Many clients come to us with co-occurring trauma and substance use disorders. For some, the trauma is primary to their addictions, which arose as a way to escape from or manage unmanageable feelings. For others the trauma is secondary and arose as a result of the harm caused by their active addictions.
In the past, treatment strategies have attempted to focus on working with one or the other as the primary problem. Strategies such as these often fail because trauma and addiction can become so intertwined or braided together that it is virtually impossible to “touch” one without evoking the other. The current paradigm, and one we ascribe to here at Recovering Champions, is the concurrent approach addressing both the trauma and addiction. We treat the addiction with a structured, well-supported recovery plan, while providing psychoeducation on the nature and effects of trauma and how it relates to substance abuse. Then, we teach simple coping strategies for better managing the thoughts, feelings and behaviors associated with trauma that contribute to addiction.
Those interested in how such an approach works might take a look at the work of Linda Najavits as expressed in her acclaimed curriculum Seeking Safety. As the title implies, Seeking Safety emphasizes the importance of developing and maintaining personal safety and self-care while reducing self-harm, The curriculum covers the ways we feel, think and behave, and the environments in which we live and work. In these stages of earliest recovery, what we strive to avoid is “digging” into any deeper emotional work, lest we trigger or evoke unmanageable trauma reactions which can upend a recovery in a heartbeat. Although the abreactive process (that is, resolving conflicts and gaining coping strength by having and working through feelings) is evidence based and effective, such work is best saved for later, when coping for maintaining sobriety and safety has been securely established. So, the outset is all about sobriety, psychoeducation, and development of coping strategies.
What we tell clients is this: if you build a strong, structured and reliable self-care plan for your addiction, by virtue of this supported self-care and your sobriety, you are also able to heal from your trauma without necessarily having to talk about it. In fact, staying sober is the first, most important, and sometimes only thing you need to do to heal, given that using is the absolute worst thing you can do.
This “algorithm” captured above is a quick reference assessment tool to help clients tell where they are at any time in the management of their recoveries from addiction and trauma. The line down the middle represents “stuff” that happens from day to day, and our management of this stuff is really all the matters. If something happens, and a client allows him or herself to react emotionally, they can be said to be “in” their addiction or trauma. Conversely, if they instead respond, that is, have their feelings but exercise some control (thinking and coping, not acting out), they are in their recoveries and on the right track. Of course this is a learning process, so we encourage clients to be patient with themselves. Should they find themselves on the wrong side in some way, well, at least they can tell and now need to invoke the better coping skill or self-care behavior to get back on track and into safer territory.
Get a PDF of the algorithm here
Given that people vary so much in their patterns, we are forever individualizing this form to the client. For instance, for those most prone to acting out, their self-care would focus on behaviors. Those prone to “acting in” would be most prone to punishing thoughts and thus their plan would emphasize thought management strategies and interventions.
Visit our YouTube channel for a video presentation on this topic.