A New Paradigm

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A New Paradigm

• Rethinking How We Approach Addictions

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• In the field of addictions treatment success
  rates vary, and often depend upon how recovery is
  operationally defined. If one chooses recovery to
  mean that an individual would remain abstinent
  and not misuse illicit substances or alcohol for
  the remainder of their lives, then the success
  rate for treatment begins to look dismal.

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• When further expectations are added, such as a
  reclaiming of selfhood with full participation in
  healthy interpersonal relationships, engagement
  in meaningful work, and the ability to sustain
  health from a holistic perspective ----
  emotionally, physically, and spiritually the
  success rate begins to appear abysmal.

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• How can this be? Does it reflect on poorly
  motivated clients, are they irreparably damaged
  beyond the point of any hope? Are the numerous
  and sundry health care providers and clinicians
  in the addictions field inappropriately trained
  or lacking in skills to adequately address the
  concerns of their clients?

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• Could it be that the problem lies in lack of
  adequate funding to speak to what has been called
  the War on Drugs? Is it that perhaps the lay
  public, and possibly clinicians lack genuine
  empathy and compassion for those suffering from
  long-term addictions?

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The Distinct link Between Trauma and Substance
Use Disorders

• In Charles Whitfields book The Truth About
  Mental Illness the author describes his early
  working relationship with those who were
  chemically dependent as consisting of treating
  them for the physical effects of their drug use
  and suggesting that they should try to stop using

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Realization

• Latterly he came to realize the link between
  addictions and childhood traumas
• A link that is so strong that 153 independent
  studies involving 237,886 subjects have come to
  the same conclusion establishing not just
  correlation but causality between trauma and
  addictions

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Prospective Studies

• Prospective studies follow a subject population
  over time (i.e., into the future)
• These types of studies are usually expensive,
  require more researchers on a study team, and
  take a lot of patience and persistence

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Prospective studies contd

• Dan Brown, a clinical research psychologist
  examined 3 such studies that followed traumatized
  and non-traumatized controls over time
• He believes that the results of these studies are
  so strong that they indicate that childhood abuse
  is the cause of substance abuse and chemical
  dependency in these large populations

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Causal Link

• Brown also states that childhood trauma appears
  to be the cause of several other disorders
  including PTSD, anxiety disorders, dissociative
  disorders, somatization disorders, sexual
  problems, difficulty handling feelings, low
  self-esteem, and multiple co-morbidity.

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Treatment Implications

• A major problem has been that information
  regarding trauma has been buried in clinical and
  scientific journals and thinly sandwiched in
  between an overwhelming array of biological,
  psychological, and sociological articles that
  tend to ignore the sleeping giant of trauma

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Most Clinicians are Not Trained to Work with
Trauma

• Most psychiatrists would rather refer to brain
  neurotransmitters and prescribe psychoactive
  drugs (somehow working on the erroneous
  assumption that vast segments of the population
  are suffering from SSRIs deficiencies)
• Many psychologists, social workers, and
  counselors pay little attention to childhood
  trauma

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What does This All Mean

• The magnitude of the link between trauma and
  substance use disorder and relapse provides
  strong support justification for the affected
  individuals, their clinicians, health care
  providers and policy makers to address the
  detrimental driving force of trauma head on

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Where Do We Start

• Turning to the continuum of addictions treatment
  and recovery the process of detoxification is
  often first step
• Unfortunately, at a time when individuals are
  undoubtedly feeling extremely vulnerable this
  process can be less than welcoming
• Hospitals are reluctant to provide medical detox
  to chemically dependent

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Continuum Contd

• There is also a tendency to assume that a one
  size fits all approach is appropriate fro
  detoxing
• Given that the majority of chemically dependent
  individuals have (and continue to be traumatized)
  how does this approach make any sense
• Picture if you will sending an adolescent or a
  woman to Fort McLeod at a time when the majority
  of individuals at that time are older men with
  histories of being physically abusive

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Continuum Contd

• Similarly, consider what an individual
  experiences when they present at an addictions
  treatment facility and are exposed to a sterile,
  at arms length impersonal assessment
• Why is it that upward of 80 of clients do not
  return after their second visit?

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Continuum Contd

• Another important question to ask is given that
  the majority of individuals in residential
  treatment suffer from PTSD, and therefore are at
  a heightened susceptibility to being
  re-traumatized is it realistic to assume that we
  can emotionally and psychically deconstruct these
  individuals, equipping them with newfound
  psychological insights and with a new found
  resiliency to contending with trauma all in only
  28 days

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Continuum Contd

• Follow up TX How extensive, available,
  supportive, and available is this?
• What is needed is to provide long-term group
  therapy whose goal is to address the trauma and
  its effects including mentally cognitive),
  emotional affective), physical (somatic0, and
  spiritual felt connection and meaning)
• And that this needs to be experientially-based

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The co-morbidity between AIDS and PTSD

• Unfortunately many individuals who contract HIV
  do so under highly stressful and or traumatizing
  experiences
• Research in South Africa is now indicating how
  significantly strong this linkage is
• What does this potentially mean

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Stressful life events can hasten the progression
of AIDS in HIV

• A study conducted at the University of North
  Carolina at Chapel Hill followed 82 gay men who
  were HIV-1 over a period of 7 ½ years
• At regular 6 month follow-ups stress levels were
  assessed
• Results showed that disease progression to AIDS
  is more rapid in the presence of life stressors
  which then leads to elevated cortisol levels
  which results in decreases in immune functions

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What does this mean?

• The emotional well-being of persons living with
  HIV/AIDS is thought to be affected by a number of
  factors, including stage of disease progression
  and presence of physical symptoms, social
  support, stressors (both general and AIDS
  specific), appraisals of control over stressful
  situations, and coping behaviors