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GOALS

• Gather a better understanding of the individual with co-occurring trauma and addiction concerns

• Support client’s to choose realistic goals and timelines

• Develop therapeutic relationship while modelling appropriate boundaries within

OBJECTIVES

• Recognize the symptoms & characteristics of clients impacted by trauma including how trauma can negatively influence a, – Person’s ability to modulate emotions without

using substances to cope with (anger, stress, frustration…)

– Person’s ability to access problem-solving skills

– Person’s ability to access their impulse control • Teach client’s various methods of self

modulation

Types of Trauma

• Developmental Trauma– Living in adverse conditions that affect the

nervous system of the child• Shock Trauma

– An unexpected event that is sudden and can be extreme (May include medical procedures)

• Relational Trauma– Can be on the continuum of war, bullying,

domestic violence to sexual assault or abuse by someone we know

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Post-Traumatic Stress Disorder

• Condition where physiological and psychological processes are in a state of disequilibrium, altered by trauma impact.

• Involves intrusive symptoms with subjective loss of control and lack of awareness of trauma triggers, but fear of them.

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Trauma and Dysregulation

• Early trauma leads to affect dysregulation due to excess stimulation of Central Nervous System (CNS).

• Youth have problems learning how to regulate the intensity of feelings and impulses.

• Results in a wide array of problems- physical and mental.

• Inability to identify specific emotions.• Hard to live in body (somatic reactions

occur).

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Symptoms

• Anxiety • Low mood • Irritability • Emotional ups and

downs • Poor concentration

• Isolation • Difficulty falling

asleep/staying asleep• Hyper-vigilance• Difficulty concentrating, and

Difficulty trusting.

Psychological symptoms such as:

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Symptoms (continued)

Physical symptoms such as: • Feeling palpitations without knowing why;• Feeling sick; • Numbing out when everything seems okay;• Overreaction to sounds, smells;• Chest pain; • Headaches; • Stomach pains and;• Breathing difficulties.

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Symptoms (continued)

• Overwhelming fear and helplessness;• Belief that adults are dangerous and fail to

protect; • Inability to concentrate;• Lower Intelligence Quotients (I.Q.’s);• Low self-esteem; • Self-defeating styles of relating to others;• Affective volatility.

Attachment

• Clients who suffered attachment issues as children are unable to mollify their emotions

• They do not have any access to their endogenous opioids

• As a result, they seek out drugs or engage in behaviors that may stimulate these opioids

• Can lead to anger management issues and other behavioural difficulties including criminalized behaviour

Analytical

Logical

Precise

Repetitive

Organized

Details

Scientific Detached

Literal

Sequential

Creative

Imaginative

General

Intuitive

Conceptual

Big picture

Heuristic

Empathetic

Figurative

Irregular

Psychophysiology of Early Childhood Trauma/Neglect

We start here – Non Use

Non use

Experimental Use

Dependent/

Chaotic Use

Regular Use

OccasionalUse

WE DEVELOP A NEW NORMAL

Before LongYou Need toUse to GetBack Here

Communication

Rituals Now what?

Precontemplation

Contemplation

Action

Maintenance

Nah…..

Hmm…

Doing it!

No Issue?

Understanding How People Change &Why They May Be Ambivalent

HistoryEnvironmentSelf Talk/Beliefs

Preparation

Treating Trauma & Addictions• Stabilization and safety

– Bottom-up: settle autonomic responses– Increase relative safety in current life– If relational trauma – relationship with

worker is more important• Separating past from present and future

– Develop language for emotion and sensation

Expand flexibility and ability to adapt / cope• Rebuilding balance

– Self confidence, self-esteem; Healthy connections

Stabilization and Safety• Structure, predictability• Educate about trauma• Stabilization / regulation tools• Awareness of sensation• Self-care & basic needs• Dealing with other stressors

When exposed to repetitive crisis;Our arousal begins to rise; Hyper or Hypo arousal becomes

the constant State; This influences positively and

negatively how we deal with conflict?

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S & S: If You Want to Teach Efficient Coping Strategies

1. Explain the approach

2. Confirm the client understands the approach

3. Give time to ask questions & give consent, and

4. Confirm that the client can stop if needed.

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Safe Place Visualization/Filmmaking

– So let’s go to your “happy place.”– Tell me - can you see… ?– What is _____ doing? – What are you doing?– What do you…

• The job of the worker is to have discussed something that the person enjoys and work to have them visualize the experience.

• Please use the template to assist you.

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S & S - Body/Breathing

• 3 – 6 Breathing • Many people who have suffered, are

typically chest breathers. • They typically only breathe in their

chest and rarely down into their stomach.

• The object of this exercise is to get people breathing into their stomach.

• Our work is to help them see that they can de-escalate themselves through a very simple process of breathing.

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Breathing Exercises

• Sipping – have your client pretend to be taking deep breaths through a straw. Inhale is through the straw, exhale is through the nose.

• Three to Six breaths – have your client inhale deeply to the count of three and exhale for up to six seconds.– Contraindication – this could make people feel

lightheaded.

When Over-Reaction is a Theme

• Teach them about the brain • Help them learn how to think when getting

angry • Teach them skills to do that:

– Emotional Freedom Therapy (EFT)– Find out what worked; – Use distractions in the moment…– What have you used???

Grounding Techniques

• Movement - Dance – Exercise (with focus on releasing the negative energy)

• Assertiveness training – BIO – Behaviour – Impact – Options or what Outcome do you want

• Rituals – coping card – what has worked in class when you are mad

• Write out what you are mad at – read it – write it again – read it – write it – until you figure out how to deal with it “well”

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Sensory Grounding and Containment Body 3 - 2 -1

NAME SEE HEAR FEEL

Three things you:

Two things you:

One thing you:

Groups of three• Attempt to teach your colleague and do one

of the safety exercises

How you know you learned is:

If you feel differently;Think differently;Act differently.

Name three areas where you will use the skills;BRAINSTORM.

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