3. GOALS Gather a better understanding of the individual with co-occurring trauma and addiction concerns Support client’s to choose realistic goals and timelines Develop therapeutic relationship while modelling appropriate boundaries within

4. OBJECTIVES Recognize the symptoms & characteristics of clients impacted by trauma including how trauma can negatively influence a, –Person’s ability to modulate emotions without using substances to cope with (anger, stress, frustration…) –Person’s ability to access problem-solving skills –Person’s ability to access their impulse control Teach client’s various methods of self modulation

5. Types of Trauma Developmental Trauma –Living in adverse conditions that affect the nervous system of the child Shock Trauma –An unexpected event that is sudden and can be extreme (May include medical procedures) Relational Trauma –Can be on the continuum of war, bullying, domestic violence to sexual assault or abuse by someone we know

6. 5 Post-Traumatic Stress Disorder Condition where physiological and psychological processes are in a state of disequilibrium, altered by trauma impact. Involves intrusive symptoms with subjective loss of control and lack of awareness of trauma triggers, but fear of them.

7. 6 Trauma and Dysregulation Early trauma leads to affect dysregulation due to excess stimulation of Central Nervous System (CNS). Youth have problems learning how to regulate the intensity of feelings and impulses. Results in a wide array of problems- physical and mental. Inability to identify specific emotions. Hard to live in body (somatic reactions occur).

8. 7 Symptoms Anxiety Low mood Irritability Emotional ups and downs Poor concentration Isolation Difficulty falling asleep/staying asleep Hyper-vigilance Difficulty concentrating, and Difficulty trusting. Psychological symptoms such as:

9. 8 Symptoms (continued) Physical symptoms such as: Feeling palpitations without knowing why; Feeling sick; Numbing out when everything seems okay; Overreaction to sounds, smells; Chest pain; Headaches; Stomach pains and; Breathing difficulties.

10. 9 Symptoms (continued) Overwhelming fear and helplessness; Belief that adults are dangerous and fail to protect; Inability to concentrate; Lower Intelligence Quotients (I.Q.’s); Low self-esteem; Self-defeating styles of relating to others; Affective volatility.

11. Attachment Clients who suffered attachment issues as children are unable to mollify their emotions They do not have any access to their endogenous opioids As a result, they seek out drugs or engage in behaviors that may stimulate these opioids Can lead to anger management issues and other behavioural difficulties including criminalized behaviour

12. Psychophysiology of Early Childhood Trauma/Neglect

13. Non useExperimental Use Dependent / Chaotic Use Regular Use Occasional Use Before Long You Need to Use to Get Back Here

14.  Communication  Rituals Now what?  Precontemplation  Contemplation  Action  Maintenance Nah….. Nah….. Hmm… Doing it! No Issue? Understanding How People Change & Why They May Be Ambivalent  History  Environment  Self Talk/Beliefs  Preparation

15. Treating Trauma & Addictions Stabilization and safety –Bottom-up: settle autonomic responses –Increase relative safety in current life –If relational trauma – relationship with worker is more important Separating past from present and future –Develop language for emotion and sensation Expand flexibility and ability to adapt / cope Rebuilding balance –Self confidence, self-esteem; Healthy connections

16. Stabilization and Safety Structure, predictability Educate about trauma Stabilization / regulation tools Awareness of sensation Self-care & basic needs Dealing with other stressors

17. When exposed to repetitive crisis; Our arousal begins to rise; Hyper or Hypo arousal becomes the constant State; This influences positively and negatively how we deal with conflict?

18. 17 S & S: If You Want to Teach Efficient Coping Strategies 1. Explain the approach 2. Confirm the client understands the approach 3. Give time to ask questions & give consent, and 4. Confirm that the client can stop if needed.

19. 18 Safe Place Visualization/Filmmaking –So let’s go to your “happy place.” –Tell me - can you see… ? –What is _____ doing? –What are you doing? –What do you… The job of the worker is to have discussed something that the person enjoys and work to have them visualize the experience. Please use the template to assist you.

20. 19 S & S - Body/Breathing 3 – 6 Breathing Many people who have suffered, are typically chest breathers. They typically only breathe in their chest and rarely down into their stomach. The object of this exercise is to get people breathing into their stomach. Our work is to help them see that they can de-escalate themselves through a very simple process of breathing.

21. 20 Breathing Exercises Sipping – have your client pretend to be taking deep breaths through a straw. Inhale is through the straw, exhale is through the nose. Three to Six breaths – have your client inhale deeply to the count of three and exhale for up to six seconds. –Contraindication – this could make people feel lightheaded.

22. When Over-Reaction is a Theme Teach them about the brain Help them learn how to think when getting angry Teach them skills to do that: –Emotional Freedom Therapy (EFT) –Find out what worked; –Use distractions in the moment… –What have you used???

23. Grounding Techniques Movement - Dance – Exercise (with focus on releasing the negative energy) Assertiveness training – BIO – Behaviour – Impact – Options or what Outcome do you want Rituals – coping card – what has worked in class when you are mad Write out what you are mad at – read it – write it again – read it – write it – until you figure out how to deal with it “well”

24. 23 Sensory Grounding and Containment Body 3 - 2 -1 NAMESEEHEAR FEEL Three things you: Two things you: One thing you:

25. Groups of three Attempt to teach your colleague and do one of the safety exercises

26. How you know you learned is: If you feel differently; Think differently; Act differently. Name three areas where you will use the skills; BRAINSTORM.