Substance Abuse and Trauma – Disorder Example

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"Substance Abuse and Trauma" is a perfect example of a paper on the disorder. On the whole, trauma results in stress. The condition of being stressed is difficult, resulting in a need to seek a restoration of homeostasis (Jacobsen, Southwick, & Kosten, 2001). The reality that a link exists between trauma and substance abuse has been established for many years by experts who treat individuals experiencing both trauma and substance abuse. The substance abuse model for reducing stress hypothesizes that some individuals manage stress by consuming cigarettes, alcohol, or other drugs.                       According to Brady and Sonne (1999), stress is regarded as a key contributing factor to the start, continuance, and relapse of substance abuse.

Research has demonstrated consistently that the possibility of drug and alcohol abuse if greater when there is a high level of stress (Khantzian, 1985; Kosten et al, 1986; Sinha et al, 2000; Dawes et al, 2000).                       Since stress is increased by trauma, it is a logical assumption that trauma is also associated with the start, continuance, and relapse of substance abuse. Also, prevention and treatment experts must have the awareness that post-traumatic stress disorder takes place together with depression, anxiety disorder, alcohol abuse, drug abuse, and other substance abuse.   Trauma and substance abuse resulting from sexual abuse                       The need for trauma and substance abuse to be treated simultaneously has been long suggested by high rates of sexual abuse in the past and subsequent substance abuse (Evans & Schaeffer, 1980; Barnard, 1989; Glover, 1999).

In 1997, a study was conducted by Janikowski, Glover, and Bordiere involving 732 respondents residing in treatment institutions and they concluded that more than one-third of the respondents have experienced incest in the past.                       For the traumatized individuals, consuming drugs, and/or alcohol was a way of coping with the symptoms of stress such as low self-esteem, nightmares, flashbacks of the traumatic event, numbness, and avoidance.

Moreover, traumatic sexual abuse usually results in the over-sexualization, the individual developing sex-related phobias, being confused about his or her sexual identity, and making use of sex as a way of giving or receiving attention.                       It may be difficult to recognize the sexual abuse symptoms among individuals under treatment facilities for substance abuse since the displayed symptoms are often very similar to those related to substance abuse. If the individuals who have experienced sexual abuse are left untreated, they may make use of drugs and/or alcohol to cope with feelings of numbness and hold back memories that are recurring and painful, as well as manage overwhelming emotions of betrayal, shame, and helplessness.                       Symptoms of Post Traumatic Stress Disorder                       Teenagers who have gone through traumatic events in the past turning to drugs or alcohol in order to cope with post-traumatic stress disorder symptoms are not uncommon.

They may find at first that drugs and/or alcohol seem to ease their stress, either through avoiding severe emotions that may result from traumatic events, or through the increased gratifying feelings induced by the substance. However, in the long run, substance abuse may bring about a cycle of avoidance, making recovery more difficult. The symptoms of post-traumatic stress disorder often include the following (Strand et al, 2000; National Child Traumatic Stress Network, 2011; American Psychological Association, 2000):   Substance abuse Difficulty in sleeping Deterioration of performance in school Thoughts of committing suicide Physical complaints Avoiding going to school Isolation; withdrawing from other people Unruly behavior Problems with friends or changing friends Guilt, depression, and becoming uninterested in activities Feelings of worthlessness Avoiding things that would remind the teenager of the traumatic event Having nightmares and flashbacks. Fear of the traumatic event happening again Loss of trust in anyone   Substance abuse problems usually include the following (Hawkins et al, 1992; American Psychological Association, 2000; National Institute on Drug Abuse, 2011):   Poor hygiene or changes in physical appearance Having difficulty sleeping Feelings of anxiety Depression Unruly behavior Locking doors, lying, sneaking out, and other secretive behaviors Extremely moody; sudden outbursts of hostility Dropping out of activities Deterioration of performance in school Avoiding going to school Changing friends Not introducing friends to parents Frequently intoxicated and usually noticed by others   Relationship between trauma and substance abuse                       The link between trauma and substance abuse is complex and important.

Trauma, on the whole, involves witnessing, experiencing, or being threatened with one or more events that imply serious physical or emotional damage to oneself or to other individuals, or even the possibility of death. Horror, helplessness, and extreme fear are the usual response to such traumatic events.                       There is a crucial necessity to deal with trauma as part of the treatment of substance abuse.

Trauma-associated symptoms that are misdiagnosed or misidentified impede help-seeking, slow down commitment to treatment, result in early withdrawal, and increase the likelihood of relapse (Janinowski & Glover, 1994; Brown et al, 1995; Brown, 2000).                       The treatment of trauma has three stages, as identified by Herman (1992):   establishment of safety, recollection and sorrow, and reattachment with everyday living.   The first stage concentrates on the establishment of safety, both in the physical and psychological aspects, and on helping the individual feel secure and understood within the therapeutic setting.

One usual worry of treatment experts is that for the traumatized individual, the treatment of trauma would imply the recollection of memories of the traumatic event. For individuals in early recovery and those with active substance abuse, particularly women, the center of trauma treatment should be on safety, security, stabilization, and understanding the relationship between trauma and substance abuse, instead of on the re-telling of the traumatic event. Using this approach, the traumatized individual is supported, strengthened, and assisted in learning new ways of coping, before he or she proceeds to the later phases of treatment.   Responses to Trauma and Substance Abuse                       Individuals are affected by trauma in various ways and at different levels, for many different reasons.

Their responses to a traumatic experience are relevant with: coping strategies and skills in place and those used in the past the resiliency of the traumatized individual the protective factors and risk factors in the area of the traumatized individual and his or her family, friends, and school, the understood intensity of the traumatic experience, and the understood and the actual effect of the traumatic experience.   The individuals who are more resilient, have positive coping strategies, and high levels of protective factors have a higher likelihood of faring better than the individuals who lack in any or all of these aspects.

In other words, individuals who are not resilient, lack positive coping strategies, and/or have high-risk factor levels tend more to exhibit poor responses to traumatic experiences. Because it is a fact that stress is induced by trauma, and stress increases the risk for an individual to resort to substance abuse in order to cope, it is crucial for prevention and treatment professionals to take their role in the prevention of post-traumatic substance abuse into consideration.   Levels of Recovery from Trauma                       On the whole, recovery from trauma involves three levels.

Traumatized individuals will eventually get better, stay the same, or become worse. While most traumatized individuals will function less for a length of time subsequent to a traumatic experience, these levels take in hand the overall life functioning of the traumatized individual beyond 18 to 24 months.                       The first level is referred to as the “ depleted self” . In this level, the traumatized individual is not capable of returning to a level of functioning that was at least as good as the level of functioning prior to the traumatic experience.                       The second level is referred to as the “ pre-trauma self” .

At this level, meanwhile, the traumatized individual is capable of returning to a comparable level of functioning. Despite being affected by the traumatic experience, he or she has adjusted and accommodated and is able to benefit from and contribute to daily life.                       Finally, the third level is referred to as the “ elevated self” .

In this level, the traumatized individual is capable of functioning at an improved level. He or she has gained from having gone through the traumatic experience. He or she has meditated upon or examined his or her life and made changes that brought about an increase in the level of functioning. The said changes could be in many different aspects, such as spiritual, vocational, emotional, cognitive, physical, or psychological. As a result, the traumatized individual may feel higher levels of motivation, focus, contentment, and fulfillment.                       As a prevention and treatment professional, the objective is to return the traumatized individual at least to the second level, i.e. , the “ pre-trauma self” .  

References

American Psychological Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC.

Barnard, C.P. (1989). Alcoholism and sex abuse in the family: Incest and marital rape. Journal of Chemical Dependency Treatment, 3, 131-144.

Brady K. T., Sonne S. C. (1999). The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol Research Health, 23, 263-271.

Brown, P. J. (2000). Outcome in female patients with both substance use and post-traumatic stress disorders. Alcoholism Treatment Quarterly, 18(3), 127-135.

Brown, V. B., Huba, G. J., & Melchior, L. A. (1995). Level of burden: Women with more than one co-occurring disorder. Journal of Psychoactive Drugs, 27, 339-346.

Dawes, M. A., Antelman, S. M., Vanyukov, M. M. (2000). Developmental sources of variation in liability to adolescent substance use disorders. Drug and Alcohol Dependence 61(3), 14.

Evans, S. & Schaefer, S. (1980). Why Women’s sexuality is important to address in chemical dependency treatment programs. Grassroots, 37, 37-40

Glover, N. M. (1999). Play therapy and art therapy for persons who are in treatment for substance abuse and have a history of incest victimization. Journal of Substance Abuse Treatment, 16, 281-287.

Hawkins, J. D., Catalano, R. E., & Miller, J. Y. (1992). Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention. Psychological Bulletin, 112(1), 64-105.

Herman, J. (1992). Trauma and recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror. New York: Basic Books.

Jacobsen L. K., Southwick S. M., & Kosten T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. American Journal of Psychiatry. 158(8),1184-90.

Janikowski, T. P., & Glover, N. M. (1994). Incest and substance abuse: Implications for treatment professionals. Journal of Substance Abuse Treatment, 11, 177-183.

Khantzian , E. J. (1985). The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry 142:1259-1264.

National Child Traumatic Stress Network (NCTSN) (n.d.) Types of Traumatic Stress. Retrieved, March 23, 2011 from http://www.nctsnet.org.

National Institute on Drug Abuse (NIDA) (n.d.). Understanding Drug Abuse and Addiction. Retrieved, March 23, 2011 from http://www.nida.nih.gov/Infofacts/understand.html.

Sinha, R., Fuse, T., Aubin L. R., O'Malley S. S. (2000) Psychological stress, drugrelated cues, and cocaine craving. Psychopharmacology ,152,140-148.

Strand, V.C., Sarmiento, T. L., & Pasquale, L. E. (2005). Assessment and Screening Tools for Trauma in Children and Adolescents. Trauma, Violence, & Abuse,6(1), 55-78.

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