It is an unfortunate fact that most women with chemical dependencies have a history of trauma in their lives, including physical or sexual abuse. Understanding this trauma and its effects on these women is vital to providing substance abuse treatment that is the most effective, caring and comprehensive.
The U.S. Department of Health and Human Services Office on Women’s Health estimates that 55 to 99 percent of women in substance use treatment and 85 to 95 percent of women in the public mental health system report a history of trauma, most commonly in childhood. Similar results were found when the Centers for Disease Control and Prevention, along with Kaiser Permanente, conducted one of the largest investigations ever about associations between childhood maltreatment and later-life health and well-being. Almost two-thirds of the participants in the Adverse Childhood Experiences (ACE) study reported at least one adverse childhood experience of physical or sexual abuse, neglect or family dysfunction, and more than one in five reported three or more such experiences.
The American Psychological Association reports that women are twice as likely to develop Post-traumatic Stress Disorder (PTSD), experience a longer duration of posttraumatic symptoms and display more sensitivity to stimuli that remind them of the trauma.
Although women are at greater risk for negative consequences following traumatic events, many often hesitate to seek mental health treatment. Survivors often wait years to receive help, while others never receive treatment at all, the APA notes. Untreated post-traumatic symptoms not only have tremendous mental health implications, but can also lead to adverse effects on physical health. Female survivors may encounter physical symptoms, including headaches, gastro-intestinal problems and sexual dysfunction. Despite the sometimes debilitating effects of trauma, health professionals fail to diagnose it in many women due to a lack of training, time and resources, the APA reports. When properly diagnosed, women can be treated successfully with cognitive-behavioral therapy, group treatment, pharmacotherapy and psychodynamic interventions.
Realizing the prevalence of trauma among women facing substance abuse is important because a history of trauma affects women in many ways and for years after the event. A traumatic experience can leave women with physical, mental, behavioral, social and spiritual effects that will surface during treatment for chemical dependency and affect the likelihood of success. Treatment professionals must investigate a history of trauma because in many cases the patient will not willingly share this information. Women who have suffered physical or sexual abuse often feel shameful and guilty, making them reluctant to volunteer that they have been traumatized.
Understanding the patient’s trauma allows the behavioral health professional to provide substance abuse treatment that is fully informed and responsive to the patient’s unique needs, sensitivities and coping abilities. A good trauma-informed addiction treatment program for women will provide the patient a safe setting, transparency, peer support and empowerment. The program also is likely to address cultural, historical and gender issues in a way that helps the patient address her past trauma and the current addiction.
When considering a substance abuse treatment plan for a woman with a history of trauma, a key component must be patience. Don’t rush. One of the biggest mistakes new therapists make is trying to speed traumatized addicts through treatment. They want to address the traumatic issue right away, thinking that a cathartic discussion of traumatic events will enable the addict to stop using in short order. Instead, pushing the woman to address the traumatic history too quickly can have the opposite effect. She may feel pressured and shut down, denying or refusing to discuss the trauma. That only delays progress in treating the substance abuse.
Patience is required, in part, because the woman may not understand that she has a history of trauma to relate. Many women battling substance abuse may have terrible histories of physical and sexual abuse but will honestly say they have not experienced any trauma in their lives. These women do not realize that what they experienced was trauma because they see the events or situations of their lives as normal. Some education must occur first so they can develop an understanding of normal, safe and healthy day-to-day living.
Early in treatment, clients need help recognizing, expressing and processing their trauma, whether that was the direct experience of physical, emotional or sexual violence, ongoing abuse, witnessing abuse at home or some other devastating experience. Only at that point can they understand that what happened to them was not normal and explore the ways it might have an effect on their current substance abuse. Then they need to learn healthy mechanisms for managing anxiety, discomfort, fear and other emotions first before they can deal with trauma.
The medical community has determined that a trauma-informed approach to substance abuse will take the trauma into account when designing a treatment plan, and counselors and staff members will respond accordingly to support the woman’s coping capacity. A trauma-informed plan also works to avoid triggering traumatic memories unnecessarily or re-traumatizing the woman. The overall goal is to allow women to manage their trauma symptoms successfully so that they are able to successfully complete the substance abuse treatment plan.
A good trauma-informed treatment plan involves not just the therapist, but everyone associated with the treatment center. All staff members, from the receptionist to anyone else the patient encounters, should recognize that the womans history of trauma may influence her interactions with staff and clients, responsiveness to program guidelines and the effectiveness of interventions. For a detailed discussion of how behavioral therapy programs can address patients with traumatic histories, see www.ncbi.nlm.nih.gov/books/NBK207201/.
A rehabilitation center like the Malibu Beach Recovery Centers can provide a corrective experience for addicts with traumatic pasts by establishing a soothing environment that wraps around clients like a blanket to protect them. We reduce visual stimulation with low lighting levels, provide stress balls and other tactile objects for comfort and infuse the rooms with soothing scents. For many of our female clients, being around men can increase stress, so Malibu offers a caring setting for women by women. The environment reduces the amount of stimulation that the brain must handle to free more of it to work through the trauma.
Once clients have a sense of general security, and therapists work with them to develop personalized safety plans. As issues come to the surface, therapists work with the psychiatric team to gain a better understanding of the trauma, even for clients who cannot yet verbalize what happened. Together, the team and the client set a comfortable pace so that they have the tools in place to deal with new issues as they arise.
Throughout the process, the client learns healthier ways to deal with experiences she has and gains a toolbox of techniques to use when she leaves treatment. Our program also connects clients with outside therapists and other support in the community so they can continue their work and sustain their healthy habits when they return home.