Trauma & Substance Abuse Presented At: Presented At: Women Across the Life Span: A National Conference on Women, Addiction & Recovery By: By: Norma Finkelstein,

Trauma & Substance AbuseTrauma & Substance Abuse

Presented At:Presented At:Women Across the Life Span:

A National Conference on Women, Addiction & Recovery

By:By:Norma Finkelstein, Ph.D.

Institute for Health & RecoveryJuly 13, 2004

Trauma & Substance Abuse 1- NF - 7/13/2004

Institute for Health & Recovery

“I am an incest survivor & never dealt with it. Left treatment, did drugs. The most important thing is to integrate [services]. I’m a slicer & before no place would take me & if [I] say I’ve been sexually abused they boot you…I thought here we go again. Substance abuse identified and you’re welcome..…need to work all 3 areas…others throw you out because they are afraid.”



Definition of TraumaDefinition of Trauma

Shock or severe distress from experiencing a disastrous event

Traumatic reactions occur when people feel powerless, when nothing they can do matters



“Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence & death. They confront human beings with the extremities of helplessness & terror, & evoke the responses of catastrophe. According to the Comprehensive Textbook of Psychiatry, the common denominator of psychological trauma is feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation’.”

(Herman, Trauma Recovery)



Defining Violence Against WomenDefining Violence Against Women

United Nations [1993]United Nations [1993]

“…any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.”



Types of ViolenceTypes of Violence

Physical assault

Sexual abuse – including rape & incest

Emotional or psychological abuse

Environmental violence

Experienced as an adult or a child

May have occurred over time or been one incident and / or time limited



Violence Against GirlsViolence Against Girls

83% of girls report being touched, pinched & grabbed in sexual ways in school

1 in 5 high school girls has suffered sexual / physical abuse from a boyfriend. [JAMA, 2001][JAMA, 2001]

More than 1/2 of women raped were under 18; over 1/3 were under 12 [National Violence Against Women Survey, 1995][National Violence Against Women Survey, 1995]

Institute for Health & Recovery Trauma & Substance Abuse 1- NF - 7/13/2004

Abuse EffectsAbuse EffectsResearchers say that girls who suffer physical & sexual abuse by dating partners are more likely to engage in risky behaviors. (Note: Odds of 2.0 mean a girl is twice as likely to engage in the behavior as one who was not abused.)

Behavior Odds

Heavy smoking (within 30 days) 2.5

Binge drinking (within 30 days) 1.7

Cocaine use (ever) 3.4

Diet pill use (within 30 days) 3.7

Laxative use & / or vomiting (within 30 days) 3.7

More than three sex partners (within 90 days) 3.3

Pregnancy (ever) 3.9

Considered suicide (within 1 year) 5.7

Attempted suicide (within 1 year) 8.6

Source: JAMA, 2001



Substance Abuse & Abuse HistorySubstance Abuse & Abuse History

Women in community samples report a lifetime history of physical & sexual abuse ranging from 36 to 51%, while women with substance abuse problems report a lifetime history ranging from 55

to 99% [Najavits et al. (1997)][Najavits et al. (1997)]



Substance Abuse & Sexual Assault Substance Abuse & Sexual Assault

50% of substance abusing women in treatment had experienced rape or incest (Woodhouse, 1990)

Women with a history of childhood sexual abuse were 2 times as likely to become heavy consumers of alcohol & 20% more likely to become injection drug users (Zierler et al. 1991)

50% of women seen in a variety of psychiatric settings had been sexually abused as children (Muesser et al. 1998)



80% of women with substance abuse disorders had been the victim of domestic violence (Research Institute on Addictions, 1997)

42% of victims of domestic violence contacting the police had used alcohol or other drugs on the day of the assault (Brookhoff et al., 1997)

Substance Abuse & Domestic ViolenceSubstance Abuse & Domestic Violence



Special Issues of Victims of Violence Special Issues of Victims of Violence Who Are Substance AbusersWho Are Substance Abusers

The presence of both substance abuse & domestic violence increases the severity of injuries & lethality rates (Mackey, 1992)(Mackey, 1992)

Perpetrators may pose risk to partners by: Introducing partner to drugs Forcing or coercing partner use Isolating partner from help Coercing partner to engage in illegal acts Using withholding drugs as a threat Using legal history as a threat Blaming abuse on partner use



Adverse Childhood EventsAdverse Childhood EventsACE Study ACE Study

Kaiser Permanente (Felitti) & the CDC (Anda)

Large-scale epidemiological study of influence of stressful / traumatic childhood experiences

Interviewed over 17,000 people

Compares adverse childhood experiences against adult health status



ACE StudyACE StudyRecurrent & severe physical abuse 11%

Recurrent & severe emotional abuse 11%

Contact sexual abuse 22%

Growing up in a household with:

Alcoholic or drug-user 25%

Member being imprisoned 3%

Mentally ill, chronically depressed, or institutionalized member

19%

The mother being treated violently 12%

Both biological parents NOT present 22%(Felitti, 2003) Origins of Addiction



ACE StudyACE Study

Scoring system used – one point for each category of ACE before 18

ACE’s not only common, but effects were cumulative

Compared to persons with ACE score of 0, those with ACE score of 4 or more were 2 times more likely to be smokers, 12 times more likely to have attempted suicide, 2 times more likely to be alcoholic and 10 times more likely to have injected street drugs.



Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

Disease, Disability

Adverse Childhood Experiences

Early Death

Death

Birth

The Influence of Adverse Childhood Experiences Throughout Life

ACE’s Major Determinant of Health & Well Being (Felitti, 2003)



Trauma is Central and PervasiveTrauma is Central and Pervasive

Central to the development of addiction, & mental health problems in women

Impacts MANYMANY aspects of a woman’s life



“The treatment facility I was lucky enough to be accepted into was one of the first dual diagnosis facilities in the country…[it] was not trauma-informed, even though they diagnosed the PTSD. Although I learned a lot about dual diagnosis, trauma was not part of their curriculum. There were about 15 women in the facility, and all of us were trauma survivors. We would discuss our trauma with one another. However, the staff remained ill-informed. I often wondered why my trauma was never talked about.”



(Begin Anywhere)

VictimizationVictimization

Trauma Trauma SequelaeSequelae

MentalMentalHealthHealth

ProblemsProblems

Self-Self-MedicationMedication

AddictionAddiction

Lack ofLack ofSelf-CareSelf-Care



Impact of TraumaImpact of Trauma

Feelings

Fear, terror

Anger, revenge, hate

Frustration

Guilt or self-blame

Shame, humiliation

Grief or sorrow

Beliefs

About self

About other people

About the world



Symptoms & behaviorsSymptoms & behaviors

Attempts to cope with the trauma

Goal of treatmentGoal of treatment

To return a sense of autonomy & control to the woman



“One of the most important things I have learned is how to keep myself safe. The word SafetySafety never came up in treatment. I now realize how much jeopardy I put myself in when I was using substances, not caring what time of the night it was, not caring that the guy just came into the room waving a gun, just give me another hit. We continue to put ourselves in situations that can retraumatize us on a daily basis. Learning how important safety safety is to my recovery process has changed my outlook.”

Documents

Trauma & Substance Abuse Presented At: Presented At: Women Across the Life Span: A National Conference on Women, Addiction & Recovery By: By: Norma Finkelstein,