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© 2014 by Johanna O’Flaherty. All rights reserved. Published 2014.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written permission of the publisher.
Publisher: Central Recovery Press
3321 N. Buffalo Drive
Las Vegas, NV 89129
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ISBN: 978-1-937612-95-5 (e-book)
Author’s Note: This book is derived from a presentation at the US Journal 6th Annual Advances in Counseling Conference in Las Vegas, Nevada, on March 21, 2014. This e-book adaption of the presentation is designed for the general public and has been edited for style and content and modified for this format.
Central Recovery Press offers a diverse selection of titles focused on addiction, recovery, and behavioral health. Our books represent the experiences and opinions of their authors only. Every effort has been made to ensure that events, institutions, and statistics presented in our books as facts are accurate and up-to-date. The opinions expressed are those of the authors only.
Contents
The Nature of Trauma and Co-Occurring Addiction
Touching Suffering—the Interactional Challenges of Trauma
The Enduring Toxicity of Childhood Trauma
Addressing Trauma in Addiction Treatment
Assessment, Containment, and Being Present
I was first exposed to both trauma and addiction in my family of origin, and this set the stage for my interest in the connection between them when I became a professional psychologist. The focus of this discussion is the connection between trauma and addiction, and how best to view and address these conditions when they co-occur in a treatment setting or clinical context.
Prior to working in inpatient treatment settings, I had the pleasure of managing Employee Assistance Programs (EAPs) for two major airlines, Pan American Airways (PAA) and Trans World Airlines (TWA). My first response to an aviation disaster was the bombing of Pan Am Flight 103 over Lockerbie, Scotland in December of 1988 that killed 243 passengers, sixteen crew members, and eleven persons on the ground in the small Scottish village of Lockerbie. A team of airline employees were dispatched to London and Lockerbie to assist the grieving family members. In my role as Corporate Manager of PAA’s EAP, I was responsible for overseeing the bio-psycho-social-spiritual aspects of this disaster. As a result of that experience I became a different kind of pioneer in the aviation industry—organizing, training, and responding to aviation disasters, and facilitating trauma processing, grief counseling, and Critical Incident Stress Debriefing.
Subsequently, I was involved in the Trans World Airlines (TWA) Flight 800 disaster in which a Boeing 747 exploded and crashed into the Atlantic Ocean near East Moriches, New York in July of 1996, just twelve minutes after takeoff from John F. Kennedy International Airport. All 230 people on board were killed in what was the third-deadliest aviation accident within US territory. Additionally, I had the honor of assisting airlines employees in the aftermath of the terrorist attacks on the World Trade Center and the Pentagon on 9/11.
In my professional capacity I consider myself a witness to the individual in treatment. For me, it’s an honor to walk with the patient on her or his journey of healing. Having long ago stepped into the river of healing myself, it is incredibly life-affirming to be able to accompany others on this amazing adventure of getting one’s life back.
The Nature of Trauma and Co-Occurring Addiction
When people are traumatized, they are overpowered. They do not give their power away; it is taken from them. At the moment of trauma, the individual is rendered helpless by overwhelming force. Trauma is an event or a series of events that overwhelms our natural coping abilities. We all have different coping abilities, and that’s why no two individuals will react exactly the same way to trauma.
However, events which are by definition traumatic, because they are so big and so devastating, leave their mark on all of us. No doubt you are familiar with the idea that a picture is worth a thousand words. Everyone knows precisely where they were, what they were doing, and who they were with when they heard about the terrorist attacks on the World Trade Center and the Pentagon on September 11, 2001. We call these “flashbulb memories.” These are memories so powerful that they are effectively imprinted into our psyche.
I first became interested in the correlation between trauma and addiction many years ago. Correlation does not mean causation. Trauma does not necessarily cause addiction and addiction does not cause trauma per se, but they frequently co-occur and they often contribute substantially to one another. Correlation in this context means association. All around the country, a very high percentage of the patients who come in for addiction treatment have experienced trauma.
It’s essential for treatment professionals to understand that a traumatized individual does not respond to stress the way somebody who has not been traumatized responds. The following is a brief case scenario that describes how trauma and addiction are typically linked together.
A twenty-eight year-old woman is admitted to your inpatient program with an extensive history of addiction. She was incested by her father from age four to age eleven, and began using alcohol and other drugs at age twelve. Subsequently, she became a sex worker (specifically, a prostitute), and was serially abused by her various pimps and numerous johns, prior to entering treatment.
You only have fifteen days for treatment and thirty days total to work with her, if you are fortunate. What do you do?
In the traditional twelve-step-oriented philosophy of many addiction treatment programs, the message is, “Don’t drink/don’t use, go to meetings, and use the steps.” That in and of itself is essential because before we can effect any real treatment, we need the individual to be abstinent, stable, and have some sort of a foundation. However, when trauma is involved, that advice is nowhere near enough. For those with trauma, alcohol and other drug use can become a survival strategy. Obviously, it’s a strategy that doesn’t work in the long-run, but alcohol and other drugs help numb the distress, the anxiety, the depression, and the fear precipitated by trauma.
For many years, when patients presented with trauma to addiction treatment professionals, we would say, “Now is not the time to deal with the trauma. Keep it on the shelf until the patient’s abstinence is stable.” As a young therapist I would confer with my preeminent psychiatrist and psychologist colleagues and say, “Doc, that’s fine with me, but tell me, what shelf? Where is this shelf?” Meanwhile, intense trauma-based