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Stephanie S. Covington, Ph.D., LCSW Institute for Relational Development Center for Gender Justice La Jolla, CA 43rd

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Stephanie S. Covington, Ph.D., LCSW Institute for Relational Development Center for Gender Justice La Jolla, CA 43rd

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    1. Stephanie S. Covington, Ph.D., LCSW Institute for Relational Development Center for Gender & Justice La Jolla, CA 43rd Annual Addictions Conference May 30, 2011 Toronto, Ontario

    2. © S. Covington, 2011

    3. Crisis=Danger & Opportunity © S. Covington, 2011

    4. Levels of Violence Childhood Adolescence Adult Street (workplace and community) Consumer Culture Media War Planet © S. Covington, 2011

    5. Global Violence Violence is a leading cause of death among people aged 15-29 © S. Covington, 2011

    6. © S. Covington, 2011

    7. Two Kinds of Suffering Natural Created © S. Covington, 2011

    8. Definition of Trauma The diagnostic manual used by mental health providers (DSM IV-TR) defines trauma as, “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.” (American Psychiatric Assoc. [APA] 2000, pg. 463). © S. Covington, 2011

    9. Definition of Trauma (cont.) “The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve disorganized or agitated behavior).” (American Psychiatric Assoc. [APA] 2000, pg. 463). © S. Covington, 2011

    10. Definition of Trauma Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources. (Bloom & Fallot, 2009) © S. Covington, 2011

    11. Violence Against Women Violence against women is so pervasive that the United Nations has addressed and defined violence against women as “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.” (United Nations General Assembly, 1993). © S. Covington, 2011

    12. Moral Challenges 19th century - slavery 20th century - totalitarianism 21st century – brutality against women and girls © S. Covington, 2011

    13. Traumatic Events Trauma can take many forms: Emotional, sexual or physical abuse Neglect Abandonment (especially for small children) Extremely painful and frightening medical procedures © S. Covington, 2011

    14. Traumatic Events (cont.) Catastrophic injuries and illnesses Rape or assault Muggings Domestic violence Burglary Automobile accidents © S. Covington, 2011

    15. Traumatic Events (cont.) Immigration Natural disasters (hurricanes, floods, earthquakes, tornadoes, fires, volcanoes) Terrorism such as September 11, 2001 Witnessing violence such as a parent harming another parent © S. Covington, 2011

    16. Traumatic Events (cont.) Loss of a loved one and severe bereavements (even of a pet) Combat/war Torture Kidnapping Intergenerational (cultural) trauma © S. Covington, 2011

    17. Historical Trauma Across generations Massive group trauma Examples include: Aboriginal (First Nation), Native Americans, African Americans, Holocaust survivors, Japanese internment survivors © S. Covington, 2011

    18. Traumatic Events Of all these forms of trauma, women are at greater risk of interpersonal abuse than men. © S. Covington, 2011

    19. Trauma-Informed Services Trauma-informed services: Take the trauma into account. Avoid triggering trauma reactions and/or traumatizing the individual. (Harris & Fallot) © S. Covington, 2011

    20. Trauma-Informed Services (cont) Adjust the behavior of counselors, other staff and the organization to support the individual’s coping capacity. Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain and benefit from the services. (Harris & Fallot) © S. Covington, 2011

    21. Core Principles of Trauma-Informed Care Safety (physical and emotional) Trustworthiness Choice Collaboration Empowerment (Fallot & Harris, 2006) © S. Covington, 2011

    22. © S. Covington, 2011 Process of Trauma

    23. © S. Covington, 2011

    24. © S. Covington, 2011

    25. ACE Study (Adverse Childhood Experiences) Results ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity (Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE). © S. Covington, 2011

    26. Men 16% Sexual Abuse Men 30% Physical Abuse Women 27% Sexual Abuse (Felitti and Anda, 2010) © S. Covington, 2011

    27. Women 50% more likely than men to have a score of 5 or more. (Felitti & Anda, 2010) © S. Covington, 2011

    28. If a male child has six or more “yes” answers, his risk of becoming an IV drug user increases by 4,600% compared to a boy with a score of zero. (Felitti & Anda, 2010) © S. Covington, 2011

    29. © S. Covington, 2011

    30. © S. Covington, 2011

    31. © S. Covington, 2011

    32. Childhood Traumatic Events Largest Effect-Mental Health Psychotropic medication Mental health treatment Attempted suicide Traumatic stress (Messina & Grella, 2005) © S. Covington, 2011

    33. Childhood Traumatic Events Largest Effect-Mental Health 980% increase in odds if exposed to 7 CTE’s (Messina & Grella, 2005) © S. Covington, 2011

    34. Critical and Interrelated Issues Substance Abuse Mental Health Trauma Physical Health © S. Covington, 2011

    35. Areas of Separation Training Treatment Categorical Funding © S. Covington, 2011

    36. Key Elements (Staff and Clients) Learn what trauma/abuse is Understand typical responses Develop coping skills © S. Covington, 2011

    37. Definition of Recovery © S. Covington, 2011

    38. Prevalence of Trauma and PTSD in Substance Use/Abuse 60% to 90% of a treatment-seeking sample of substance abusers also have a history of victimization More than 80% of women seeking treatment for a substance use disorder reported experiencing physical/sexual abuse during their lifetime © S. Covington, 2011

    39. Prevalence of Trauma and PTSD in Substance Use/Abuse Between 44% and 56% of women seeking treatment for a substance use disorder had a lifetime history of PTSD 10.3% of the men and 26.2% of the women with a lifetime diagnosis of alcohol dependence also had a history of PTSD © S. Covington, 2011

    40. Histories of Trauma / Violence among Clients Treated for Methamphetamine Persons in treatment for methamphetamine report high rates of trauma 85% women 69% men © S. Covington, 2011

    41. Histories of Trauma / Violence among Clients Treated for Methamphetamine Most common source of trauma/violence: For women, was a partner (80%) For men, was a stranger (43%) History of sexual abuse 57% women 16% men © S. Covington, 2011

    42. Disorders Related to Trauma and Substance Abuse in Women’s Lives Depressive Disorders NOS 22.9% Major Depressive Disorders 17.5% Post traumatic Stress Disorders 16.3% Neurotic Anxiety Disorders 13.8% Bipolar Disorders 13.7% Mood or Dysthymic Disorders 5.3% Psychotic Disorders 4.8% Personality and Misc. Disorders 5.8% Source: Patterns of Comorbidity among Women with Childhood Interpersonal Trauma, Mental Health Disorders, and Substance Related Disorders. Journal of Behavioral Health Services & Research (in press) © S. Covington, 2011

    43. Post-Traumatic Stress Disorder Re-experiencing the event through flashbacks and nightmares. Avoidance of stimuli associated with the event (for example, if a woman was raped in a park, she may avoid parks, or if she was assaulted by a blonde man, she may avoid men with blonde hair). © S. Covington, 2011

    44. Estrangement (the inability to be emotionally close to anyone) Numbing of general responsiveness (feeling nothing most of the time) © S. Covington, 2011

    45. Post-Traumatic Stress Disorder (cont.) Hyper-vigilance (constantly scanning one’s environment for danger, whether physical or emotional) Exaggerated startle response (a tendency to jump at loud noises or unexpected touch) (DSM – IV) © S. Covington, 2011

    46. Sexual abuse Physical abuse Emotional abuse Domestic violence Witnessing abuse/violence Self-inflicted violence Military sexual assault (MST) © S. Covington, 2011

    47. Trauma of Stigmatization Poverty Race/Culture Sexual Orientation Mental Illness Physical Disability Incarceration © S. Covington, 2011

    48. Trauma © S. Covington, 2011

    49. Gender-Responsive Treatment Creating an environment through: site selection staff selection program development content and material that reflects an understanding of the realities of the lives of women and girls, and addresses and responds to their strengths and challenges. © S. Covington, 2011

    50. Gender-Responsive Materials (Trauma-informed) Women and Addiction: A Gender-Responsive Approach Helping Women Recover Helping Men Recover Voices: A Program for Girls Beyond Trauma: A Healing Journey for Women Women in Recovery A Woman’s Way through The Twelve Steps Beyond Violence: A Prevention Program for Women

    51. Trauma Materials for Women ATRIUM (Dusty Miller) Beyond Trauma (Stephanie Covington) Healing Trauma (Stephanie Covington) Seeking Safety (Lisa Najavits) TREM (Maxine Harris) © S. Covington, 2011

    52. Helping Women Recover: A Program for Treating Addiction Theory of Addiction Holistic health model Chronic neglect of self in favor of something or someone else Theory of Women’s Psychological Development Relational–Cultural Model (Stone Center) Theory of Trauma Three Stage Model (Herman) Upward Spiral – A Transformational Model (Covington) © S. Covington, 2011

    53. Helping Men Recover: A Program for Treating Addiction By Covington, Griffin & Dauer © S. Covington, 2011

    54. Impact of male socialization on the recovery process Relational needs of men Issues of abuse and trauma Self, relationships, sexuality and spirituality © S. Covington, 2011

    55. Power and Control Wheel © S. Covington, 2011

    56. © S. Covington, 2011 Voices: A Program of Self-Discovery and Empowerment for Girls

    57. © S. Covington, 2011 Beyond Trauma: A Healing Journey for Women Trauma Theory Sandra Bloom, M.D. Mary Harvey, Ph.D. Judith Herman, M.D. Peter Levine, Ph.D. Integrates cognitive-behavioral, expressive arts, guided imagery, and relational therapy.

    58. © S. Covington, 2011 Client Assessment Scores Improve after Completion of HWR and BT

    59. © S. Covington, 2011 Prison Study (NIDA Funded) Randomized control group Gender-responsive vs. Therapeutic Community Significant differences

    60. © S. Covington, 2011 Drug Court Study (NIDA Funded) Four sites in San Diego County Randomized control group Preliminary results

    61. © S. Covington, 2011 Trauma: Stages of Recovery

    62. © S. Covington, 2011 Trauma: Stages of Recovery

    63. © S. Covington, 2011 Trauma: Stages of Recovery

    64. © S. Covington, 2011 Trauma Three Group Models

    65. © S. Covington, 2011 Trauma Three Group Models

    66. © S. Covington, 2011 Trauma Three Group Models

    67. © S. Covington, 2011 Emerging Paradigm Values-Based Services Gender-responsive Trauma-informed Culturally competent Recovery-oriented

    68. © S. Covington, 2011 Sanctuary

    69. © S. Covington, 2011 What is Sanctuary? Sacred place Place of refuge/protection Shelter Oasis

    70. © S. Covington, 2011 What Makes a Difference? Creating a safe environment Listening to her/his story Empathy

    71. © S. Covington, 2011 Upward Spiral

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