As individuals experience trauma, whether in childhood or in adulthood, those traumatic events begin to shape them and impact every aspect of their lives, affecting how individuals view themselves, shape how they see the world and their place in it. Because of the high prevalence of trauma, it is unsurprising that many individuals that deal with trauma also begin to experience struggles with drugs and alcohol. This important intersection between addiction and trauma led MARC to building out and developing a more comprehensive approach to trauma and integrating trauma-informed care into the clinical philosophy and treatment approach for patient’s receiving care at MARC. Supported by the MARC clinical and medical providers, MARC’s approach to trauma-informed care has been both integrated into the overall treatment approach and clinical philosophy for all patients, while also offering specific stand-alone trauma care and recovery treatment and services for those patients in need of a higher level of trauma care and support. Below is an overview and understanding of MARC’s approach to treating trauma and addiction.
Anyone suffering or recovering from a severe substance use disorder has experienced trauma. As an addict or alcoholic, this can look like losing relationships, jobs, the inability to regulate emotionally and physically, and losing a sense of self. Very often, drugs and alcohol are used to self-medicate an overactive nervous system that resulted from trauma. When we face things that are terrifying or overwhelming, our brains and bodies prepare for survival through hypo or hyper arousal. Long after the scary event has ended, our nervous system prepares to survive the threat when it comes again—sometimes by convincing us that it never ended. Talk therapy can be important but will not heal the systems that are most impacted by trauma.
In addition to trauma informed staff and highly trained clinicians, MARC offers several trauma specific modalities for patients receiving treatment at MARC for substance use disorder that are also dealing with trauma. Some of these therapeutic approaches include EMDR, brainspotting, psychodrama, trauma specific groups and experiential therapy. In each of these groups and therapeutic approaches, we utilize elements of Internal Family Systems (IFS), Psychodrama, Gestalt therapy and Relational Trauma Repair. When a patient initially admits to MARC, they complete a trauma assessment which helps the trauma supervisor and primary therapist tailor a plan specific to their needs and individualize the care they will receive while in the MARC treatment continuum. Patients may participate in specific groups or be led through a particular treatment modality in one-on-one sessions. The purpose of this approach is to figure out the specific trauma needs of the patient, and what approach will work for them. While many patients are impacted by trauma, patients respond to trauma differently and not every trauma-informed approach will work for every patient. Therefore, by tailoring needs and approaches to each patient, MARC clinical staff is able to appropriately clinically support that individual patient’s needs and recovery support.
You really can’t have a cookie cutter approach when it comes to trauma and addiction. Why?…
- Some patients cannot participate in trauma work until their SUD is under control while others cannot begin managing their SUD without engaging in trauma work first!
- Some patients don’t identify trauma until later in treatment due to suppressed memories assisted by prolonged substance use or due to a need to develop a sense of safety in themselves and their surroundings before disclosing.
- What may work for one may not work for another. Humans are incredibly adaptive. Each person that enters treatment has developed a well-established strategy for surviving horrific circumstances. These strategies were chosen by each person’s brain (often without their awareness) to have the best chance of surviving a specific situation. In order for the brain to accept an alternative strategy, it must believe that it is safe to do so. Safety will look different to everyone.
This is a closed group that runs for two months. It includes patients in all levels of care offered at MARC and participants are invited through a referral from a clinical team member. Meeting once a week, members receive interactive psychoeducation around trauma and gain an understanding of how overwhelming events impact the brain, body, and behavior. One of the most exciting things about this group is the lightbulbs that go off constantly as participants gain insight into why they do the things they do. Individuals often leave the first session with less shame as they begin to see trauma-related symptoms as survival strategies rather than pathologies or moral short-comings. We spend the first hour of each group reading through a workbook written by the great Janina Fischer entitled Transforming the Living Legacy of Trauma. We take turns reading but stop every few sentences to ask questions, learn more or relate to the content. The second half of each group is focused on building skills that actually treat the impact of trauma. Members are guided in the practice of mindfulness skills, meditation, art, yoga, yoga nidra, and breathing exercises. These skills tone the overactive nervous system of our members and train the brain/body to remain in the here and now vs. the there and then.
This is a small, closed group that runs for two-month cycles. Members participate in a series of experiential exercises that get them out of their chairs and processing within their bodies. Patients will use props, empty chairs, and other members to move through thoughts or feelings that are “stuck.” Much of the trauma we hold is not stored in parts of the brain related to speech. Therefore, talk therapy will only achieve so much. The safety that is established within this group allows participants to engage in deep work without in a contained space. Each group creates agreements with one another at the start of each cycle that will create a sense of safety for all members. Individuals participate in a variety of hands-on activities that assist them in physically moving through their trauma the support of their peers.