Category: Addiction & Recovery

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.

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

When Talking Isn’t Enough: Action Methods in Addiction (and Trauma) Recovery

By Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, PAT

Published November 2021 in The Group Psychologist – newsletter of APA Division 49: Group Psychology and Group Psychotherapy – https://www.apadivisions.org/division-49/news-events/action-methods-addiction

Addiction, substance use, and overdose rates have significantly increased in recent years, particularly during the covid-19 pandemic. Relapse rates are high and many clients struggling with substance use disorder have been to treatment multiple times. Most of these clients have accrued significant knowledge about addiction and recovery – they could probably present a lecture on addiction just as well most addiction counselors! The problem is, however, that knowledge alone does not lead to change – it must be put into action. This very concept is reiterated by the popular Alcoholics Anonymous saying that “self-knowledge availed us nothing.” Families understand this just as well as others as they have heard their addicted loved one apologize and verbally commit to recovery many times, only to experience them continue to drink, use drugs, and engage in the same behaviors. When it comes to addiction, words so quickly become meaningless unless followed with action. Psychodrama and other experiential therapies have a unique capacity to engage clients in addiction treatment, addressing underlying fueling factors of addiction, and role training clients for the life skills needed for sustained recovery (Dayton, 2005; Giacomucci et al., 2018).

Many addiction experts have asserted trauma to be one of the primary causes of addiction – some research studies indicate self-reported histories of trauma in over 80% of inpatient addiction populations (Cohen & Hien, 2006). Post-Traumatic Stress Disorder (PTSD) is one of the most common co-occurring disorders for folks with a substance use disorder (Creamer et al., 2001; Roberts et al., 2015). Trauma and addiction exist in a cyclical relationship. Trauma survivors often turn to alcohol or drugs (or other addictive behaviors) to self-medicate the stress, feelings, or physical sensations related to prior trauma, loss, neglect, or abandonment (Morgan, 2019). Furthermore, the lifestyles often associated with addiction makes someone much more vulnerable to experience more trauma, which in turn creates more adverse feelings to fuel substance use. All addiction treatment is trauma treatment; addiction recovery is incomplete without trauma recovery. Maintaining long-term recovery from addiction requires that we address underlying causes which often include trauma, loss, neglect, and abandonment. Otherwise, we are simply engaging in symptom control and avoiding the causes of the addiction.

When it comes to addiction and trauma, words and talking is limited. Many people in recovery and trauma survivors have no words for their trauma, avoid talking about it, or talk about their trauma but are clearly dissociated from the associated feelings. Research even shows that the Broca’s Area, the language and speech center of the brain, (and the entire left brain hemisphere) is largely inactive when one remembers a traumatic memory (Rauch et al., 1996; van der Kolk, 2014). Similarly, addiction involves the hijacking of survival systems and choices which often appear absent of rational thought (Morgan, 2019). Neurobiologically, both trauma responses and addictive behaviors operate below levels of consciousness, rational thought, or cognition. Trauma impacts the body and the nervous system in implicit and unconscious ways. Even when one doesn’t consciously remember a traumatic event, the nervous system may still be impacted and imprinted by it. Both trauma and addiction impact an individual biologically, psychologically, socially, and spiritually (or existentially) (Giacomucci, 2021). Breaking these cycles requires new experiences that can create new neural pathways in the brain. Experience changes both the brain and the mind – this is the most important neuroscience finding of the century (Siegel, 2012). The brain maintains neuroplasticity, or the ability to change, throughout the entire lifespan. This means that new experiences have the power to renegotiate and change the impact past experiences have had upon an individual. Experiences in treatment, therapy, and recovery can be corrective and effectively repair the damage done from past experiences of trauma or addiction (Giacomucci & Stone, 2019).

Many addiction counselors intuitively try to make their groups and programs more engaging through creative exercises. Psychodrama training offers a time-tested and systematic approach to using action methods in addiction treatment and beyond. Experiential therapies and psychodrama in particular have had a long relationship with the addiction treatment world tracing their connections back to psychodrama’s use in the original addiction therapeutic communities or prominent trainers such as Virginia Satir, Sharon Wegscheider-Cruse, or Tian Dayton who were very active in teaching psychodrama to addiction counselors (Dayton, 2005). As the addiction treatment community continues to evolve it has been further adopting trauma-informed principles, philosophies of empowerment, and holistic approaches – all of which are congruent with psychodrama (Giacomucci, 2021). In my own experience integrating psychodrama at Mirmont Treatment Center, an addiction treatment center, we found that the patients respond very well to it. It was one of the most requested therapies on their patient satisfaction surveys propelling us a few years before covid-19 to significantly expand our use of experiential therapies and psychodrama throughout the entire inpatient clinical program. The trauma-focused psychodrama group that I run is in such high demand that it almost always has a waitlist of patients wanting to join.

Trauma and addiction result in repetitive patterns, reenactments, helplessness, frozenness, and stuckness. Talking about it is often simply not enough to promote change or healing. Clients often state that their addiction treatment groups (inpatient, PHP, IOP, and OP) feel no different than a free 12-step meetings or other support groups. Many clients are sick of talking about it again and again throughout their treatment experiences and have lost hope in the ‘talking cure’. Breaking free of the cycles of addiction and trauma requires action and more action. The experiential nature of psychodrama and experiential therapies helps to get clients into action – exploring new roles, rehearsing new behavior, role training new skills, renegotiating somatic imprints of trauma, releasing frozen emotion, and developing action insights throughout the process.

References:

Cohen, L. R., and Hien, D. A. (2006). Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatr. Serv. 57, 100–106. doi: 10.1176/appi.ps.57.1.100

Creamer, M., Burgess, P., and McFarlane, A. C. (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-Being. Psychol. Med. 31, 1237–1247. doi: 10.1017/s0033291701004287

Dayton, T. (2005). The Living Stage: A Step-by-Step Guide to Psychodrama, Sociometry, and Experiential Group Therapy. Deerfield, FL: Health Communications Inc.

Giacomucci, S. (2017). The sociodrama of life and death: young adults and addiction treatment. Journal of Psychodrama Sociometry, & Group Psychotherapy, 65(1): 137–143.

Giacomucci, S. (2020a). Addiction, traumatic loss, and guilt: a case study resolving grief through psychodrama and sociometric connections. Arts Psychotherapy, 67:101627.

Giacomucci, S. (2020b). Experiential sociometry in group work: mutual aid for the group-as-a-whole. Social Work with Groups 33, 53–68. doi: 10.1080/01609513.2020.1747726

Giacomucci, S. (2021). Social Work, Sociometry, and Psychodrama: Experiential Approaches for Group Therapists, Community Leaders, and Social Workers. Springer Nature. https://doi.org/10.1007/978-981-33-6342-7

Giacomucci, S., Gera, S., Briggs, D., and Bass, K. (2018). Experiential addiction treatment: creating positive connection through sociometry and therapeutic spiral model safety structures. Journal of Addiction & Addictive Disorders, 5, 17.

Giacomucci, S., & Marquit, J. (2020). The Effectiveness of Trauma-Focused Psychodrama in the Treatment of PTSD in Inpatient Substance Abuse Treatment. Frontiers in Psychology, 11, 896. https://dx.doi.org/10.3389%2Ffpsyg.2020.00896

Giacomucci, S., & Stone, A. M. (2019). Being in two places at once: Renegotiating traumatic experience through the surplus reality of psychodrama. Social Work with Groups. 42(3), 184-196. https://doi.org/10.1080/01609513.2018.1533913

Morgan, O. J. (2019). Addiction, Attachment, Trauma and Recovery: The Power of Connection. New York, NY: W. W. Norton & Company Publishing.

Rauch, S.L., van der Kolk, B.A., Fisler, R.E., et al. (1996). A Symptom Provocation Study of Posttraumatic Stress Disorder Using Positron Emission Tomography and Script-Driven Imagery. Arch Gen Psychiatry. 53(5): 380–387.

Roberts, N. P., Roberts, P. A., Jones, N., and Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin. Psychol. Rev. 38, 25–38. doi: 10.1016/j.cpr.2015.02.007

Siegel, D.J. (2012).  Developing mind:  How relationships and the brain interact to shape who we are. New York: Guilford Press.

van der Kolk, B. A. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York: Viking Press.

We are excited to share the newly released on-demand video training by Dr. Scott Giacomucci, Addiction & Trauma: A Psychodramatic Approach, hosted by the new Action Explorations Education online education platform.

This course involves a lecture on the intersection of addiction and trauma as they related to the basics of psychodrama psychotherapy. A 1-1 individual psychodrama session is demonstrated via telehealth with a focus of strength-based roles for recovery. After the psychodrama demonstration, the demo is processed and analyzed with additional insights.

Here’s a trailer for a sneak peak of the course:

Access the 4.5 hour course ($100 for 100 day access) here – https://actionexplorations.education/home/course/addiction-amp-trauma-a-psychodramatic-approach/16

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