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Together with Sunshine Coast Health Centre, we are presenting three-day workshops in Trauma Treatment with Dr. John Briere, Ph.D, and Dr. Christine Courtois, Ph.D., in Vancouver, May 26-28, 2010, and in Calgary, May 31-June 2. With that in mind, here is a little background on the connection between trauma and addiction. Heather Good is doing an evening presenter on the topic of "Mindfulness and Body Focused Coaching for Addiction" on day 2.

Trauma and Addiction: Probing the Connection

By Chris Drummond, MA
Psychotherapist
Sunshine Coast Health Center

Modern war and major disasters such as 9/11 and New Orleans have highlighted the horrendous effects of trauma. Here are some rates of post-traumatic stress disorder (PTSD): 23 percent in regions in Israel that have been shelled, 40-70 percent in Gaza, 17 percent of US military personnel, 44 percent in high school seniors in Kosovo five years after hostilities ended, and 30 percent in New Orleans after the hurricane.

Many of these poor souls have turned to alcohol and other drugs to deal with the impact. New research is helping us develop new ways to treat these clients with co-occurring disorders.

The Impact of Trauma on the Brain
Trauma imprints itself in the brain's memory system. Stress hormones that accompany the emotional intensity of trauma activate the amygdala, which in turn activates other subcortical structures in the limbic system, the primitive, ënon-thinking', part of the brain. In other words, emotion mediates how memories are consolidated. The precise mechanisms involved are still debated, but neuroscientist James McGaugh says everyone agrees that “Stronger emotional experiences make for stronger, more reliable memories” (2003, p. 327). Memories of a wartime fire-fight or a collapsed building may intrude repeatedly in a survivor's daily life or lead to nightmares. Survivors appear to be so sensitized that even a door slamming or an image on television can trigger the intense experience. As psychologist David Myers puts it, “It is as if they were burned in” (2010, p. 342). Even months or years later, traumatic memories are so clear that victims recall the event with remarkable detail.

To understand the power of trauma on the memory, think back to 9/11. Chances are that you remember what you were doing on September 11, 2001. But do you remember what you were doing September 11, 1999? Myers reports a study in which victims of car accidents, rape, and other traumatic incidents were given either a placebo or propranolol, a drug that blunts memories. Three months later, half the placebo group and none of the propranolol group experienced stress disorder. “Weaker emotion means weaker memories” (Myers, 2010, p. 342).

Trauma and Drug Use
Statistically, there is an association between addiction and trauma, though much more work is needed to discover what the precise link is. Some say that those suffering from trauma are more vulnerable to addiction; the earlier the trauma, the stronger the association. This may be due to the impact of early trauma on the brain's development. Others say that the addicted brain makes people more vulnerable to PTSD. Some suggest that traumatized people are more vulnerable to addiction because they want to medicate their condition. Still others say that those with trauma who are addicted to substances are not medicating their pain, but using substances as any addict does to relieve boredom, despair, guilt, loneliness, and a lack of a sense of belonging. And so on.

Treatment
Traditionally, scientific treatment for trauma and addiction has relied on cognitive-behavioral therapy (CBT). Among the most the most famous for co-occurring addictions and trauma is Lisa Najavits' Seeking Safety (2002) program. But many are questioning whether CBT and traditional psychotherapy are enough. One of the more controversial figures advocating a new clinical approach is Bessel van der Kolk (2005). He has suggested that because trauma affects structures in the brain's limbic system and inhibits key functioning in the ëthinking' brain, that body-oriented and self-regulation therapies may be more effective than traditional talk therapies alone.

Based on brain-imaging techniques that show traumatic memories appear to be mediated or moderated by the limbic system, some trauma experts are using techniques that integrate the mind and the body. James Gordon (2010), head of the college of mind-body medicine at Saybrook University, works with US soldiers and local residents in Gaza, Bosnia, Afghanistan, and elsewhere. Gordon's mind-body approach focuses on client strengths, builds resiliency, and balances the sympathetic nervous system's fight or flight response with the parasympathetic nervous system's relaxation response. Initially, after creating a safe environment, he follows a three-step process: shake, breathe, and move to music. Strange as the idea may first appear, this body-work frees participants sufficiently to deal with the trauma. They often break down sobbing during this somatic process, able to talk about what happened to them. Other clinicians use EMDR and OEI, various types of body-work, forms of psychodrama, and other cutting-edge techniques.

Today, little of this trauma work is applied in the addiction field. But there is great hope that as addictions clinicians become more familiar with trauma, their traumatized clients will fare better.

References

Gordon, J. S. (2010, Jan 19). Trauma and transformation: Healing the wounds of war and other disasters. [Workshop]. College of Mind-Body Medicine, Saybrook University, San Franciso, CA.

McGaugh, J. I. (2003). Memory and emotion: The making of lasting memories. New York, NY: Columbia University Press.

Myers, D. G.. (2010). Psychology. New York, NY: Worth Publishers.

Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: The Guilford Press.

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399.

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