Author: Chris Klem

Written by: Meryl Lammers, LSW, MT-BC

Early sobriety and trauma therapy go hand in hand. Whether you are the person in recovery or the loved one of someone who is, early sobriety can feel like a roller coaster: You may experience emotional ups and downs that you never have before. There’s the fear of a relapse, anger and resentment, sadness and grief, and wreckage of what a life in active addiction can cause. Many people in recovery and their loved ones have experienced traumatic events, whether from early childhood, or during active addiction, and these experiences can be triggered during early sobriety. Addiction and trauma affect the whole family system and therefore it’s important for everyone to seek support.

What to Expect in Early Sobriety

For the Person in Recovery

For the person in recovery, early sobriety can manifest in different ways. You may need to go to an inpatient facility or partial hospitalization program (PHP) for 30-60 days to help with medical management of withdrawal or detoxification and need to be physically separated from your drug of choice in a safe environment. You may need to take leave from a job and your living environment. This time away from your life can be a crucial part of the healing process, as you will be offered medical and psychological support to get through the hardest part: Detaching from your drug of choice.

But the journey doesn’t end with inpatient treatment. Most often, you will then be referred to an Intensive Outpatient Program (IOP) for 2-3 days a week to continue with support with relapse prevention through group and individual therapy. Trauma therapy in conjunction with other modalities usually starts in these programs as a form of relapse prevention.

Mutual aid programs such as Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery are highly recommended during this time for continued community support. Once IOP is completed, often the recommendation is to attend an outpatient therapy facility for individual, couples, and/or family therapy.

Maybe you didn’t go to treatment due to lack of resources/finances/insurance. Maybe you’re not sure what to do. Mutual Aid Programs like AA, NA, SMART Recovery, and Dharma recovery are free community resources filled with people in recovery eager to help the newcomer to sobriety that can be easily accessed through an internet search or phone app. You may also find support through religious and spiritual organizations. If you need medical detoxification for withdrawal, it is best to seek help at your nearest emergency room.

For the Loved Ones

For the loved ones, you can expect to be living alone or feel an emptiness while your loved one is in treatment, all while carrying the burden of the household. You may have already been experiencing this loneliness during active addiction. Maybe your partner/loved one was physically present, but unable to connect with you, share with domestic labor, or help financially due to their substance use. Or maybe they were physically absent all together.

Resentment, fear, and frustration can build during this time due to the unfair burden. The stress and emotional toll are immense during this time. Many of the programs listed above offer couple and family sessions, which would be beneficial to join. Trauma therapy is also an option for you, as living with someone in active addiction can be traumatizing, or maybe you’ve experienced past traumas that are being triggered by your loved one’s behavior.

Al-Anon, Al-Ateen, Codependents Anonymous (CODA), and Adult Children of Alcoholics and Dysfunctional Families (ACA) are free supportive community organizations that can also provide needed support during this time. You can do a quick internet search for these programs in your area.

Types of Therapy

Many inpatient, PHP, and IOP programs offer Cognitive Behavioral Therapy (CBT) and Dialectic Behavioral Therapy (DBT), which are a top-down approach where the focus is on how the individual’s thoughts are affecting behavior. These techniques are helpful for relapse prevention and increasing awareness of patterns of destructive thoughts and behaviors and actionable steps to take towards change. This is usually implemented once the individual is clear from withdrawal symptoms and can be useful for relapse prevention and coping skills.

What About Trauma

If you are someone who experienced trauma, being clear minded in early recovery can be a double-edged sword. You are physically clear from your drug of choice, but you may start to have memories or flashbacks from traumatic experiences that you used the drugs to forget.

You may experience the following:

• Nightmares related to traumatic memories or dreams about using drugs/drinking
• Heightened anxiety/nervousness
• Depression/hopelessness
• Thoughts of using drugs/drinking to cope with memories
• Feeling disconnected from your body

This is a common experience, and you are not alone. There is help available.

Stabilization

Trauma specific therapy is often introduced in early sobriety, sometimes in higher levels of care, but more often addressed once you are in outpatient therapy. This is because of the need for physical stabilization and emotional safety offered in higher levels of care. Experiential Trauma Therapies typically use a bottom-up approach, which prioritizes addressing trauma starting with the body’s responses and sensations, rather than focusing on the thoughts and memories associated with the traumatic experience.

Re-telling of traumatic experiences in early sobriety can cause emotional dysregulation and intense physical discomfort, which could lead to urges to drink or get high. However, at the same time, engaging in trauma therapy in early sobriety can help prevent relapse fueled by unresolved trauma or loss.

Trauma therapy in early sobriety often involves somatic approaches:

• Breathing exercises
• Yoga postures and movement
• Mindfulness
• Progressive muscle relaxation, movement
• Expressive arts therapies (art and music)
• Psychodrama techniques
• EMDR Resourcing and grounding techniques

The Bottom-Up Approach

The bottom-up approach enhances relapse prevention and creates safety and stability. This sets the stage for deeper trauma work down the road, such as reprocessing and desensitizing traumatic memories using Eye Movement Desensitization and Reprocessing (EMDR).

These bottom-up approaches are also useful for loved ones of those in early recovery to help manage anxiety, fear, frustration, anger, and even traumatic experiences caused by your loved one while in active addiction. If you are experiencing the following, you may benefit from therapy as well:

• Resentment/Anger
• The intense need to control and micromanage
• Increased stress/anxiety
• Flashbacks/Nightmares
• Sleeplessness
• A sense of dread
• Increase in your own substance use to cope with emotions/stress

Addiction affects the whole family. But help is out there. Recovery is available to all those who seek! If you are in early sobriety or the loved one of someone who is and you’re in need of help, call the Phoenix Center today to book with one of our trained experiential trauma therapists. You are not alone.

By: Meryl Lammers, LSW, MT-BC

Is it perimenopause or trauma? Mood swings. Body changes. Brain Fog. Anxiety. Sleeplessness. Why don’t I feel like myself? I don’t recognize my own body. Why does it feel like I’m going through puberty all over again? Why do my joints hurt all the time? Where did my patience go?

If you are in your late 30’s-early 50s and you are a woman or person who menstruates, you may be experiencing perimenopause.

What is Perimenopause?

Perimenopause is the transitional period before menopause. This is a time when bodies of people who menstruate begin to change and prepare for the cessation of menstruation. This phase, which can last for 3-14 years, is characterized by hormonal fluctuations, particularly in estrogen and progesterone levels, leading to various physical and emotional symptoms. These symptoms may include:

• challenging emotional changes
• sleeping disturbances
• decreased sex drive
• fatigue
• weight gain
• cognitive change
• dry skin
• joint pain
• muscle aches
• headache
• heart palpitations
• changes in taste
• digestive problems

People who have a trauma history may experience more severe perimenopausal symptoms, including hot flashes, sleep disturbances leading to fatigue, difficulty managing emotions, and heightened anxiety and depression.

Perimenopause and Trauma

Studies indicate that people with a history of trauma, particularly during childhood or adolescence, may experience a higher risk of depression and PTSD symptoms during perimenopause. Some red flags to look out for include:

• Increased feelings of depression/loneliness/isolation/anxiety
• Flashbacks of traumatic memories
• Inability to regulate emotions
• Increased suicidal ideation
• Feelings of hopelessness

Perimenopause and Neurodivergence

Is it ADHD or perimenopause? The rising diagnosis rates of neurodivergent conditions, like ADHD and autism, in people undergoing perimenopause is a phenomenon linked to hormonal changes and the impact of masking strategies. The decline of estrogen during perimenopause can worsen symptoms associated with neurodivergence, making previously masked traits more apparent and leading women to seek diagnoses.

Hormonal Changes and Neurodivergence

The hormonal fluctuations during perimenopause can directly impact dopamine regulation, a neurotransmitter crucial for focus and executive function. This can lead to an increase in symptoms like brain fog, forgetfulness, and difficulty concentrating, which are often associated with ADHD. Similarly, for autistic women, hormonal changes can exacerbate sensory sensitivities, social anxiety, and challenges with executive function.

Masking and the “Tipping Point”

Many neurodivergent women may successfully mask or hide their traits for years, particularly in childhood and adolescence. However, the physical and emotional changes of perimenopause, combined with life transitions, can overwhelm existing coping mechanisms. This can lead to a “tipping point” where previously hidden traits become more noticeable, prompting a diagnosis.

Increased Awareness and Intersectional Considerations

Increased awareness about neurodivergence and a shift towards more intersectional diagnoses are also contributing to the rise in late-life diagnoses. Additionally, the physical and emotional symptoms of perimenopause, coupled with the psychological impact of a late diagnosis and potential trauma history can make this transition particularly challenging for neurodivergent people who menstruate.

Where Can I Get Help?

If you…

The Phoenix Center

Experiential Trauma Therapy uses evidenced base techniques that can be beneficial for people in perimenopause of all neurotypes who are experiencing these symptoms. Research suggests that somatic or body-based therapies are effective in helping people in menopause cope with trauma. At the Phoenix Center, we specialize in providing EMDR, IFS, Psychodrama, Somatic work, and Creative Expressive Arts, such as music and art therapies, which all have a somatic component. We are here to support you through all life phases!

If you’re ready to get support during this significant life change, contact The Phoenix Center today to schedule with one of our experiential trauma therapists.

Maintaining long term sobriety and leading a happy life is often not possible without addressing the underlying issues that fueled the addiction in the first place. A significant overlap exists between trauma and substance abuse. Studies indicate that a substantial percentage of individuals who have experienced Adverse Childhood Experiences (ACEs), or early childhood trauma, also struggle with substance use disorders (SUDs), and vice versa. Individuals with a higher ACE score are 7-10 times more likely to develop substance use disorders than people without ACEs or with lower ACE scores. Certain ACEs, like emotional neglect, sexual abuse, and physical abuse are particularly strong predictors of substance use disorders.

Offering Trauma Therapy for Parental Stress at the Phoenix Center in Media, PA or Online!
484-440-9416 | Support@PhoenixTraumaCenter.com

Going Back into the Past

As people continue to recover, they may rejoin their lives, their jobs, their families, and lead a fulfilling life. They may not see the benefit of going back into the past to work through difficult experiences because they start to feel better. Sometimes people in long term recovery can become complacent with what helped them get sober. Maybe they reduce or stop going to 12 Step meetings or mutual aid programs, stop therapy, or reduce their use of coping skills for staying away from substances.

Additionally, people may also experience common life stressors, difficulties, or even experience significant loss or trauma well into sobriety. These experiences have the potential to resurface past traumatic experiences that may not have been dealt with in early recovery. Left undealt with, the past experiences may increase depression, suicidality, and poor occupational functioning, or decrease your ability to handle stressful situations which can lead to relapse.

Twelve Step Programs

Bill Wilson, the co-founder of Alcoholics Anonymous (AA), experienced a childhood marked by the abandonment of his parents and a subsequent period of depression at 17 after the death of his first love. He wrote extensively about his struggles with depression, insomnia, and fatigue in long-term sobriety. He noted that depression specifically required its own unique recovery process.

Bill began therapy years into his depression in the 1940s (40 years before PTSD was recognized) with a Jungian therapist and shared that therapy helped him work through what he called “psychic damages,” which included inferiority, guilt, shame, and anger. He wrote that doing a “psychic inventory,” like the moral inventory of AA, would help reduce the effects of these “psychic damages.” His therapeutic work later informed his writing in the 1953 book, Twelve Steps and Twelve Traditions, which were essays expanding upon the 12 Steps from the 1939 book, Alcoholics Anonymous.

Individuals with long term sobriety and a history of childhood trauma would benefit greatly from engaging in trauma therapy to help maintain both physical and emotional sobriety. For many people in long-term recovery, trauma therapy is a necessary form of relapse prevention.

Benefits of trauma therapy for people with long term sobriety include:

Offering Trauma Therapy at the Phoenix Center in Media, PA or Online!
484-440-9416 | Support@PhoenixTraumaCenter.com