Changes in the Field of Addictions and Trauma

At the beginning of February, I attended the 32nd Annual Training Institute on Behavioral Health and Addictive Disorders in Clearwater, FL. The main theme running through this year’s institute appeared to be the mind/body connection and how it pertains to trauma and substance abuse. It was a three and a half day conference, packed full of presentations. Rather than summarize each of the keynotes or workshops, I am going to give you an overview of the overall themes (intended and unintended) of the conference and how they pertain to the work of the Open Doors Project here in New Hampshire.


To Diagnose or Not to Diagnose – More than one speaker at the conference commented that there is frustration in the addictions field with the current system of diagnosing patients based on the DSM-IV (Diagnostic and Statistical Manual). It was strongly stated that labeling patients with a diagnosis leads to treating of the diagnosis rather than the person. In fact, many diagnoses lead to stigmatizing of the person and tend to have a cumulative affect resulting in a person having many diagnoses over their lifetime with none being removed from their record. It is also important to note that many diagnoses do not take a person’s trauma history into account, denying the person the possibility of healing.

In the past year, I have seen a few women for whom the treating of the diagnosis rather than the individual failed to resolve issues and created more. In two cases, the women were in their fifties and had a long list of diagnoses that they had accumulated since their late teens and early twenties. Both had been sexually abused as children and, when they started to have strong reactions to their trauma, they were both medicated heavily and, in one case, hospitalized for significant periods of time. The woman who was hospitalized was sexually assaulted during her stay and another had years of her life that she could not recall due to the amount of medications she had been taking. It was only when they found trauma informed professionals who recognized the basis for their symptoms and could provide trauma services did they begin to heal.

The addictions field seems to be far ahead of the mental health field in recognizing trauma as a root cause of substance abuse. The mental health field is currently restrained by the dictates of the insurance companies to provide diagnoses that justify payment for services and the pressure of pharmaceutical companies to medicate based on diagnosis.

There is a lot of work to be done in order for changes to be made in the systems that provide paid services to persons with mental health and substance abuse issues. However, it was nice to know that the conversations about the needed changes are taking place.

Mind/Body Medicine – The mind/body connection has been a major topic of discussion at most of the conferences relating to trauma and substance abuse that I have attended over the past couple of years. The connection between trauma and substance abuse has become mainstream knowledge, more so than in the field of mental health. Along with this has come the knowledge that modes of treatment need to move beyond medication and traditional psychotherapy. Mindfulness based stress reduction, spirituality and meaning making, exercise, chiropractic, therapeutic massage, Reiki, acupuncture, and yoga and Chi Gong are gaining wide recognition as being beneficial to the recovery process for trauma survivors who have been using substances or process addictions (i.e. porn, over/under eating, gaming, gambling) to self medicate the effects of trauma in their lives. Many treatment centers in the country are incorporating these modalities into their programs because they recognize the importance of engaging the whole person.

The Most Important Element of Healing from Trauma – The Therapeutic Relationship. Research is showing what counselors and advocates have known for a long time. It is not the mode of treatment, the therapeutic milieu, or the medication that has the most effect on a person’s ability to heal from trauma. It is the relationship between the therapist (or advocate) and the person who has been traumatized. The components of the relationship include empathy, compassion, and non-judgment. Dr. John Briere of the University of Southern California www.johnbriere.com highly recommends mindfulness training for counselors as a means of assisting them in holding a space of compassion and non-judgment in the relationship with the survivor.  This idea has been also been discussed by Judith Herman in her book, Trauma and Recovery.  She states that "trauma occurs in relationship.  Therefore, healing from trauma must occur in relationships."

How does this apply to our work with survivors of domestic violence and sexual assault?

First of all, we do not need to be intimidated by the list of diagnoses that a person may give us when they walk through the doors of our agencies and shelters. These are just labels that have been given to them in response to their behaviors on the day they were diagnosed and a limited history. The diagnosis is not the person and by looking at them through fresh eyes without the lens of the diagnosis we can meet them with compassion and empathy.

It is also becoming more evident that providing opportunities for women in shelter to engage in exercise, creative arts (journaling, drawing, fiber arts), yoga, Chi Gong, Reiki, or mindfulness based stress reduction can decrease reactions to possible triggers. These activities also increase a sense of empowerment as the survivor begins to learn ways to manage stress without the use of alcohol or drugs.

I hope the above generates discussion and opportunities to expand services to survivors. I understand that budget constraints play a big part in the provision of services, but there are many volunteers in our communities who would love the opportunity to provide a service to our programs.