What is Trauma Informed Care?
6 Main Principles of Trauma Informed Care
Physical and psychological safety is paramount. This means both creating a physically safe environment and fostering a sense of safety among staff and patients. This can include personal items or friends and family members as requested and recommended.
Trustworthiness is centered around clear, honest communication between the healthcare provider and patient. There should also be an additional focus on nurturing trustworthiness among staff and patient families.
This collaboration specifically focuses on communication between all members of the diagnostic team. This means every member of the organization is treated as part of the overall diagnostic team. This practice allows for a fluid exchange of information which in turn lessens the time between correct diagnosis and treatment options. Furthermore, it lessens the power gap between the levels of the organization.
The peer principle encourages a therapeutic element wherein a patient is exposed to people who have a similar traumatic history. This can decrease feelings of isolation and create a stronger feeling of safety in the patient.
Empowerment is based around positive reinforcement of the achievements, positive values, remarks, and interests of the patient. To achieve empowerment as defined; healthcare providers must understand the powerful impact of listening to both patients and coworkers on any level of the organization. Additionally, medical professionals should seek to understand and validate valid patient suggestions concerning their traumatic triggers. This principle must also be applied to all staff interactions.
This principle implies medical consideration of a patient’s culture or gender in terms of both treatment and patient receptiveness to treatment. This can include historical trauma, personal trauma, and further cultivating an environment in which the patient feels safe. This principle also suggests due consideration of personal bias and perception on the part of the healthcare provider.
Each of the 6 principles of Trauma informed care share a patient-first viewpoint. However, it is suggested that to achieve and maintain these principles that the organization must also apply them to all levels of staff. I.E. The staff must be treated with consideration to their safety, empowerment, etc.
Other Principles of Trauma-informed Care
Trauma informed care employs an evidence-based treatment method. This means if a patient displays signs or symptoms of known conditions then the response would be the corresponding treatment for these conditions. This method shifts medical treatment options to reflect data as opposed to hunches, or instincts.
Trauma informed care is also focused on the overall betterment of physical and mental health, regardless of condition or treatment. It encourages the viewpoint of the patient being a unit as opposed to individualized parts. It acknowledges the effects that a condition may have on other parts of the body. For example, a person with substance use disorder may consequently experience depression which in turn can lead to high blood pressure, and so on.
Types of Trauma
Adverse Childhood Experiences
Adverse childhood experiences or ACE include any form of abuse, loss, or physical and/or psychological injury. 1 in 6 adults has multiple ACE experiences. These experiences can differ wildly as can the perception of these experiences. It’s important to allow room for the patient to talk about their trauma.
The effects of combat or violent experiences on the brain are well documented. This category is most often applied to combat war veterans returning from tours. However, an abusive upbringing can cause many of the same signs and triggers.
Death or Loss
Death or loss will invariably occur in everyone’s life. Depending on the longevity, emotional connection, and mental state of the patient these events can cause severe traumatic triggers and relapses. These effects can be compounded if experienced during adolescence or in violent means.
Domestic violence can severely disrupt the ability to form healthy interpersonal relationships. Survivors of domestic violence events can have issues with feelings of safety, trustworthiness, and empowerment. This includes both the person subjected to the physical effects and anyone subject to the emotional repercussions of the abuse.
Emotional abuse is one of the most nuanced forms of abuse. It includes making you doubt yourself or gas-lighting, guilt-tripping, and generally any nefarious form of emotional manipulation. Survivors of emotional abuse may have difficulty trusting their instincts and possess a negative self-image.
Trauma Informed Care in Addiction Treatment
Correlation Between Trauma and Substance Use Disorder
On average, people with PTSD are 5 times more likely to need treatment for substance use disorder. The connection between the two is enough evidence to include trauma therapy and treatment to most patients in substance use recovery programs.
A PTSD diagnosis also means there is an increased risk of consuming alcohol at a much higher rate and frequency than other groups of drinkers. Often this can create a cycle of drinking to subdue PTSD-affected thoughts and feelings, which in turn builds both dependence and tolerance. Often, concurrent treatment for the two will involve therapy to teach healthy coping mechanisms.
PTSD and SUD Rates
- 46% of people with PTSD also have SUD
- 59% of all woman in SUD treatment programs also have PTSD
- The combination of PTSD and SUD affects 40% of the population
- People who have been physically abused are 12 times more likely to develop an alcohol use disorder
Treating SUD and Trauma at the Same Time
- Healthy coping mechanisms
- Improving self-image
- Change in mindset
- Letting go of certain emotional triggers when applicable
Focus on Empowerment
Studies on the Effectiveness of Treating Trauma While Treating SUD
Treatment Models for SUD and Trauma
ATRIUM, short for, addiction and trauma recovery integration model. It is a 12-week model designed for women who have suffered childhood or interpersonal trauma. ATRIUM is centered around the betterment of mind, body, and spirit as a method for recovery. ATRIUM also teaches the scientific physical and psychological impacts that trauma causes. It also encourages artistic expression as a form of CBT.
Helping Women Recover
Helping Women Recover is a 17-session model with a focus on self. Throughout the course, women learn the psychological and spiritual understanding of self. Sessions will focus on understanding how external factors affect the self and how these changes are viewed and internalized. It also opens discussion into sexuality, body image, motherhood, and interpersonal or familial relationships.
Seeking Safety is an evidenced-based 24 session model for trauma recovery. It’s specialized for women and adolescents but can be used to help any trauma survivor. It is centered around safety, ideals, content, and integrated treatment options.
TREM, short for, Trauma Recovery and Empowerment Model is a 29-session model for women-centered around self-care. It has a pronounced focus on recovery skills and coping mechanisms. TREM also teaches the understanding of the long-lasting effects of traumatic events.
Triad is a 16-week course to teach essential emotional skills and lessons vital for long-term recovery. It’s centered around bettering the effects of trauma, mental health, and substance abuse. Triad is considered a holistic approach due to the view that trauma can cause other conditions in separate parts of the mind and body.
What is Re-Traumatization?
- Loud Noises
- Touch without consent
- Specific songs
- The place of the traumatic event
- The day of the traumatic event
- The presence or semblance of the abuser
- Unbridled negative thought
Practices to Avoid Re-Traumatization
- Identify and recognize triggers
- Build a routine
- Strengthen coping mechanisms
- Study how trauma changes the brain
- Build a rapport with a patient
- Explain the impact of trauma
- Maintain an open communication
- Consider and respond to patient remarks
- Positive reinforcement
How Should Addiction Treatment Address Trauma in Treatment?
Policies and Procedures
An organization must have policies and procedures in place that are conducive to trauma informed care. This allows for a seamless and integrated recovery environment in which all members of the diagnostic team share a direct and common focus and understanding of trauma informed care. These procedures should be refreshed periodically for renewed understanding.
Focuses and Aspirations
Trauma informed care is focused on shifting the overall view and day to day practice of healthcare as it’s historically known. This holistic method allows for deeper, more effective treatment options. To be successful in this practice, an organization or recovery environment must maintain its focus and aspiration on the patient and the betterment of their health while also fostering a staff that upholds the essence of trauma informed care.