Treatment for Trauma, PTSD and, Substance Use Disorders in Women: - PowerPoint PPT Presentation

Treatment for Trauma, PTSD and, Substance Use Disorders in Women: An Adlerian Based Treatment Approach By Shirley Butcher

INTRODUCTION

WH WHAT IS IS TRA TRAUMA? UMA? • An event or series of events that threaten you, perhaps even with death – that causes physical or emotional harm and/or exploits your body and/or integrity • Trauma is pervasive and life-altering

* DSM DSM-5 5 Def efinit ition ion of PTSD PT PTSD SD as as exp xposur ure to ac actual al or t threa eaten tened ed de death, th, serio rious us inju jury ry or sexual al violatio tion. n. • Pays more attention to the behavioral symptoms 4 Clusters sters: • re re-ex exper periencing iencing, , • av avoida dance ce, , • nega gative tive cogniti itions an and mood, d, • an and ar arousal al.

Pr Pres esen enta tation tion Purp urpose ose • Post-traumatic stress disorder (PTSD) and substance abuse (SUD) are commonly co-occurring conditions. • Both PTSD and SUD can be conceptualized as disorders with significant experiential avoidance components. • Adlerian Individual Psychology, social al inter eres est can be developed through interventions in the integrated treatment setting and in individual therapy. • To look at clinical presentations, issues, and treatment options

*I *Importance ortance of Treating ting Traum uma & SUD • Treatment is ineffective unless it acknowledges the realities of women’s lives of abuse. • A history of being abused increases alcohol and other drugs • Without treating all issues -- fall through the cracks, and eventually end up in the correctional system • We need to address Trauma & SUD at the same time

SIG IGNIF NIFICA ICANCE NCE AND ND PREV REVALANC ALANCE • Trau auma has as been een repo port rted by 55 55-99% 99% of femal ale substan stance ce abuse ab sers rs • 25 25-80 80% % of women en & & 20 20+% +% of men hav ave a histo story ry of sexual al victimiza timizatio tion. • Girl rls in high gh income me fam amilies lies ar are at grea eatest test ri risk for inces est • Women en who were sexual ually ly ab abuse sed in child ildho hood od ar are more than an twice ce as as likel kely to be re-victim ictimized zed as as ad adults ts • >40% 0% of w women en on w welfar fare were sexual ally ly ab abuse sed as as child ldren en • The he maj ajori rity ty of people le in the cri rimin minal al justice ice sys yste tem were ab abuse sed as as child ldren en

SIG IGNIF NIFICA ICANCE NCE AND ND PREV REVALANC ALANCE • Trauma betrays-- beliefs, values, and assumptions • Trust – about the world around us • Trauma leads to unhealthy behaviors • An adaptation not a pathology

*SIGNIF IGNIFICA ICANCE NCE AND ND PREV REVALANC ALANCE Women in ja jail: Have histories of caregiver violence were 9x as likely to run away as • teens; • Partner violence were 4x as likely to engage in sex work and 2x 2x as likely to deal drugs; • Witnessed violence were 2x 2x as likely to commit property crimes or assaults and 9x 9x as likely to use weapons; • Substance use disorder was 7x 7x as likely to get DUIs and 6x as likely to engage in sex work; • Women with SMI were more likely to have experienced trauma, to be repeat offenders, and to have earlier onset of substance use and running away.

* Commonly only Overloo erlooke ked Traum umatic tic Ev Events nts – Falls or sports injuries – Surgery (especially in the first 3 years of life) – Sudden death of someone close – A car accident – Breakup of a significant relationship – A humiliating or deeply disappointing experience – Discovery of a life-threatening illness or disabling condition

*Commonly mmonly Ov Overlooked rlooked Trauma umatic tic Ev Events ts Histor torical cal Trauma auma- • Multig igener erati tional onal trau auma ma exper perien ienced ced by a s speci ecific fic cultur ural al grou oup is cumulative tive an and collec lective tive Examp amples les- • Immigr igran ants ts • Inter ergener eneratio tional al Pov overt rty • Peop ople of of Col olor or • American rican Indians/F s/First irst Natio tions Peop oples les

TR TRAUM AUMA TH THROUGH OUGH TH THE LEG EGAL AL SYSTEM STEM • Handcuffs ndcuffs • Manda date ted medi dication tion • Secl clusion usion & rest strai aint nt typ ype pr procedur cedures es

*SCOPE PE OF THE HE PROBLEM BLEM • As many as 90 90% of women seeking SUD treatment report histories of sexual and physical assault • Among substance abusers, rates of PTSD range from 14 14-60 60% • Among PTSD populations, co-occurring substance use disorders may occur in 60 60-80% 80% of individuals

*Am *Among ong Women men in Resi sidentia dential Drug ug and nd Al Alco cohol hol Treatment tment Cente ters rs: • 57 57% report rt emotio otional al ab abuse se • 49% report rt phys ysical ical ab abuse se • 40% report rt sexual ual ab abuse se • 73 73% of women en report rted ed a histo story ry of rap ape • 45 45% repo port rted repe peated ted rap ape exp xper erie iences ces • Man any hav ave multip tiple le issues ues

MEN EN WITH CO-OCC OCCURRIN URRING DISOR SORDE DERS RS • Men with co-oc occurring curring di diso sorders ders frequently quently have trauma uma • Studi udies es su suggest est 12-15% 5% have PTS TSD and SUD • Men report port crime victi timi miza zation, tion, di disa saster, ster, and comba bat more ofte ten than an child ldhood hood abuse use

IMPO PORTANC ANCE of the AC ACE STU TUDY DY to TR TRAU AUMA & SUD • 90% 0% of pu public lic mental tal heal alth clien ients ts hav ave been en exp xposed sed to, an and most hav ave ac actual ally ly exper erienced, ienced, multiple tiple exposu sures es of t trau auma ma • ACE (Adv dver erse se Childho ildhood Experi rience ences) s) Study dy • Almost ost 2/3 of the study udy par articipa ticipant nts report rted at leas ast one ad adverse se childh dhood ood experien ence ce of phys ysica ical or sexual al ab abuse, e, neglect ct, or fam amily ly dysfu function nction • More than one in five reported rted three or more such ch experi rien ence ces • (ACE TEST)

ACE STUDY

TR TRAUMA RI RISK • Ri Risk sks of an an Eve Event bei eing Trau aumatic ic • It happ ppened ened un unexpect xpectedly. edly. • You were un unpr prepar epared ed for it. • You felt lt po powerless erless to pr prev event ent it. • It happ ppened ened repe peate tedly. dly. • Someone eone was intentionall ntionally crue uel. l. • It happ ppened ened in ch child ldhood. hood. • You are too oo se sensiti nsitive. ve.

Tri riune une Brain

Ne Neur urob obiological iological Ch Changes es • Limbic System -- Hippocampus and Amygdala • Neurotransmitters and Peptides -- Numbing and Depression • Changes in Hormonal System -- HPA axis > Arousal

*TRAUMA AND THE BRAIN

Brain Responses to Fear

TRAUMA AND THE BRAIN

Trauma auma Re Rela lated ted Brain ain Ch Chan anges es • Chang anges in brai ain functio tioning ing an and de developm lopment nt • Affect ect the way ay the he brai ain copes es with stres ess • Suicid cidal al ide deatio tion/a n/attempts ttempts • Self lf-destru destructive ctive beh ehavio aviors rs-cu cutting tting • Increase ease ri risk for de depres essio sion, n, an anxiet ety • Borde derl rline ine pe pers rsonality ality di disorder der • Increase ease ri risk for par aran anoia, a, hal allu lucina cinatio tions ns • Anger er problems, ems, poor attent entio ion, n, an and concen entr tratio tion

Clinical linical Cha halleng llenges es in the he Trea eatment tment • Abstinence may not resolve comorbid trauma-related disorders – for some PTSD may worsen • Confrontational approaches typical in addictions settings frequently exacerbate mood and anxiety disorders • 12-Step Models often do not acknowledge the need for pharmacologic interventions • Treatments for PTSD only may not be advisable to treat women with addictions or may be marked by complications • Improve less , Worse coping, Greater distress • More positive views of substance use (understandably)