed Marriage and Family Therapist Presbyterian Medical Services 505-962-6642 (O) 505-321-5115 (C) hoyt_roberson@pmsnet.org

2. Trauma is….  Extreme stress that overwhelms a person’s ability to cope.  Develops intra-personally.  May result in feelings or thoughts of  Vulnerability  Helplessness  Fear  Self-blame  Grief  Re-experiencing, Avoidance/Numbing, Hyperarousal, Negative Cognitions

3. Trauma does not necessarily result in PTSD  A minority of survivors develop clinically diagnosable PTSD  Being below clinical thresholds  Does not mean the absence of significant symptoms  May result in reduced services  May result in greater stigma

4. Indicators of greater risk for PTSD  Multiple traumas  Little or no social/familial support  Type of trauma  Accidental or intentional  Childhood abuse  Female  Presence of other mental health issues  Individual’s interpretation of the event

5. An experience of significant trauma or multiple experiences of trauma, may affect the individual’s view of, and understanding of  Themselves  The “world”  The reliability or safety of others  Their religious beliefs

6. Adverse Childhood Experiences Study  Childhood abuse and neglect are intimately correlated with adult mental and physical health issues.  The affects of childhood abuse and neglect continue through generations unless interdicted.

7. Neurosequential Development Theory  Dr. Bruce Perry  The brain develops in stages which create vulnerable or critical windows of development  Interference with brain development within those time windows adversely affects functional development of the brain  Abilities and functions are diminished  Will affect the person across their lifetime  Results in behavioral, cognitive, and emotional impairments

8. Prevalence of Trauma  25% of children and adolescents experience at least one potentially traumatic event before the age of 16.  13% of 17 year olds have experienced PTSD at some point in their lives.  Up to 59% of young people with PTSD develop substance abuse problems  75% of Americans will experience a traumatic event in their lifetime  25% of women in NM sexually assaulted  Trauma is ubiquitous in the United States

9. Results of Trauma  Emotional difficulties  Cognitive difficulties and distortions  Social impairments and difficulties  Ability to handle transitions and change  Interference with developmental momentum

10. Results of Trauma  Trauma memories and negative self- talk/image are often key in maintaining symptoms.  Avoidance of memories and self image issues results in continued symptoms and lack of treatment.  Instead of treatment, self-medication with substance is often the coping strategy selected.

11. Results of Trauma  20% of veterans with PTSD also have SUD  30% of veterans with SUD also have PTSD  48% rates in some studies of SUD have PTSD  SUD + PTSD have higher comorbid mental health issues

13. Mental Illness Substance Abuse Trauma We Used to Think

14. Mental Illness Substance Abuse Trauma Now We Know

15. Recovery From Trauma  Judith Herman  Safety  Mourning  Reconnecting  Neurosequential Development Theory  Re-form or repair lost abilities  In the order of natural development  Treat both trauma and substance use  Address behavioral, cognitive, and interpersonal deficits

16. Treating Trauma  Front line or evidence-based treatments  Prolonged Exposure  Cognitive Processing Therapy  EMDR  Seeking Safety  Various forms of CBT for adults  Trauma-focused CBT  Medication  Alternative or complementary treatments  Accupuncture, massage, biofeedback, Yoga  Pastoral counseling

17. Trauma-Informed Care  Moved from “what’s wrong with you?” to “what happened to you?”  Involves an entire agency and systems of care.  Integrated treatment  Behavioral Health/Substance Abuse  Behavioral Health/Primary Care  Both trauma-informed and trauma- competent

18. What Can You Do?  Identify an agency champion for trauma- informed care  Use a consultant  Complete an agency assessment  Develop a plan to train, orient, and update  Know what works  Insist on competence and follow-through  Care for staff  Celebrate successes

19. What Can You Do?  Get trained in trauma-informed care  Get trained in trauma interventions  Join a learning team or community

20. What Can We Do?  Make trauma-informed care a priority throughout our systems  Develop networks for warm hand-offs and treatment of clients  Implement programs to intercept and eliminate generational transmission of trauma and substance abuse  Use programs that work  Expect staff to be informed and competent

21. What Can We Do?  Provide training  Motivational Interviewing  Seeking Safety  Prolonged Exposure  Cognitive Processing Therapy  Trauma-focused CBT  Support and encourage learning teams and communities

22. Veteran and Family Support Services  Originally a veteran and family program  Developed a trauma-competent staff  Behavioral health, substance abuse, case management, and medication management  Trauma-informed lagged

23. Veteran and Family Support Services  Clients (VFSS, Jail Diversion, Mental Health Court, and Drug Court) are provided the full range of services we provide.  Assessments and therapeutic interventions ensure the whole person is treated.  Facilitate a Veterans Advisory Council  Provide community education and engagement