The 4 R’s of Trauma-Informed SUD Care
As someone who has experienced substance use disorder in my own life, I firmly believe that examining the other underlying issues closely associated with SUD is an essential component of effective treatment. Often, trauma is a significant contributor to SUD, and it is crucial to consider that trauma when approaching treatment.
Psychological trauma occurs when an individual experiences a stressful event that has long-lasting effects on their mental well-being. This may mean experiencing traumatic events directly or bearing witness to such events happening to a loved one or even a stranger. Unfortunately, long-term mental and physical health issues can arise as a result of these traumatic experiences, including SUD.
Considering the effects of trauma with trauma-informed healthcare can provide the best shot at healing for many people with SUD.
Trauma and Substance Use Disorder
Substance use disorder (SUD) frequently develops after prolonged stress or trauma. Someone who has been exposed to consistently stressful and chaotic environments, such as being neglected by their parents or guardian, suffering abuse at the hands of a loved one, or experiencing a close family member or friend’s death, can be more susceptible to experiencing substance use disorder. They may rely on substances to help them cope with the harsh reality of their life or as a way to escape from it.
Stress caused by traumatic events can become so harmful to a person’s health that it can impact the functions of the brain and affect their behavior. Eventually, this can make addictive behaviors, such as misusing substances, more likely. People experiencing stressful or traumatic environments in their younger years are more susceptible to substance use disorders as they get older.
Additionally, chronic stress and trauma can impact the parts of the brain that affect motivation and the ability to learn. These stressors can impede the brain from functioning in a productive way. They may also affect a person’s self-control and cause them to be more apt to give in to sudden impulsive decisions. Trauma can also intensify urges for things that may be harmful such as drugs, alcohol, and unhealthy food.
It is worth noting that SUD and prolonged substance use can change the brain in much the same way. Trauma-informed care that considers the effects of trauma on the individual as well as the changes to the brain caused by SUD is essential to provide a legitimate path to recovery. Those who have experienced trauma and SUD must understand how both conditions have affected them to approach healing properly.
Unique Effects of Trauma
While most people do not experience traumatic events and seamlessly return to life with no impacts, no two individuals react to trauma in the same way. This means that many are negatively impacted in the long term, but the effects can look different from person to person. This is especially important due to the varied groups who frequently experience trauma; these groups include children, military personnel, and first responders.
Several outside factors can affect how a person copes with stressful and chaotic situations. Whether a person has the capacity to cope in a healthy way can depend on whether they have healthy relationship skills, strong mental health, and a solid support system. How they have dealt with traumatic events in the past may also inform how they deal with new events.
Trauma can impact a person on multiple levels.
- Emotional Health – The person may not be able to regulate their emotions, or they may not be able to feel anything at all.
- Mental Health – They may also experience mental health issues such as anxiety and depression or even post-traumatic stress disorder (PTSD).
- Physical Health – People may experience headaches, high blood pressure, insomnia, or constant fatigue.
- Brain Health – Trauma can even affect cognitive functions, such as having trouble concentrating, difficulty remembering things, feeling constant shame and guilt, dissociating from reality, or having vivid flashbacks to a traumatic event.
- Relationship Health – The person may start to isolate themselves from social events or stop spending time with friends and family.
Cultural or Familial Influences
If a person has grown up in a culture or a family where processing trauma and looking for outside help is stigmatized, they may hide any signs of having a traumatic history and shun seeking professional help. These negative coping skills can further enhance the effects of the stress. In these situations, substances are often used to cope with the negative impacts of trauma.
PTSD and Substance Use Disorder
Those who have experienced traumatic events may develop PTSD. Someone who suffers from PTSD has frequent flashbacks of a frightening or traumatic event, intrusive thoughts, continued fight-or-flight response, and other symptoms. Because these flashbacks can happen at any time, they may have constant feelings of fearfulness, anxiety, anger, or shame.
Individuals who suffer from PTSD often turn to substances such as drugs and alcohol as a way to cope. Unfortunately, in some individuals, this coping mechanism can develop into a substance use disorder (SUD).
It is not unusual for someone with this PTSD to have co-occurring disorders/dual diagnosis, which typically refers to someone who has a mental illness and a substance use disorder at the same time. The likelihood of developing some kind of serious mental disorder is even greater if the person experienced trauma at a young age. Individuals with co-occurring disorders have a higher propensity to experience other physical symptoms as well as relational issues and are at a greater risk of committing violent acts or dying by suicide.
The 4 R’s of the Trauma-Informed Approach
According to the Substance Abuse and Mental Health Services Administration, there are four keywords associated with trauma-informed care, otherwise known as the 4 R’s of trauma-informed care:
- Realization – Everyone involved in the care of a person with an SUD must understand what trauma is and its impact on individuals, families, groups, organizations, and even entire communities.
- Recognition – It is crucial that loved ones and especially care providers have the ability to identify the symptoms that often signify trauma.
- Response – Treatment providers must have a system in place that can effectively use trauma-informed techniques to help the individual.
- Resistance – Treatment professionals and loved ones alike participate together in the recovery and well-being of the individual and resist re-traumatizing them.
Trauma-informed care can be utilized by mental healthcare professionals, primary care physicians, school counselors and teachers, social workers, and community leaders. However, it is essential that family members and other loved ones carefully consider the role of trauma in a person’s development of SUD.
Realize the Impact of Trauma
It is very important to recognize trauma when it comes to someone who is dealing with substance use disorders or other mental health issues. When others fail to see the negative effects of trauma on the mind and the body, that person continues to feel isolated and hopeless.
Instead, it is crucial to acknowledge what happened to them was not right and that whatever feelings are associated with the traumatic event are valid. It is when someone notices a person’s pain and becomes an empathetic witness that that person can truly start to heal and begin the road to recovery.
Recognize Trauma’s Impact
Another important aspect of helping someone who has experienced trauma and is struggling with substance use disorder is recognizing how it is affecting them. Take notice if the individual is not participating in social events, is quieter than usual, or appears to be emotionally distant. They may also be more aggressive in their interactions, have a negative view of themselves or others, or shut down conversations with those closest to them.
Those who have experienced serious trauma are often attempting to figure out how to survive, even if it is not in a healthy manner. In many instances, instead of responding to trauma using the learning part of the brain, a person responds with the survival portion of the brain.
This means that the brain is responding to stress instinctually, which involves the fight, flight, or freeze response. When the survival brain takes over, the learning brain’s responses (which include knowing how to analyze the current situation or how to control impulses properly) are temporarily forgotten.
It is completely natural for someone who feels unsafe and has a traumatic past to respond with either the fight, flight, or freeze response. Unfortunately, many people attempt to circumvent this stress response by numbing the response or avoiding the stressor altogether – sometimes with substance use.
People helping an individual with SUD and a history of trauma should consider the things that trigger these feelings and responses. Triggers can involve anything that reminds the person of the traumatic events that have happened to them, such as being rejected or ignored, volatile situations, or a particular person that reminds them of someone else who hurt them. Identifying trauma triggers, like substance use triggers, can help the person avoid them, deal with them appropriately, or use a coping skill to reduce the stress brought on by the trigger.
Respond in a Way That Lets Others Know They Are Heard
When dealing with someone who has suffered from trauma, it is extremely important to remember that their brain is constantly in survival mode. A trauma-informed approach focuses on providing ease and calm. People must feel as though they have a safe person to come to who will listen to them and ensure that their emotional needs are met.
Trauma can cause a person to feel as though they have no power over their circumstances and no voice. Give them back their right to be heard and seen, and empower them with the knowledge that they have a voice and can take charge of their circumstances.
Resist Re-Traumatization
Part of a trauma-informed approach is not only being able to recognize it but also understanding the individual’s history of trauma and even family trauma. In some cases, there may be cultural trauma that has impacted generations within the family, such as slavery or genocide. A person’s own individual trauma can be greatly affected by racial, cultural, or historical trauma. They may also be re-traumatized by smells, sounds, or sights surrounding them.
It is important that those who are seeking to help someone struggling with a substance use disorder and trauma do all that they can to avoid re-traumatizing that individual. A holistic approach considers the whole person, including how a person relates to their physical and social environment. For example, if there is one area in their life that is lacking, they may struggle with being easily triggered and re-traumatized. It can be helpful to assess their current physical, mental, emotional, or spiritual needs to ensure that each of those needs are met.
Additionally, people can benefit from identifying their triggers so that they can be aware and avoid things that make them feel unsafe. Consider helping them create a routine that gives them a feeling of familiarity and safety. Let them know that it is good for them to have autonomy, meaning that they are allowed to say no to anything that makes them feel uncomfortable or unsafe. Be prepared with resources if they need further help, and do all you can to support and encourage their recovery process.
The Importance of Trauma-Informed Care
Using a trauma-informed approach is crucial, no matter your connection to a person with a substance use disorder and trauma in their past. Understanding the major effect that trauma can have on an individual, recognizing the symptoms, avoiding retraumatization, and supporting their recovery journey can make all of the difference as they work through their trauma and mental health concerns.
Recovery is possible with the right treatment and hard work, but you or your loved one do not have to do it alone. Whether you are a close friend or family member of someone who is struggling with trauma and a substance use disorder or you are looking for support to find your own road to recovery, seeking help is a crucial first step. Connect with me for more information.
Stay Strong,
Jim
Sources:
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- National Coalition for Homeless Veterans. (n.d.). Trauma-Informed Care: Supporting Homeless Veterans (Research Brief No. 61). SAMHSA. Retrieved from https://www.nchv.org/images/uploads/Research_Brief_61_-_SAMHSA_Trauma_Care.pdf
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. U.S. Department of Health and Human Services. Retrieved from https://store.samhsa.gov/sites/default/files/pep23-06-05-005.pdf
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