Expert Roundtable Discussion on trauma featuring:
- Abe Antine, MSW, LCSW – Clinical Director
- Maria Talamo, MA, RN, NEA-BC, EDAC, FACHE – Chief Operations Officer
- Ryan Drzewiecki, PsyD, LP – Director of Psychology, Clinical Documentation, and Informatics
- Ryan Soave – Associate Clinical Director & Program Director of APN Coaching
Trauma Deserves More Than Just Buzzword-Level Attention
Abe Antine: One of the things that I thought was missing most – I’ve been working in residential addiction treatment for the last 10-12 years – that was most alarming to me when I started my own program in south Florida called Next Chapter (we treated men with addiction and trauma issues) was the lack of focus and attention on trauma and how it plays such an important part in the addictive process.
There’s a buzzword out there – “trauma-informed care.” But I think that what we do and what was missing is really integrating trauma as part of the treatment for addiction.
Trauma is Simpler than You Might Think
And when I say trauma – trauma is a big word. It’s a widely misunderstood word. We’re really talking more about some of the more covert trauma that happens in childhood – some of the things that people don’t really understand or see as a significant event. And we really looked at how some of that early childhood wounding – neglect, abandonment, and of course physical and sexual abuse – how that really drives the addictive process. And that’s something that we really specialize in here at All Points North Lodge.
Trauma Can Occur Throughout all Life Stages
Maria Talamo: Trauma can come at any time in a person’s life. It could be an adverse childhood experience, as Abe says. It could be trauma from the battlefield. It could be trauma from a horrible natural disaster – surviving a hurricane or tornado, something that was massively destructive and scary. It could be trauma that occurs later on in life, in an adult relationship where a person is emotionally or physically abusive to another. It could be an accident.
Trauma comes in many, many forms. But it’s something that stays with you and wounds you. It can cause you to seek relief. It can cause you to seek to medicate that pain or wound with something that makes you feel good.
Addiction is, in Part, a Disease of Reward System Dysfunction
We are programmed as human beings to survive. And the survival center of the brain is the same place in the brain where the reward system is. Addiction is a disease of reward system dysfunction, among many other things. So we have to be sensitive to that.
When Abe talks about trauma-informed care, it means that when we take care of people, we have to always look at it through the lens of trauma to understand that you can’t treat what’s going on in isolation. You have to know where the pain is.
Treating Trauma is a Critical Part of Effective Addiction Treatment
Ryan Drzewiecki: As Abe alluded to, there’s been a long rule of thumb in the field of substance abuse treatment not to touch trauma – and that applies to acute traumas.
In some ways, that makes sense based on the amount of time that a person can spend in care. If somebody’s in residential care and they’re only able to get a few weeks of coverage, that may very well be something to consider.
But one of the advantages of what we offer at All Points North Lodge is the ability to have a continuum of care. When someone is here throughout multiple levels of care, we have the ability to address the trauma – not just the acute major traumas but the relational trauma or the developmental trauma that almost always factors into severe addiction.
Not All Trauma Looks Like PTSD
Ryan Soave: I think it’s also important to make a distinction between the treatment of PTSD and what we’re talking about as relational trauma. They can go hand in hand, but when someone has a diagnosis of PTSD, there may be specific events that they’re reliving and having reactions to. They’re struggling to survive in their current environment based on some specific past experiences, and those are things we need to treat.
But oftentimes, people ask, “Well, what is trauma, and who has it?” And I would say, “Everybody.”
Trauma Affects All People – Just in Different Ways
When we make it a broader definition of trauma to look at wounding or stressors or even underlying issues, those are the things that lead to addiction and other strategies that people use to cope. Some of it, like Abe was saying, is very covert. Like someone who had to become very uncontained emotionally to get attention as a child. Or they had to become very contained emotionally. Maybe they needed to seek out attention or NOT seek out attention, just to be able to get along.
If the wounding and stressors in their family of origin that led to these strategies were not resolved, the strategies can persist into adulthood. So as adults, they’re still applying them to current situations where it might not work. As a kid, maybe you had to scream and yell to get attention. But as an adult, screaming and yelling to get attention doesn’t really bode well in relationships.
Unresolved Childhood Trauma Trickles into Adult Dysfunction
And that’s the kind of stuff that then leads people to feel like, “I don’t really seem to fit in. I don’t know how to survive. I don’t know how to live. I can’t get to the place that I want.” And then they’ll start maybe it’s drinking or maybe it’s drugs or sex or gambling.
It’s some sort of strategy that they’re using to try to alleviate the stressors that have been caused by them trying to employ strategies that helped them in their earlier years but are no longer effective. Often these habits are survival strategies that have become maladaptive.