By GREGG ARMSTRONG, LMHC, CAP
One of Coalition Recovery's new treatment programs focuses on a trauma and cognitive based approach as the center of addiction recovery. It is best to understand substance abuse and addiction as a "mode of being." The behavior of addiction stems from an underlying psychological condition that manifests as symptom relief for emotions or feelings that are disruptive to life. Depression and anxiety to name a couple. The psychological conditions that are driving the emotional base must have a point of origin, or root cause. It begins in childhood. Adverse childhood experiences or childhood trauma. Trauma has ramifications on cognitive, emotional, and physical development that can persist into adulthood. Stress from a past trauma can be constant throughout an extended period of time. Science shows the longer stress exists from trauma, the more damage progresses in the brain in the parts that affect most processes of the person and their ability to make healthy decisions - consequently leading to harmful behaviors such as substance abuse and addiction. This approach to treating substance abuse is locating the origin of these stressors, coming to terms with this reasoning, and establishing a new way of thinking. This is taking Cognitive Behavioral Theory as well as Dialectical Behavioral Theory and diving deeper into understanding the reasons behind dysfunctional behavior and emotions - something that has never been the clinical centerpiece in the substance abuse treatment industry.
C-PTSD and Childhood Trauma
Post-Traumatic Stress Disorder (PTSD), is associated with seemingly disastrous events such as natural disasters, terrorist attacks, car accidents and any other occurrence that may flood someone with powerful emotions such as fear or sadness. These symptoms may be present well after the incident. However, there is another type of post-traumatic stress called Complex Post Traumatic Stress Disorder (C-PTSD) which occurs as a result of long-term exposure to traumatic stress, rather than a response to a single event. C-PTSD typically arises as a result of ongoing stress referred to as developmental trauma disorder (DTD). Childhood Trauma is a common form of C-PTSD.
Childhood Trauma can range from having faced or witnessed extreme violence, the loss of a parental figure in the family, being unwanted, abuse whether it be physical, emotional, sexual, or psychological, or growing up with substance abuse in the family. Both men and women who were victimized as children report more stressful events over their lifetimes suggesting that early child abuse and neglect is part of a broader constellation of life stressors. In the Adverse Childhood Experience Study (ACE) comparing the relationships of indicators of childhood abuse and neglect to changes in the symptoms of mental disorders over the period from early adolescence to adulthood, youths with an official record of victimization of child physical abuse showed elevated levels of disorders and symptom rates for almost every clinical disorder. The disorders carry forward through childhood into adolescence, and become the core emotional base for adulthood. Unresolved childhood trauma, as an adult, has significant consequences on mental and emotional health. Physical health may also be impacted by illness or chronic pain.
Symptoms of C-PTSD
- Avoidant symptoms: It is common to develop avoidance strategies to get away from memories or present manifestations of childhood trauma. This involves avoiding people and the places that serve as reminders of the past. Avoidance can take the form of denying that past, repressing feelings, idealizing parents, minimizing pain or dissociating.
- Intrusive Symptoms: High arousal symptoms, characterized by feelings such as anxiety, aggression, and irritability, are often experienced by those individuals with C-PTSD. These often manifest in what is known as emotional dysregulation, or sweeping emotions of sadness, rage or fear. These can feel intrusive and hijack the relationship with yourself, your family, and your world and can result in feeling stuck in patterns of disconnection, resentment or abandonment with family and friends.
- Depressive Symptoms: Low arousal symptoms, such as hopelessness, despair, and depression, reside in the other side of high arousal symptoms. These symptoms typically result from living in a threatening environment with no escape. When you have no ability to change your situation, you may be left feeling ineffective, powerless, and helpless. Shame and unworthiness are signatures of depressive symptoms of C-PTSD.
Treatment - A Cognitive Based Approach to Trauma
Treating the whole person, mind/body/spirit will result in the best possible outcome for a healthy, long term recovery from addiction. This treatment philosophy has an accelerated trauma focus with a cognitive based approach. It is effective to develop a story-line of the individual in an effort to the find the root cause of their destructive patterns of behavior such as addiction and substance abuse. These root causes are the effect of trauma. Trauma can range from PTSD to C-PTSD such as childhood trauma. Using a Cognitive Behavioral Therapy technique (focusing on solutions, encouraging patients to challenge distorted cognitions and change their destructive patterns of behavior) is not enough because it focuses solely on how to handle these distorted and destructive patterns, but does not give reasoning to why these thought patterns exist. Trauma Focused, Cognitive Based Approach is formulated with the use of cognitive interventions, such as Cognitive Behavioral Therapy, Dialectical Therapy, Motivational Work, Interpersonal Interventions, Neurological Theory among other interventions. Educating the patient as to the root cause of their current clinical issues aids their understanding of "Why" and accelerates the healing process.
Accelerated Trauma programs are effective within the traditional 90-day period to establish a foreground for treatment and start changing cognitive behavior, while also treating these dysfunctional emotions and behaviors. Additional clinical hours and on-going care, built on the basis of programs such as these, will only improve outcome statistics. Aftercare programs that offer substantive ongoing resources such as connecting patients to ongoing clinical care with their local clinicians are essential. With aftercare resources like these in place, patients are able to continue trauma-specific clinical care far beyond traditional treatment.
Gregg Armstrong is an expert in trauma-focused care in accelerated settings and his work in the field spans over 16 years. He is a published author for his research, work, and studies examining instances of childhood trauma/c-ptsd and its correlation to substance abuse disorders and other maladaptive behaviors in adults. He currently serves as the Clinical Director for Coalition Recovery.