Trauma And Addiction

In this webinar, our panel of experts discuss the connection between trauma and substance abuse. They’ll offer perspectives on the intersection, including:

  • The definition of trauma and its impact
  • The connection between trauma and substance abuse
  • Challenges faced by addicts and their families
  • Effective assessment and intervention strategies
  • Available support and resources for other professionals

Featured panelists:

Blythe Landry, LCSW, M.ED, Grief & Addictions Expert

Greg Powers, MSW, LCSWS, VPCS, Clinical Director of Discovery Point Retreat

Noelle Carmen, Host and Moderator

Trauma And Addiction Podcast, Video and Transcript

CARMEN: 00:03Welcome to Recovery Out Loud, a Niznik Behavioral Health podcast, where we discuss addiction, mental health, and recovery. We’ll explore the true nature of addiction with behavioral health experts and to hear firsthand personal testimony about what the path to recovery really looks like. From Niznik Behavioral Health, I’m your host, Noel Carmen.
CARMEN: 00:34Welcome to Recovery Out Loud. This week’s episode features audio from a webinar hosted by Niznik Behavioral Health. Video recordings of our webinars can be found on our website, which is linked in the description. There, you can also find information about upcoming webinars and other events. Thank you and enjoy.
CARMEN: 00:56Okay. So I think that we are ready to begin this conversation. Welcome everyone to today’s conversation. It should be a fantastic one. I’m Noel CARMEN and we are talking about how these clinicians approach diversity and intersectionality in our practices. We have an incredible panel here today. Before I introduce them, let’s just take care of some housekeeping. Please be aware that you will receive your CE information in an email by the end of business tomorrow. Okay, so onto our fantastic panel. I want to introduce Lindsay Wallach, the director and founder of Meraki Wellness and Healing. I would like to introduce Christian Vasquez. Am I saying that correctly? I hope I’m saying that correctly.
VASQUEZ: 01:42Correctly, Christian Vasquez, yes.
CARMEN: 01:44Vasquez, excuse me. He is the clinical director for Meraki Wellness and Healing. He is an alum HC. Mar Trujllo, she serves as a registered mental health counselor intern. And finally, Allison Moore, finally, but certainly. Certainly not least you, you specialize in substance use and are a lead therapist for Discovery Point Retreat. Welcome everybody to the conversation. Thank you for being here.
WALLICK: 02:14Thank you for having us. Thank you.
CARMEN: 02:16Okay. And to our audience, as always, I would like to invite you to ask all the questions, make all the comments. I will do my very best to address all of them. If I missed some of them, we will make sure in the email following that we will connect you with our speakers and also try to address any questions left unanswered. Okay, so all of that is done. Housekeeping is done. So let’s get to the conversation. So, Christian, I’d really like to start with you, and I’d like to get us all on the same page in terms of defining and describing what we mean when we are talking about approaching our practices from the standpoint of diversity with multicultural populations. Just intersectionality, just all of it, what does that mean?
VASQUEZ: 03:09Well, first and foremost, thank you for having me. It’s a pleasure being here today, being part of this conversation. It’s a conversation that at times can be very controversial and we’re like, very, “Oh, let’s not talk about that,” but we need to. It’s a very important topic discussion and about the question you just asked, I’m going to relate it personally in my clinical experience. So I can also say that based on our modalities and theories and practices that we have learned in school. So I feel that we can always approach that and understand it, dissect it in our mind as far as like what we take from it, what we understand. But to make it more diverse and feel for that multicultural background of how we engage in diversity is basically that within the topic that not one style of practice can be applied to one specific demographic or population of clients. So we have to do our own research, as well. And also with the experience gained over practicing, in view of the clients, making sure that we are understanding and getting a feel for those interactions. I feel that the human connection goes above just one modality or one situational when it comes to diversity.
CARMEN: 04:39Mar, I’m going to throw this to you, and you and I had discussed offline about this being a process. So what does diversity mean for you in terms of your practice?
TRUJILLO: 04:52So where I’m working with miracles and healing with Flimsy and Christian. Thank you also for having me on today. Diversity is so much. Diversity is so broad. You can have diversity both– or in race, in religion, in culture, in ability, or disability, in size, and everything. It’s just the difference, right? That’s what diversity is. There is difference. I think, to say that we are all the same, we don’t see color, we don’t see religion, and I think that that diminishes so much of the human experience, diminishes all of the human experience. And so just understanding that there is a strong difference between humans and between groups throughout our practice, but throughout, really, humanity, it’s a hard thing, I guess, to boil down to one very simple term. But that’s kind of what it is. It’s just this absolute human difference that we have.
CARMEN: 05:59So I think that you’re saying something really interesting, profound, and maybe a little vulnerable. And Allison, I’m going to throw this to you, which is just to build upon that. Looking at difference in terms of diversity, isn’t that kind of a–isn’t that a scary thing to say in a sense? Because in creating an other, we’re looking at difference and that could possibly create a lens that maybe isn’t what we want clinically. Can you take that apart for us, unspool that a little bit?
MOORE: 06:37Well, let me just say thank you as well for having me on. Being an African American woman and then also being a Christian counselor, some clients have a wall when it comes to my spirituality alone because of the environment I work in. I work in a treatment facility, so word gets around. The best advertisement is word of mouth. So clients already have a preconceived idea of me as a clinician before even meeting me. And so when they hear that I’m a Christian counselor or I have this spirituality, one of my clients said, “I thought I was going to come into your office and see crosses hanging all over the walls everywhere.” So they already have a preconceived notion of me. And so diversity comes in all forms. And for me, it is my skin color and my religious beliefs. So I get it from even the client’s point of view being on the clinician side of it.
CARMEN: 07:53And that actually segues right perfectly into the next thing that I would like to bring up is intersection because we’re not all just one thing I know I sound like a broken record. We’re not all just one thing. We’re not just queer. We’re not just a person of color. You’re a person of color who happens to also have a religious identity. So Greg I’m going to throw this at you in terms of intersection, because it’s challenging enough, right, just to understand the queer perspective, but take that and then add layers to it. This is a challenging job for we clinicians to make sure that we are able to grasp our clients in this way. Well, what are your thoughts on that?
POWERS: 07:38No, and I’m looking at some of the chats and comments and stuff and people have talked about Enron and Bernie Madoff and divorce and financial things, and when we think of trauma, sometimes people think, oh, okay, it was somebody tried to hurt me or I was in a horrible car accident or something like that and that encompasses trauma. What we don’t always recognize is trauma takes the form in many ways. And so we can be traumatized. I’ll pick the most recent in the news, the January 6th Capitol thing. For a lot of people, that was very traumatic. Not necessarily were you there at the Capitol? But that perhaps was a traumatic event for somebody and maybe triggered some things that have happened in the past or it kind of reassured some of their ultimate fears of what’s going on in the country. And so that can become a very traumatic event for somebody. And it’s going to be different for everybody. So whereas the panel here, it may be two out of the six, right, that are saying, “Oh my gosh, that was really traumatic. And I can’t believe this happened.” And others of us are like– so it does take root. And it’s in different forms of how we look at trauma and how we react to it. That kind of goes into– and I don’t want me to jump into what I was going to talk about. But really, how it affects the body and alters us in that sense. And what we need to recognize with traumas, it’s really a chemical reaction in the brain causes just this constant state of tension and arousal. And it’s kind of that fight or flight thing that people may be more familiar with and that it’s just that constant state of, oh my gosh, something’s going to happen to us. I hope I answered that question. But–
CARMEN: 09:41I want to address this idea of this. What I’ve read – and all of you are the experts on this – it’s not just an event. It’s an event over time. So can you kind of differentiate that? Kyle, hi. I see you’re back on. Do you–
TURNER: 10:00Can you hear me?
CARMEN: 10:01Oh, that’s so much better. Can you talk about trauma in terms of not just a single event, but a series of events or a prolonged period of time that does do what Greg is talking about in terms of actually changing the chemical nature of the structure of the brain?
TURNER: 10:23I’ll grab this one. Going back to the little T trauma. I don’t know if you can hear any of that. That’s before–
CARMEN: 10:29No, go for it.
TURNER: 10:30Okay, so I’ll go back to the little T trauma. I’ve worked in domestic violence for a long time. So I imagine a woman who’s been married to an abusive man for a decade. And he’s not physically violent, but he’s emotionally abusive, spiritually abusive, and he controls most aspects of her life. Over time, her, I believe it’s the hippocampus actually will shrink because she is so involved in managing his emotions, taking care of his needs. She doesn’t even have time for her own needs. And again, there’s not a moment where he’s blacked her eye. He’s put her in the hospital. But over a decade or more, the brain responds to that level of fight or flight, that level of cortisol and what hormones are actually being used. And it really impacts brain chemistry and structure. And that’s a long term. And when you go back to a child and you’ve got kids who live in that environment, it’s really, really detrimental when their brains are developing and they have that level of trauma.
CARMEN: 11:36And that speaks to, like you’re saying, that adaptability for both negative and positive, right? So as the brain is adapting in childhood – and we’ll get more adept to this in just a little bit – for positive things, does that create plasticity and an ability to bounce back later in adulthood adulthood when an adult experiences trauma. That’s for you, Pat.
TURNER: 12:07Oh, yes. No, I’m thinking. It can create resilience and plasticity I think if the trauma has been resolved. Typically, what we see if it’s unresolved and the individual’s still struggling with the pain from their past and the negative thoughts they have about themselves in that moment, it tends to repeat the pattern. And they’ll find a way to act out that trauma or recreate that trauma over and over in their lives. It might be different. It might be a different scenario, but it’s the same kind of betrayal, the same kind of hurt. So it really does make a big difference if that person has engaged the trauma and resolved it or if they continue to live with it, and they’re trying to figure it out without going to extra lengths to get to professionals and get some true processing and healing.
CARMEN: 12:57Okay. And one last question for you, Kyle. You’re talking about almost like the brain ourselves, try to place ourselves back in those same situations in order to create a scenario where we can find resolution. Is that what you’re talking about because that’s a pretty powerful thing? Can you speak on that?
TURNER: 13:19Yeah, absolutely. One of my favorite books Patrick Carnes has put out, he’s usually the guru of sex addiction. But he put out a book called The Betrayal Bonds. And it talks about shaming and exploitive relationships. That kind of breaks out of his typical niche. And it defines trauma bonding and trauma repetition. So the assumption is if we don’t resolve the trauma from childhood or early adulthood, then we’re going to find behaviorally a way to try to resolve it ourselves. And again, our brain’s wired by those experiences. So we tend to find ourselves falling into, if we if we’re acting out of trauma, the same kinds of traumas over and over whether that’s relationships or in abusive work environments. There’s lots of ways that we recreate those experiences if we’ve not resolve them. And our brain’s hardwired to feel that that is a familiar place for us to be.
CARMEN: 14:15So this segue ways right into what I want to ask you, Andrea, in terms of let’s talk about adaptability. Is trauma–? and Greg touched on this, but I want to go a little more in depth about trauma defined by self, by experience. What distinguishes one person’s ability to cope with trauma versus someone who perhaps experienced the same thing and truly is in a state of fight or flight, in a state of trauma?
HORWITZ: 14:50So my colleagues have definitely talked about resilience, right, which is really like a set of skills that can be learned, right. Trauma doesn’t really promote resilience. So what do we need? We need optimism and definitely realistic optimism. It’s somebody’s moral compass, right. And that’s also going to determine how we deal with or how a person can deal with their trauma. Their religious and their spiritual beliefs play a role in that. Their cognitive and emotional flexibility, how they connect socially, right, so if they have people that they can talk to. And in their adaptability to change, right. And also social-cultural factors come into play and their accessibility to mental health. So people don’t have accessibility to mental health and social connections whether that means outside, like in their family, outside of their family, that really plays a role in their resilience and how they deal with trauma. And I know we’re going to get into, but their childhood part, it’s the lack of being able to express their emotions. Some people just don’t feel safe and learned that it’s not safe to do that. And so I think that plays a very huge role in how somebody is more resilient and deals with their trauma different than other people. And, of course, we know what that risk and protective factors, right? And that also comes into play. And one of the biggest things– Lisa Harvest was very big in seeking safety and a lot of trauma. But she talks about, like, you are not your trauma, which makes a really big difference. And I think in helping somebody in their trauma, right, so they don’t identify as their trauma, I think that’s a really great way to get them to separate their thinking and their mind, right. And how they can now perceive and have more resilience in dealing with it.
CARMEN: 17:27So this brings us to diving into childhood trauma. I read so much about the impact of childhood trauma. Can you give us an overarching notion of your understandings, your workings in terms of trauma in the formative years?
LANDRY: 17:54So when we were little, our entire frame of reference are the people who were caring for us. We get fed by those people. We get housed. If we’re not on hold by those people, we get attention from those people. And that is how we literally develop into an understanding of relatability, love, connection or lack thereof, consistency. These people are mirroring for us. In a place where there is emotional inconsistency due to mental illness or due to addiction in the home, in a place where there is financial insecurity, and people are always connected and then withdrawn, or if you have a parent, as I said, with mental illness who’s depressed and in bed for weeks at a time; if you had a rager in the house; if you have sexual molestation going on in the house; if you have religious shame happening in the house; if you have financial punishment happening in the house, any and all forms of either aggressive, negative, repetitive behaviors, and/or emotional vicissitudes and inconsistency can lead to an ultimate body of all out, massive confusion. Being abandoned, having apparently and never come back or call you again, these are all different levels of trauma. Everyone is born with different levels of resilience. So two kids can live in the same house, have totally different perceptions of the exact same experience, and not all children in the home are treated the same way. Some parents, a lot of abusers identify certain children in the house to focus on. So you could have a varying types of trauma in the house where one person is the one being abused, and the other child is the one not able to protect the one being abused, who then becomes a rescuer, has a rescue complex, etc. The biggest thing that happens is children will attach to their parent at any cost. It’s the only way they can survive. And children, in a not a negative way, are naturally self-absorbed because their entire the world is related to people fueling attention to them. So almost in every situation, they will develop shame, self-blame, self-loathing, or create fantasies that aren’t based in reality to protect their relationship to the caregiver, no matter how abusive they are. The other form of that is often the child will be angrier at the parent who’s not abusive than the parent who is abusive because that can still keep them linked to someone they want to desperately have a relationship with. So whatever level of childhood trauma one has– let’s say, growing up with an alcoholic. It’s very hard to grow up with addiction. There’s something called the ACOA trauma syndrome that the addicts are often very nice and then not and then nice and then not and attentive and then not and then funny, then mean. And it can often happen within a breath. That makes the person– much like Kyle was talking about. When someone goes off to combat, and they come back, and they think everyone’s shooting at them, and it’s just a car backfiring. This type of personality that develops, especially if the child is exceptionally vulnerable or empathetic. They will literally constantly be vigilant, like Andrea was talking about, to what is happening in the people around them to the point where they have no sense of self in order to protect. An emotional shift, any nuance change in behavior is taken as a rejection or an abandonment. And the more that happens, the harder it gets to resolve. Then whatever happens to us in childhood informs how we respond to trauma later in life. So somebody who had a healthy childhood with a secure attachment to parents who were trying their best– we’re human. But consistent in their emotional expression, might have something very dramatic happen later in life, a horrifying car accident. They might get emotionally abused by a boss. They might have a partner that is not healthy. They will most likely respond to it in a much more effective way than someone who already has trauma.
LANDRY: 21:58And as Kyle and Andrea and Greg all referenced, what happens is when you go out into the world and you choose people who mirror those exact behaviors, it feels like attraction. It’s not. It’s abuse. And what feels good – and I know we’re going to talk about that later – feels bad. And what feels bad feels good. This is very hard to change. You have to be really willing to be uncomfortable and do some pretty substantial personal work. It’s possible, but it takes a lot of time.
CARMEN: 22:28Kyle, let’s talk about how important it is, the significance of identifying childhood trauma in these formative years because we know the impact is so dire as they grow into adults. Can you talk about your approach, how you go about doing that?
TURNER: 22:50Sure, sure. I work with individuals, couples, and families. So it’s a little different in each setting. With individuals, I’ve got a couple of my favorite tools. Sometimes, I’ll just talk about attachment. And in the first couple of sessions, six basic attachment things we need. We need to be attuned to mom and dad. They were able to read our needs, and then we need to be responded to. When they see the need, they need it. We need them to engage our heart. So engagement is important. They need to know us as people, not just things to take care of. And then they need to help organize our feelings, even if we have big feelings. And the last thing that we need an attachment is repaired. If mom and dad hurt us, we need repair. And I’ll list up the six for you students out there, attunement, responsiveness, engagement. That’s one, two, and three. Attunement, responsiveness, engagement. Organizing feelings is number four. Organizing difficult feelings is number five. And the number six is that repair if needed. So I’ll often ask clients, “Hey, how did that go for you?” In session two or three, how well, did you feel like your mom, or dad, or caregiver did those things for you, and it’s a good diagnostic. I’ll do a trauma timeline sometimes with folks with the cognitive behavioral model, and just look at the good stuff that happened above the trauma timeline, and then difficult things that happened below. As couples, I see a lot of, “We can’t resolve fights. We don’t know how to fight well,” or one person seems to be to blame for all the problems in the relationship. And usually that person is the trauma victim, and they just didn’t get the tools that they needed in early childhood to do a securely attached relationship. So they’re without any help. They’re kind of flying blind. So that’s the way that it shows up, so we’ll talk about their relationship. And in family systems, I’m thinking of one in particular. My mom had been horribly abused by her father, so the family complained of mom being super controlling. And when we dug down into her timeline, because I did some individual with mom, she had lots of reasons to be controlling, and she didn’t realize how deeply she was impacted, and her family was impacted, husband and kids, by the trauma that she was still responding to as a young woman, as a 10 to 14-year-old girl. So when I talked to the importance of it– I mean, when we’re traumatized, it affects everything, and we can’t help it, right? Now, if we deal with it, and it doesn’t become PTSD, or we get the help we need soon, it’s not going to have the ripples that it might if we don’t deal with it early on, or we don’t when the symptoms start to show up, then it affects all the things. It affects the workplace that we have, the relationships, friendships and partners, family interactions. So I think in identifying early childhood trauma, it’s imperative that if there is a trauma survivor that we’re working with, we grab that quickly, and really give them the help they need. Because they might not even know why they’re behaving the way they do. They might have repressed those memories, and finding out why they’re doing what they’re doing can give them a lot of clarity. And it’s a relief, like, “Okay. Now I know what I need to be working on.” So I think there’s a lot of relief in that. I will say as a caveat– well, there’s another question. Later I can deal with this. So go ahead.
CARMEN: 26:28They already know all the questions. We’ve already planned this. Someone said that they are really hoping to learn more about effective interventions and techniques, and I’m just telling you, we’re going to get there. So just hang on to your hat. We’re just we’re going through the front part of this conversation first. Greg, so I wanted to just address kind of the difference in identifying trauma in childhood versus adulthood. I know that you said trauma is different for every person, but once you’ve identified an adult, what does that look like in contrast to a child who is formative where we adults were formed, we’re already cooked.
POWERS: 27:14So I think along the same lines, what you’re looking at are those risky behaviors, kind of the acting out, if you will. With adults, and I think I mentioned that sometimes it has to do with accessibility. So whereas a kid might be acting out in the form of anger or rage, and adults may have that, but then they also have acting out ability. Maybe they’re sexually acting out, maybe they are racing their car in and out of traffic, and that’s their fun. We also have to look at the build up and the ability and accessibility of drugs and alcohol. Adults who have a trauma history sometimes are going to maybe go towards the alcohol, and the drugs to maybe even counteract. Or even sometimes we see that individuals are seeking that feeling that the trauma brought on, because for them that has become normal. And so we see a lot of those risky behaviors, and use of drugs and alcohol in changing. I can kind of give you a story of a client that I recently saw, and that she came to us with an alcohol problem. She had been arrested a few times, and family was concerned about her use. And so she came to us for treatment for the alcohol. And in having a conversation with her and looking at what the history was that led to her coming to us, she had been physically and sexually abused from about the age of 6 to 14. She was a athlete, and during her high school, and early college years, she had a pretty significant injury, and she was not able to play soccer anymore. From there, she delved into multiple relationships, the relationships that she thought was the love of her life. She unfortunately witnessed his drowning and death. She never recognized the fact that through all of this, her alcohol consumption was continuing to increase. That for her was how she was coping. The issue in working with her was, yes, she came to us because she was abusing alcohol. The treatment that we dealt with was the abuse, the loss. And I think Blythe and Kyle both talked about the fact we have to go back to the beginning, and for her, it was she was being physically and sexually abused by a parent. That was a significant loss. Our parents are supposed to be there to protect us. That was not the case in her situation. She thought that she had found that with her boyfriend, and that he was going to protect her and keep her safe. He died. So she kept having these repeated traumas in her life, and she resorted to going towards the alcohol. So, again, what we really talked about is, yes, we’re going to address the alcohol, but the elephant in the room is the grief and loss.
CARMEN: 30:42Blythe, I want to get into some deeper notions in terms of trauma, rewiring our perceptions. You’ve definitely touched on this, but I want to go back to it because I think it’s so key to everything that we’re talking about. We talked about trauma being more than an incident, and how trauma informs our own safety, and what that does in terms of our responses to the world there.
LANDRY: 31:15Sure. So first, I want to differentiate. There are some traumas that are just one instances, so if I was at the shooting in Vegas when that happened, that’s a massive trauma that can alter the course of a human being’s life. But there are also these traumas that are the culmination of a series of events over a long period of time that begin to change the way a person perceives reality. And so what happens is in many cases, if we go back to childhood trauma specifically, because you see, I use the word recidivism, which is incorrect, but the returning of trauma over and over again is very common. So someone who is sexually abused as a child might get into situations where they find themselves repeatedly sexually assaulted as adults. That is obviously not their fault. Predators smell fear, predators smell vulnerability. And so that’s never the person’s fault. But then it reiterates this idea to them that it is their fault, that they are to be shamed, that they chose this on some level. What happens is when a person has inconsistent, emotionally abusive or, volatile parental figures or adult figures, they perceive safety as unsafe, and unsafety as safe. Kyle was speaking about the hippocampus change, the brain change of a human being. And Greg talked about fight or flight. There’s fight, flight freeze, and fawn. Trauma responses are fight. If you can’t fight, then you flight. If you can’t fight or flight, then you freeze. And if nothing else works, the fourth one that they’ve discovered is fawning. So how can I be perfect? How can I be the best girl in the world, even though I’m fifty-five or sixty-five? And if I do all good things, then nothing bad can happen. Well, that’s not how life works. So these are all trauma responses. But what happens is when a person who has had sexual molestation, or abuse as a child goes out into the adult dating world, if someone is consistently and nice and available, they will feel repulsion with that. And that is because the people that they loved are the ones that hurt them. That invites closeness and emotional intimacy that is terrifying. They will find someone who’s an addict or emotionally inconsistent or volatile. That offers them several things. It offers them the false idea of connection without having to really connect. The ability, as Kyle was talking about, to blame someone else for that pain instead of looking at themselves because while they’re not available, so I’m a victim. And also, it invites them to look normal in a world where they’re not able to achieve that level of closeness. People with this level of trauma often have difficulty even with deep friendships because you’ll find that a lot of people have inconsistent friendships, loner type behaviors because that’s what’s been safe for them. So that happens a lot. And the only way that’s going to change is if the person can sit back and say, “I keep picking people that treat me this way. Perhaps there’s something in me that I’m getting out of this.” Not that you enjoy it. Not that it’s your fault for having this as a frame of reference. So I would say a big litmus test of trauma is what’s safe does not feel safe and what is not safe feels very comfortable. And that can be very dangerous. And that’s how we get rewounded over and over and over again. And then the more we get rewounded, the more that inner child activates and says the world is bad and shuts down. So yeah.
CARMEN: 35:00Let’s talk post-traumatic stress disorder. And let’s distinguish these things. Let me read you some statistics I found. About eight million adults in the United States have PTSD during a given year. We talked about that earlier. That’s the Department of Veteran Affairs. PTSD affects more than twice as many women, 10% of all women, 4% of all men. 70% of adults in the United States experience at least one clinically significant traumatic event in their lifetime. So let’s talk specifically about post-traumatic stress disorder, Kyle, and distinguish it from how we understand trauma in and of itself.
TURNER: 35:48Sure. Also, on the diagnostic manual, there are lots of symptoms that we look for. We’ve got to meet certain symptom criteria. But the clinical definition is experiencing yourself a near-death experience, watching someone almost die, or vicarious trauma, which is as a first responder mental health professional, experiencing vicariously the trauma that someone’s discussing or talking about. So it has to be a near-death experience and in one of those three categories. Whereas when we talk about little t traumas, the traumas that don’t meet that criteria, as they mount up over time, they can feel like the equivalent of a near-death experience. But again, clinically, in the definition, it’s not accounted for. And I think we’re working to change that definition. But right now, it’s definitely you have to experience near-death trauma. And then I don’t have the list in front of me but they are hypervigilance, anger, insomnia. There’s a lot of symptoms that come with post-traumatic stress. Now, I will differentiate this. Before post-traumatic stress has time to set in, clinically, they say we’ve got about six months where it’s acute stress. So the trauma just happened– the Las Vegas shooting just happened. If we can catch it before it sets up in our mind as a filter that we see life through, then we can resolve the trauma before it becomes post-traumatic stress. I’ve got a girl right now. She was just held up at gunpoint last week. She was referred to me by a friend and it’s like, hey, it’s amazing that she’s getting that it’s a single-incident trauma. As far as I know, I haven’t done a lot of work with her yet, but this is her only big trauma. So if you can catch it early and it’s still in the acute stress stage, you can prevent a lot of the symptoms that come with a full-blown post-traumatic stress diagnosis. Does that answer that question?
CARMEN: 37:53Yes. Yes, it does. Greg, let’s talk about DSM definition of post-traumatic stress disorder. The ones that we specifically talked about – intrusion symptoms, avoidance of stimuli associated with the trauma, cognitions and mood, negative alterations, arousal and reactive symptoms – can you go through those and talk us through? What does it mean?
POWERS: 38:20Sure. So intrusion symptoms, those are going to be the events where you can’t avoid the thoughts. So it may be you’re walking down the street and hear a car backfiring, and that takes you back to maybe the shooting incident. Like if I was talking about being held up, it just brings you back. It’s not anything that you’re necessarily doing. It’s just in the moment, it kind of creeps into your mind and it’s there. Avoidance and looking at that kind of stuff, so to me the best way that I can describe that is really taking that extra step. You recognize the fact that there are situations and events that happen in your day-to-day functioning, but you are specifically avoiding going to an extreme. You won’t go to the grocery store because you walk in and there’s a large crowd and it’s scary, so you’re not going to the grocery store. You’re sending people or you’re doing remote grocery shopping. Now, with COVID, we’re all doing that. But those are the kinds of things in which you, specifically, you’re not going to go into any environment that potentially could possibly maybe even trigger a symptom, right? The cognitions and mood, what you’re looking at there is, how is it affecting the day-to-day stuff, right? So my mood is changed because I’m concerned that this is going to happen. A lot of times, when we’re talking about post-traumatic stress or just trauma in general, ultimately, it’s altering our mood. We may be more depressed. We may be more anxious. Those are things that typically are going to happen. When you start having these symptoms, our body reacts. And so you may be feeling more lethargic. You’re not necessarily remembering things like you used to. You’re kind of feeling like just bleh, right? And people think, “Oh, I’ll get over it. It’s this or it’s that.” This is the body reacting to that trauma. When we talk about arousal reactivity, that’s kind of that same thing of like I was talking about with the car backfiring. Those are heightened senses, kind of that combination with how the body’s reacting, that heightened sense of awareness. Sounds, smells, sight, just the light coming through the window can be a trigger for some people because it’s very– their heightened sense of awareness of what’s going on around them. So, whereas, you and I might be walking down the street and it’s no big deal when a car drives by. But for somebody who has that heightened sense of arousal at a traumatic event, that car brings up the memory of somebody driving by and maybe had a gun. Or if they were in an auto accident and so it scares them to the point they don’t want to be around a car. Those are all kinds of things that we take a look at when we’re diagnosing PTSD and looking at all of the symptomology of what’s going on with somebody. It’s in combination of all of those pieces that we kind go from that, as Kyle said, the immediate stress reaction to is this prolonged? Are we really looking at PTSD? And what’s going on with somebody and taking that sense? Something that you said that I kind of want to go back to, you talked about the fact that 40% of women have PTSD. And men, I think, you said something about maybe were a little less than that. What I want everybody– and I think everybody in this panel is aware and just to have this out there, those are reported. And I think sometimes we have to remember that when we’re treating and working with women, they’re a little bit more likely sometimes to report than our men clients. And so that number is probably maybe a little bit higher. And that’s something to be aware of as well, that typically men coming into treatment are not necessarily going to talk about this stuff because it makes them feel maybe less. And they don’t want to talk about that. And that’s a concern. I think we have to be aware that trauma impacts everybody. It does not matter whether you’re male or female, child, adult, senior. Trauma is real. And just because they’re saying, “No, I don’t have trauma,” doesn’t mean we don’t.
CARMEN: 43:21Blythe, it seemed like you had something to say about the men versus women. Did you want to add to that?
LANDRY: 43:30I was going to share that if Greg didn’t, that the reports are going to be skewed because men are going to be less likely to report. And that’s not to diminish the multiple traumas that women go through because it’s considered taboo. And I have quite a few male clients that I’m the only person in their entire life that they talk to about any feelings, much less talk about stuff. I’ll have male clients that I’ve worked with for years. And then I find out things later. So I find out that they have had substantial trauma that they didn’t even recognize as such. They thought it was funny. They thought those are just sublimation of discomfort and pain. So that’s not to say that we’re minimizing this, the staggering number of women who were sexually assaulted and things like that. But it is to say that I agree with– I mean, I don’t agree. I know that’s a fact. Yeah.
CARMEN: 44:32Let’s talk about trauma and addiction now. Let’s marry these things and talk about how– let’s talk about maladaptive coping skills. Avery, can you talk to us about that?
HORWITZ: 44:46So addiction to substance use is like– substance abuse and trauma’s kind of one of my favorite topics because when– what I really find is when a client can finally connect their trauma and their substance abuse, it becomes a game changer for them, that those two can really be connected, right? Because once they understand that it’s a normal reaction to an abnormal event, really helps them gain some understanding and not making them feel like they’re crazy, right, because a lot of them are like, “I just thought I was crazy because I was using, and I have this trauma. I never even knew there was a connection.” So the clinical response is not as important as their coping efforts, right, that are successful, right. So what happens is they’ll feel all these emotions or they’ll say they don’t even know what they’re feeling, and then they’re going to use substances to cover it up thinking that’s a way of gaining control, right, because they have all these emotions. They feel so out of control with all these emotions. “So now I’m going to use substances. That’s going to control these emotions.” And as we all know, it makes them even more dysfunctional and emotional dysfunctional. So it becomes that cycle.
HORWITZ: 46:30And I think one of the things that I always try to help the clients is in trauma, you learn maladaptive coping skills, right. So if your father is sexually molesting you, and you tell your mother and she didn’t believe you. And then now you learned not to ask for help because the one person I had to go to who is supposed to help me didn’t even believe me. So right now, as adults right now, they take that. Now they learn, “Well, I’m not going to ask for help.” Even boundaries in self-care, your boundaries in sexual abuse are crossed. And now that’s why they become very sexually– now I just lost my words, guys. So now they learned there’s no boundaries, right, because that’s what they learned as a kid or self-care.
HORWITZ: 47:31We were talking about ACOA, adult children of alcoholics. They learn to lie because they had to cover up. They’re either super responsible or super irresponsible because either they had to take care of things or things were let go. So I think that the behaviors are learned. And whatever is learned can definitely be unlearned. But once they can make that connection between PTSD and substance abuse, I think can become– and then you have to develop safety first, right. You have to get away from substance use, self-harm, destructive relationships. And then you have to go through mourning, right. You have to mourn the childhood that you didn’t have or mourn the relationships that you didn’t have or go through the mourning. And then you can start to reconnect and use the coping skills to learn how to reconnect again. And then kind of develop the life that you want to kind of have for yourself, those relationships or that childhood, so you can kind of reconnect if that makes sense.
CARMEN: 48:50Absolutely. Kyle, tell us there’s help. Talk to us about treatment now. So what do we do about this? We as clinicians, how do we start to look at these things and parse out mental health and trauma and addiction and really start to look at the things that are going to empirically work for the people that we’re trying to treat?
TURNER: 49:17Yeah, absolutely. So here’s my caveat that I was going to mention earlier. I got this early on in my career, and it’s really saved me a lot of I think frustration and working with trauma survivors, there’s a book I read. It’s Women Who Hurt Themselves by Dusty Miller. And towards the middle of his book, he talks about working with trauma victims, well, like you’d eat a jawbreaker because it’s multilayers, right? So the outside of the jawbreaker, for the trauma victim, is the thumbnail sketch of their trauma. And even just acknowledging that they’ve been traumatized because lots of people want to minimize even that. Once you’ve melted away that outer layer and they’re more comfortable with talking about they have been traumatized, the middle layer is more of an outline. Here are the details. They don’t have to do with the heart of the person. But it’s the details of the trauma itself, the event or the events. If it was a little t trauma that stacked up over time, here’s how badly I was emotionally abused, or here’s how hard that experience was for me. Here’s how big a deal it was. And then the inner core of the trauma is the things we tell ourselves and the things we name ourselves because the trauma happened. So when we’re working with trauma victims and survivors, I think that’s a great model to start with, because a young man I saw earlier today, I’ve seen him for six months. He’s just not comfortable giving me the beginning of the middle layer of the trauma conversation, right? I know he’s been traumatized. I knew the thumbnail sketches. But it’s taken a long time to build enough trust in our relationship therapeutically for him to even start telling me the outline. So I say that’s where we start in treating the trauma.
TURNER: 51:03I have a lot of favorite techniques, but the reason why I’m still a therapist is because there is hope, right, to watch these folks who come in and they’re desperate, some more desperate than others. But they want to see true change happen in their worlds. I really like cognitive behavioral therapy, internal family systems. I use a lot of EMDR. I don’t do psychotrauma myself but sent lots of people to get psychotrauma done because it’s amazing. There’s lots of great tools out there to help resolve trauma. But one of my favorite things is to walk with someone through the depths and the dark of the traumatic experience and get to the inner core of so I’m not dirty. I’m not broken. I am enough. And then when they start to realize the things that they name themselves out of survival is no longer true about them, then you start to see that the trauma survivors become the thriver. And I mean, that’s what keeps us in this business, right, just to watch those folks really start to thrive and come alive. And they’re wonderful, wonderful techniques out there to help people get there.
CARMEN: 52:13Okay. I would like to, because we have so many clinicians watching, – I think this is going to marry a whole other conversation – quickly go through one of your favorite ways of dealing with trauma as a clinician, just to spark this kind of conversation, moving forward into another one. And just each one of you just enlighten us as to what has really worked for you as a clinician?
POWERS: 52:46I’ve used a lot of internal family systems as a way to get into the trauma and a way to talk. And we’re looking at the outer, middle, and inner layer, a way to talk about the trauma that gives them time to acclimate. So at first, we’ll identify the parts that they have as a person and then usually identify if you’re familiar with the lingo, the protective parts that people established for coping. And then we’ll identify the exiles, which are the wounded parts that hold on to the trauma. And in just identifying, it gives people an organizing tool to help them feel less crazy and more clear about what’s actually going on internally. And then in the model, the first thing we have to do is engage the protective parts, whether that’s the way they manage their world or the way that they or the way they numb their world and try to convince those protective parts to step to the side so that we can truly get to the heart of the exiles where they’re holding on to those negative thoughts and the wounds that they have. And then the end or the culmination of that work is helping them unburden the pain that they feel in that space where they’re holding on to the exile wounds, the hurt that they have from the trauma itself. Once they’ve unburdened those exiles, then they get a lot more control over their own behavior. They have more compassion for themselves. They can see themselves more clearly and outside of the filter of, “There’s something wrong with me.” So that’s one of my favorite tools.
CARMEN: 54:16Andrea.
HORWITZ: 54:17I love doing Seeking Safety, which is an intervention. It does psychodynamics. It has the cognitive, experiential, and I do EMDR. But especially in the treatment center, really finding and seeking safety has been a real game-changer for people because it gives them the coping skills and having them really understand the connection between PTSD and substance abuse and really gives them a sense of safety. So before they leave us and then they can start doing that really in-depth work with somebody like Kyle.
LANDRY: 55:03So I’m a fan of lots of different things. I too use IFS. I refer people for EMDR. I like somatic healing therapy. There’re so many things that you can use. However, I’m going to touch on Irwin Yellowman. And he’s the guy for group therapy. And I’ll talk about the fact that any tool we use is never to replace the relationship that we can form with a human being. And so the two greatest tools that I’ve used are, one, continuing to work on myself so that I’m a consistent, safe, lovingly boundaried presence. I’m able to offer people that which they didn’t get and help as Kyle referred to that reparative relationship. This might be the first time that someone’s going to be who they say they’re going to be, be that person on a consistent basis. This helps the client understand that they’ve now made a better choice.
LANDRY: 55:59And I use that as a very, very active tool in saying, “If I’m safe, what are the things about me that you can identify so that you can go out into the world and identify those in other people?” It’s not about me. It’s about them learning to identify what works. And also I have my own eight-step process that I use. And I teach my own trauma intelligence training to organizations and things like that. That’s super, super involved. But nothing, for me, replaces the relationship, and I know Kyle is the same. So if I do IFS with one person, I may not do it with someone else, right. It’s very evolved, and you have to be highly cerebral in some ways. And I don’t think EMDR is for everyone. I don’t think somatic healing is for everyone. I don’t think CBT is for everyone. So I’m also always about what is going to work for this person. And that might be my social worker personality at heart. But that’s the long answer to your question.
CARMEN: 56:52And a wonderful answer it was. Greg, what is your favorite?
POWERS: 56:57I don’t know that I have a favorite, but I’ll tell you the three that I’ve used this week, which would be EMDR, CBT, and most recently I’ve been getting into using art and having clients painting the picture of what it is, but finishing it to a positive and really visualizing what that trauma is, but realizing that they can paint a new picture and a new ending.
LANDRY: 57:25Oh.
CARMEN: 57:26Yes–
LANDRY: 57:27I would just say it too, I’m also a certified grief recovery specialist. And if anyone out there is interested in adding that as a tool, check out the grief recovery method. It’s an amazing training. It’s the best training I’ve ever been through of any kind. And as Greg was eloquently talking about the grief when we first started this, that is a huge tool in helping people with trauma. And it’s an amazing training. It’s an amazing opportunity to help people on a deeper level.
CARMEN: 57:55So we are out of time. This has been an amazing conversation. On that note, I want to thank our panelists Blythe Landry, Kyle Turner, Greg Powers, Andrea Horowitz for sharing your time, your expertise. Also, thanks to each and every one of you who joined in the conversation, took time out of your day to be here. I want to reiterate, all attendees will receive an email with their CE certificate and a link to a program evaluation survey so that you can share your feedback. Thank you so much. I hope you all have an amazing day and look for our email because we will have another webinar the month after next in April. So happy to be here. Thank you all. Have a wonderful day. Bye.
POWERS: 58:42Bye. [music]

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