Trauma, Chemical Use and Addiction - January 2013
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Transcript of Trauma, Chemical Use and Addiction - January 2013
Tana Bridge, PhD, LMSWAssociate Professor ~ Eastern Michigan University
Supervisor/Consultant: National Institute for Trauma & Loss
A lot is Known About Trauma Unattended Trauma leads to self-
defeating, self-destructive, pathological behavior
Most will need external support to move beyond trauma
Additive Nature of Trauma
Steele (1992), Terr (1979), Pynoos(1988)
Substance Use/Trauma
Ability to escape from trauma memory/symptoms may be accomplished through drug use
Drug use can perpetuate feelings of powerlessness, fear, etc. brought about by trauma
Drug culture can expose/create victims of trauma
Trauma Defined
Acute Stress Disorder Post Traumatic Stress Disorder Disorder of Extreme Stress Not
Otherwise Specified ~ Complex Trauma
Differences in Trauma & Grief Grief
Sadness stands alone Reactions are known to
public Can usually talk about
loss Pain is
acknowledgement of loss
Trauma Terror Include grief Reactions unknown,
held within Can’t or don’t want to
talk Pain triggers terror,
powerlessness, loss of safety
Anger is non-destructive, non-assaultive
Grief does not disfigure self image
Guilt says ”I wish I would/would not have”
-dreams of deceased No trauma specific
reactions
Anger- can become assaultive
Attacks, distorts self image
Guilt says ”It was my fault, I could have prevented it
Dreams of self as potential victims
Grief reaction and trauma specific reactions.
W. Steele
Complex/Chronic PTSD~ DESNOS Prolonged and Repeated Trauma
DV woman and children Victims of ongoing child abuse Prisoners Hostages People held under the control of their
perpetrator
Also known as DESNOS-Disorder of Extreme Stress/Not otherwise specified.
Trauma is a Sensory Experience
Enters via the 5 senses
What are some events/situations that might bring about a trauma specific response?
Traumatic SituationsWar ViolenceRapeMurderBeatings/AssaultsDomestic ViolenceFires
SuicidesCar Accidents/Plane CrashesDisasters - earthquake, floods, fires, etc.Injuries or life
threatening illnessDog BitesDrowning
Exposure to Trauma
Surviving Victim/Survivor Witness to the Event Related or Connected to the Victim Hearing the Details
What are common symptoms of trauma or PTSD?
Symptoms….
Symptoms
Physical symptoms: hypervigalence, startle response, sleep difficulties, concentration or memory problems, mood problems such as anger or depression
Intrusive symptoms: recurrent recollections (thoughts, memories, dreams, nightmares or flashbacks), re-enactment (behavior or re-telling) distress at symbolic events, survivor guilt or grief
Symptoms - continued
Avoidant symptoms: avoiding specific thoughts, feelings, activities or situations, diminished interest, emotional numbness, inability to connect with future (feel they will die at young age)
Special forms of avoidant symptoms: dissociation, helplessness, loss of fear
Cognitive Struggles: 2+2 ??? 4, Magical Thinking (E.G. if I touch him he will die), concentration , recall and problem solving.Rumination or preoccupation: Continuous conscious awareness about the event and associations that go beyond ordinary thinking. Characterized by a sense of uncontrolled repetition.
How the brain receives and processes trauma….
2 Component of Brain Response1. Reaction – “auto” responses2. Memory
Development: The brain develops sequentially, with “lower” systems developing first and “higher” systems developing later.
There are several areas of the brain that are impacted by trauma.
Brain ~ parts impacted by trauma
Cortex: reasoning, problem solving, cognitive memory, planning, recognition
Limbic: emotions, survival related emotions/pleasure, emotional memory
Diencephalon: (includes thalamus and hypothalamus) “fight, flight or freeze,” stress response, receives, filters and relays sensory inputs – NOT cognitive
Brainstem: heart rate, body temperature, respiration. The brainstem also stores anxiety or arousal states associated with a traumatic event
Neurochemical basis of PTSDTrauma changes the levels of 5 major
neurotransmitters: epinephrine, cortisol, norepinephrine, serotonin and endorphins
The limbic system (involved in strong emotion) can be changed by the presence of excess norepinephrine and produces:
Neurochemical basis of PTSD - continued
Continual presence of symptoms/reactions to trauma
Kindling effect - when small amounts of norepinephrine cause a cascade effect - the person reacts to a small stressor as if a true emergency has occurred
Prolonged stress creates a dependency on the analgesic effect - the person seeks intensity to achieve overload and then the calming effects of endorphin release
National Institute for Trauma & Loss in Children
This audio section is included with the permission of The National Institute for Trauma and Loss in Children (TLC) www.tlcinst.org . - William Steele, PsyD, MSW A Program of Starr Institute for Training- 48255 Garfield Road, Suite. 111, Clinton Twp. MI 48038- Phone: 313-885-0390. Toll-Free: 877-306-5256 . - On the web: http://www.starrtraining.org/tlc- On Twitter : http://twitter.com/TLCchildtrauma- On Facebook: http://www.facebook.com/pages/The-National-Institute-for-Trauma-and-Loss-in-Children/137750291707
Putting together the pieces… What is needed for ‘resolution’ or
successful process in working through a traumatic situation….
The Process of Working through Trauma
Safety –Seeking Safety
Attachment /Connection Connect with trusted adults Elicit support of others
Educate about possible reactions Gives meaning Normalizes
Connect with Details – Nonverbal into Verbal It gives the “why”s Allows for mastery over content Allows for experience outside of self Removes negative image Challenge distorted thinking
LEARN HEALTHY coping and thinking!
Trauma and the Cognitive Triangle:
Traumatic Event
(TF-CBT: Tassell & Schmidt)
Promises of Healing
Reduced frequency of symptomsReduced fear of the symptomsReduced fear of insanityOpportunity to grieveChange from victim to survivor
Promises of Healing ...continued
Opportunity to begin enjoying lifeSense of humorProfound empathy for others who
suffer
Questions???