Adult addiction and mental illness are strongly correlated with childhood adversity including trauma, abuse, neglect, and family dysfunction.
The Adverse Childhood Experiences (ACE) Study asked thousands of participants if they had experienced 10 different types of adverse childhood experiences. The higher the ace score, the higher the likelihood of addiction, alcoholism, mental illness, and medical health issues.
These numbers highlight the importance of addressing the impact of childhood adversity which fuels addictions, mental disorders, and medical illnesses.
Today’s workshop, The Social Self in Experiential Therapy: Relationships, Attachment, & Interpersonal Neurobiology, presented the interpersonal theory and social atom of Jacob Moreno.
We explored the integrations of attachment theory, sociometric theory, and interpersonal neurobiology as they relate to experiential trauma therapy.
Moreno’s developmental phases (doubling, mirroring, & role reversal) were explored from the position of attachment within multiple parallel processes including the infant-caregiver dyad, the client-therapist dyad, the victim-perpetrator dyad (in our case today, a spontaneous sociodramatic vignette about slavery and white supremacy), within the development of a psychodrama vignette, and the layered interpersonal experience of the group itself.
Attachment styles were presented with emphasis on their role-reciprocity and role-complimentary natures. Participants explored their own attachment styles and considered its impact on their clients, supervisees, and colleagues.
Participants created social atoms and action sculpting was used to put one social atom into action integrating relational ideals into all our relations!
Today Dr Scott Giacomucci facilitated a session for incoming doctoral students at the University of Pennsylvania School of Social Policy & Practice.
The historical, philosophical, and theoretical connections of social work, Sociometry, and psychodrama were presented. Students then engaged in experiential Sociometry processes to explore shared experiences, fears, hopes, and goals.
The TSM circle of strengths was utilized to concretize the collective strengths of the cohort-as-a-whole and create a container of safety and inspiration for the years ahead as doctoral students.
Empty chairs were used to verbalize the positive & negative messages from the dissertation, the DSW degree, future self, and friends/family. Finally, students engaged in a psychodramatic vignette role reversing with themselves as future doctors of clinical social work.
“It is impossible to
understand addiction without asking what relief the addict finds, or hopes to
find, in the drug or the addictive behavior.” –Dr. Gabor Mate
Among the most common underlying factors
of Substance Use Disorders (SUDS) and other addictive behaviors are unresolved
trauma, neglect and loss. Ignoring these
fundamental issues in treatment results in a focus on symptom control rather
than addressing the actual causes of addiction and relapse.
Addiction and Trauma—a Cyclical Relationship
Addiction and Trauma/loss have a
cyclical relationship, which means they fuel each other. Trauma and loss leave one vulnerable to
developing addictions, and addictions leave one more vulnerable to experiencing
further trauma and loss.
Trauma impacts our ability to
regulate ourselves and our emotions, which is where the addiction comes in to
play a role in helping us self-soothe and numb these emotions. Both addiction
and trauma are characterized by attempts to ‘get out of ourselves’ through
numbing, dissociation, and avoidance. Recent neuroscience research shows that social pain and physical pain look identical in brain scans – any opiate addict
will tell you how well opiates work at numbing both types of pain. These
findings further highlight the intersection between addiction, trauma, and
Trauma describes any experience that
overwhelms one’s ability to function and cope.
An inclusive definition of trauma might include experiencing or witnessing
violence (relational or collective), abuse (physical, emotional, or sexual),
death or loss, neglect, and abandonment.
Research has demonstrated a strong connection between trauma and many mental health issues—including addictions, depression, and anxiety. Post-Traumatic Stress Disorder (PTSD) symptoms include intrusions, avoidance, hyperarousal, negative thought/mood states and dissociation. These could simply be described as a manifestation of past experiences (feelings, thoughts, images, relationships, physical sensations, defenses, and behaviors) showing up in the present moment.
has shown a strong correlation between adverse childhood experiences (ACEs) of
trauma, neglect and loss, with adult alcoholism and addiction. The ACE study used a simple 10 yes/no
questionnaire inquiring about experiences of trauma, neglect, and family
dysfunction in childhood. For someone reporting four or more ACEs, the results
show a 500 percent increased chance of developing adult alcoholism, and a 1300
percent increased chance of developing an addiction. Higher ACE scores were
correlated with her rates of depression, suicide attempts, and other medical
4 ACEs =
500% increase in adult alcoholism
4 ACEs = 1300% increase in adult IV drug use
6 ACEs = 4600% increase in adult IV drug use
There are many different approaches to trauma treatment and trauma recovery. While some people find traditional talk therapy to be helpful, other therapy approaches are available and may be more suitable for trauma work. Recent neuroscience research shows that the language/speech parts of the brain are offline when one remembers a traumatic event, which supports the use of or arts-based experiential therapy approaches such as music therapy, art therapy, drama therapy, and psychodrama. In the psychodrama approach, rather than talk about an issue or problem, we can put the situation into action using role-playing techniques and practice new ways of responding. In psychodrama, we could have a dialogue with God, with a deceased loved-one, or even with yourself at a different point in time. Psychodrama allows us to go places in therapy that would be impossible otherwise.
Another highly recommended and effective treatment for trauma is ‘EMDR’ or Eye-Movement Desensitization and Reprocessing. EMDR works by first providing practical tools for dealing with stress, anxiety, and overwhelming feelings. In EMDR, we call these resources; basically, there are about accessing positive memories that can change how we are feeling currently. After the resourcing stage comes the EMDR processing stage during which specific traumatic memories are targeting using EMDR’s protocol. EMDR is incredibly effective for single-incident traumatic events. EMDR and the creative-arts therapies are unique in that you can heal from trauma without having to tell someone every detail of your traumatic experience.
Yoga and meditation
are wonderful resources for trauma and addiction recovery. A recent study found
yoga to be more helpful in reducing PTSD symptoms than any medication that has
ever been researched. Research on meditation supports its effectiveness in
rewiring the brain and strengthening one’s ability to tolerate discomfort,
empathize with others, and find inner peace.
Bessel van der Kolk, MD – The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Peter A. Levine, PhD – In an Unspoken Voice: How the Body Releases
Trauma and Restores Goodness (2010)
Francine Shapiro, PhD – Getting Past Your Past: Take Control of Your
Life with Self-Help Techniques from EMDR Therapy (2013)
Christine A. Courtois, PhD – It’s Not You, It’s What Happened to You (2014)
The neuroscience evidence is pretty clear. Children who are nurtured, have secure attachment figures, a safe environment, and access to the creative arts develop the capacity for self-regulation, self-soothing, and secure adult relationships.
Adverse childhood experiences often have a lasting impact on one’s development.
Those most likely to thrive are the children who were nurtured.
There also exists a corrective and restorative potential in positive relationships or experiences today. These corrective emotional/relational experiences have the capacity to change and heal the trauma of the past.
This is one of the reasons why psychotherapy is effective – it provides an experience of a safe, secure, nurturing relationship.
Post-Traumatic Stress is simply the past emerging in the present.
Feelings, images, physical sensations, and thoughts from the time of the trauma resurface in the present moment when we are faced with a reminder of the event.
This is really just our bodies & psyches trying to protect us – but it causes lots of problems and impacts our functioning in the world.
Healing from trauma isn’t so much about telling the story of the past as it is about renegotiating how the experience lives with us today. Feelings need to be expressed, sensations experienced, beliefs revisited, and internalized roles transformed.
Treatment providers that don’t address the trauma underlying addictions are only controlling symptoms rather than dealing with the source of the problem.
Being “trauma-informed” is a good start, but not enough. The success rates of addiction treatment are horrendously poor compared to success rates of other conditions. In order to improve treatment quality, the addiction treatment field needs competently trained trauma treatment specialists.
Visit www.PhoenixTraumaCenter.com to learn more about our clinical work, training events, and consultation services for your agency.
Prolonged and extreme stress (including post-traumatic stress) significantly impacts brain development, especially for children.
The image below on the left shows a typical integrated/connected neuron from a child in a safe nurturing environment, next to an image of a neuron much less connected/integrated from a child who experienced prolonged stress. This type of stress creates fragmentation and dissociation biologically, psychologically, and socially.
Our environment impacts brain development in a very real and lasting way. Cultivating safety is an essential component of healing from post traumatic stress.