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Trauma & Substance Abuse. Presented At: Women Across the Life Span: A National Conference on Women, Addiction & Recovery . By: Norma Finkelstein, Ph.D. Institute for Health & Recovery July 13, 2004.

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Trauma substance abuse

Trauma & Substance Abuse

Presented At: Women Across the Life Span: A National Conference on Women, Addiction & Recovery

By: Norma Finkelstein, Ph.D.

Institute for Health & Recovery July 13, 2004


“I am an incest survivor & never dealt with it. Left treatment, did drugs. The most important thing is to integrate [services]. I’m a slicer & before no place would take me & if [I] say I’ve been sexually abused they boot you…I thought here we go again. Substance abuse identified and you’re welcome..…need to work all 3 areas…others throw you out because they are afraid.”

Institute for Health & Recovery


Definition of trauma
Definition of Trauma treatment, did drugs. The most important thing is to integrate [services]. I’m a slicer & before no place would take me & if [I] say I’ve been sexually abused they boot you…I thought here we go again. Substance abuse identified and you’re welcome..…need to work all 3 areas…others throw you out because they are afraid.”

  • Shock or severe distress from experiencing a disastrous event

  • Traumatic reactions occur when people feel powerless, when nothing they can do matters

Institute for Health & Recovery


“Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the Comprehensive Textbook of Psychiatry, the common denominator of psychological trauma is feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation’.”

(Herman, Trauma Recovery)

Institute for Health & Recovery


Defining violence against women
Defining Violence Against Women occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

United Nations [1993]

“…any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.”

Institute for Health & Recovery


Types of violence
Types of Violence occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • Physical assault

  • Sexual abuse – including rape & incest

  • Emotional or psychological abuse

  • Environmental violence

  • Experienced as an adult or a child

  • May have occurred over time or been one incident and / or time limited

Institute for Health & Recovery


Violence against girls
Violence Against Girls occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • 83% of girls report being touched, pinched & grabbed in sexual ways in school

  • 1 in 5 high school girls has suffered sexual / physical abuse from a boyfriend. [JAMA, 2001]

  • More than 1/2 of women raped were under 18; over 1/3 were under 12 [National Violence Against Women Survey, 1995]

Institute for Health & Recovery


Abuse effects
Abuse Effects occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the


Substance abuse abuse history
Substance Abuse & Abuse History occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

Women in community samples report a lifetime history of physical & sexual abuse ranging from 36 to 51%, while women with substance abuse problems report a lifetime history ranging from 55 to 99%[Najavits et al. (1997)]

Institute for Health & Recovery


Substance abuse sexual assault
Substance Abuse & Sexual Assault occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • 50% of substance abusing women in treatment had experienced rape or incest(Woodhouse, 1990)

  • Women with a history of childhood sexual abuse were 2 times as likely to become heavy consumers of alcohol & 20% more likely to become injection drug users(Zierler et al. 1991)

  • 50% of women seen in a variety of psychiatric settings had been sexually abused as children(Muesser et al. 1998)

Institute for Health & Recovery


Substance abuse domestic violence
Substance Abuse & Domestic Violence occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • 80% of women with substance abuse disorders had been the victim of domestic violence (Research Institute on Addictions, 1997)

  • 42% of victims of domestic violence contacting the police had used alcohol or other drugs on the day of the assault (Brookhoff et al., 1997)

Institute for Health & Recovery


Special issues of victims of violence who are substance abusers
Special Issues of Victims of Violence occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the Who Are Substance Abusers

The presence of both substance abuse & domestic violence increases the severity of injuries & lethality rates (Mackey, 1992)

Perpetrators may pose risk to partners by:

  • Introducing partner to drugs

  • Forcing or coercing partner use

  • Isolating partner from help

  • Coercing partner to engage in illegal acts

  • Using withholding drugs as a threat

  • Using legal history as a threat

  • Blaming abuse on partner use

Institute for Health & Recovery


Adverse childhood events ace study
Adverse Childhood Events occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the ACE Study

  • Kaiser Permanente (Felitti) & the CDC (Anda)

  • Large-scale epidemiological study of influence of stressful / traumatic childhood experiences

  • Interviewed over 17,000 people

  • Compares adverse childhood experiences against adult health status

Institute for Health & Recovery


Ace study
ACE Study occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

(Felitti, 2003) Origins of Addiction


Ace study1
ACE Study occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • Scoring system used – one point for each category of ACE before 18

  • ACE’s not only common, but effects were cumulative

  • Compared to persons with ACE score of 0, those with ACE score of 4 or more were 2 times more likely to be smokers, 12 times more likely to have attempted suicide, 2 times more likely to be alcoholic and 10 times more likely to have injected street drugs.

Institute for Health & Recovery


Death occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

Early Death

Disease, Disability

Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

Birth

Adverse Childhood Experiences

The Influence of Adverse Childhood Experiences Throughout Life

ACE’s Major Determinant of Health & Well Being (Felitti, 2003)


Trauma is central and pervasive
Trauma is Central and Pervasive occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the

  • Central to the development of addiction, & mental health problems in women

  • Impacts MANY aspects of a woman’s life

Institute for Health & Recovery


“The treatment facility I was lucky enough to be accepted into was one of the first dual diagnosis facilities in the country…[it] was not trauma-informed, even though they diagnosed the PTSD. Although I learned a lot about dual diagnosis, trauma was not part of their curriculum. There were about 15 women in the facility, and all of us were trauma survivors. We would discuss our trauma with one another. However, the staff remained ill-informed. I often wondered why my trauma was never talked about.”

Institute for Health & Recovery


Pathways of Co-Occurrence into was one of the first dual diagnosis facilities in the country…[it] was not trauma-informed, even though they diagnosed the PTSD. Although I learned a lot about dual diagnosis, trauma was not part of their curriculum. There were about 15 women in the facility, and all of us were trauma survivors. We would discuss our trauma with one another. However, the staff remained ill-informed. I often wondered why my trauma was never talked about.”

(Begin Anywhere)

Victimization

Trauma Sequelae

Mental

Health

Problems

Self-

Medication

Addiction

Lack of

Self-Care


Impact of trauma

Feelings into was one of the first dual diagnosis facilities in the country…[it] was not trauma-informed, even though they diagnosed the PTSD. Although I learned a lot about dual diagnosis, trauma was not part of their curriculum. There were about 15 women in the facility, and all of us were trauma survivors. We would discuss our trauma with one another. However, the staff remained ill-informed. I often wondered why my trauma was never talked about.”

Fear, terror

Anger, revenge, hate

Frustration

Guilt or self-blame

Shame, humiliation

Grief or sorrow

Beliefs

About self

About other people

About the world

Impact of Trauma

Institute for Health & Recovery


  • Symptoms & behaviors into was one of the first dual diagnosis facilities in the country…[it] was not trauma-informed, even though they diagnosed the PTSD. Although I learned a lot about dual diagnosis, trauma was not part of their curriculum. There were about 15 women in the facility, and all of us were trauma survivors. We would discuss our trauma with one another. However, the staff remained ill-informed. I often wondered why my trauma was never talked about.”

    Attempts to cope with the trauma

  • Goal of treatment

    To return a sense of autonomy & control to the woman

Institute for Health & Recovery


“One of the most important things I have learned is how to keep myself safe. The word Safety never came up in treatment. I now realize how much jeopardy I put myself in when I was using substances, not caring what time of the night it was, not caring that the guy just came into the room waving a gun, just give me another hit. We continue to put ourselves in situations that can retraumatize us on a daily basis. Learning how important safety is to my recovery process has changed my outlook.”

Institute for Health & Recovery


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