Women, Addiction and Trauma

Slide 1 Women, Addiction and Trauma

with

Stephanie Covington,

Ph.D., LCSW

Sponsored by

March 9, 2011

2:00-3:00 CST

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Slide 2

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© S. Covington, 2011

Women, Addiction and Trauma

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Slide 3

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Slide 4

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Slide 5 Women, Addiction and Trauma

with

Stephanie Covington,

Ph.D., LCSW

Sponsored by

March 9, 2011

2:00-3:00 CST

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Slide 6

Moderator:

Martha HardingDirector of Training and Consultation

Hazelden Publishing


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Slide 7

• Define trauma, trauma-informed and gender-responsive

• Describe three critical components for clients and staff

• Delineate gender differences as they pertain to trauma

and addiction

• Discuss specific interventions for women

• Explore resources available

to help improve your services

for women



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Slide 8

Presenter:

Stephanie S. Covington, Ph.D., L.C.S.W.

Center for Gender and Justice

Institute for Relational Development

LaJolla, California



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Slide 9


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Slide 10


Levels of Violence

• Childhood

• Adolescence

• Adult

• Street (workplace and community)

• Consumer culture

• Media

• War

• Planet

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Slide 11


Global Violence

Violence is a leading cause of

death among people aged 15-29

Source: World Health Organization

Centers for Disease Control and Prevention

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Slide 12


International Homicide Rates(Rate per 100,000 in 2006)

0 1 2 3 4 5 6

United States

Israel

New Zealand

Finland

Canada

Poland

Australia

Norway

Ireland

Sweden

Italy

Spain

Netherlands

Austria

Denmark

Greece

France

Switzerland

Germany

SOURCE: World Health Organization, 2006; FBI 2006; Statistics Canada; Australian Bureau of Statistics

“The death and disability caused by

violence make it one of the leading

public health issues of our time.”World Health Organization

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Slide 13


Two Kinds of Suffering

• Natural

• Created

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Slide 14


Definition of Trauma

The diagnostic manual used by mental health providers

(DSM IV-TR) defines trauma as, “involving direct personal

experience of an event that involves actual or threatened

death or serious injury, or other threat to one’s physical

integrity; or a threat to the physical integrity of another

person; or learning about unexpected or violent death,

serious harm, or threat of death or injury experienced by a

family member or other close associate.”

(American Psychiatric Assoc. [APA] 2000, pg. 463).

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Slide 15


Definition of Trauma (cont.)

“The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve

disorganized or agitated behavior).”

(American Psychiatric Assoc. [APA] 2000, pg. 463).

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Slide 16


Definition of Trauma

Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources.

(Bloom & Fallot, 2009)

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Slide 17


Violence Against Women

Violence against women is so pervasive that the United

Nations has addressed and defined violence against

women as “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.”

(United Nations General Assembly, 1993).

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Slide 18


Moral Challenges

• 19th century - slavery

• 20th century - totalitarianism

• 21st century – brutality against women and girls

(NY Times 9/23/09)

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Slide 19


Traumatic Events

Trauma can take many forms:

• Emotional, sexual or physical abuse

• Neglect and/or abandonment

• Extremely painful and frightening medical procedures

• Catastrophic injuries and illnesses

• Rape or assault

• Muggings

• Domestic violence

• Burglary

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Slide 20


Traumatic Events (cont.)

• Witnessing murder

• Automobile accidents

• Immigration

• Natural disasters (hurricanes, earthquakes,

tornadoes, fires, floods, volcanoes)

• Abandonment (especially for small children)

• Terrorism such as September 11, 2001

• Witnessing violence such as a parent harming

another parent

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Slide 21


Traumatic Events (cont.)

• Loss of a loved one and severe bereavements

(even of a pet)

• Combat/war

• Torture

• Kidnapping

• Intergenerational (cultural) trauma

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Slide 22


Historical Trauma

• Across generations

• Massive group trauma

• Examples include: Native Americans, African

Americans, Holocaust survivors, Japanese

internment survivors

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Slide 23

© S. Covington, 2011© S. Covington, 2010

Intimate Partner Violence

Of all these forms of trauma, women

are at greater risk of intimate partner

violence (IPV) than men.

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Slide 24


Events Considered to be Most

Traumatic and Prevalence of PTSD

7%

17%18%

21%

37%

%

10%

20%

30%

40%

IPV Illness/accident/

disaster

Unexpected death

of loved one

Witness trauma to

other

Childhood

maltreatment

Most traumatic event

Prevalence of PTSD

49%

42%44%

27%17%

N = 89

Source: Grella, Messina & Rodriguez presentation at American Psychological Association Conference, San Diego, CA on August 14, 2010

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Slide 25


Trauma-informed Services

Trauma-informed services:

1. Take the trauma into account.

2. Avoid triggering trauma reactions and/or

traumatizing the individual.

3. Adjust the behavior of counselors, other staff and

the organization to support the individual’s coping

capacity.

4. Allow survivors to manage their trauma symptoms

successfully so that they are able to access, retain

and benefit from the services. (Harris & Fallot)

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Slide 26


Core Principles

of Trauma Informed Care

• Safety (physical and emotional)

• Trustworthiness

• Choice

• Collaboration

• Empowerment

(Fallot & Harris, 2006)

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Slide 27


Process of TraumaTRAUMATIC EVENT

Overwhelms the Physical & Psychological Systems

Intense Fear, Helplessness or Horror

SENSITIZED NERVOUS SYSTEM

CHANGES IN BRAIN

CURRENT STRESSReminders of Trauma, Life Events, Lifestyle

PAINFUL EMOTIONAL STATE

RETREAT SELF-DESTRUCTIVE ACTION DESTRUCTIVE ACTION

ISOLATION

DISSOCIATION

DEPRESSION

ANXIETY

SUBSTANCE ABUSE

EATING DISORDER

DELIBERATE SELF-HARM

SUICIDAL ACTIONS

AGGRESSION

VIOLENCE

RAGES

RESPONSE TO TRAUMAFight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing,

Hyper-vigilance, Hyper-arousal

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Slide 28


ACE Study(Adverse Childhood Experiences)

Before age 18:

• Recurrent and severe emotional abuse

• Recurrent and severe physical abuse

• Contact sexual abuse

• Physical neglect

• Emotional neglect

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Slide 29


Growing up in a household with:

• An alcoholic or drug-user

• A member being imprisoned

• A mentally ill, chronically depressed, or

institutionalized member

• The mother being treated violently

• Both biological parents not being present

(N=17,00


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Slide 30



Results

ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.

• Smoking

• Alcoholism

• Injection of illegal drugs

• Obesity

(Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003

Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE).

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Slide 31


ACE Study(Cont.)

Women 50% more likely than

men to have 5 or more

(Higher scores more common in women)

(Feletti & Avida, 2010)

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Slide 32


Childhood Traumatic Events

Largest Effect-Mental Health

• Psychotropic medication

• Mental health treatment

• Attempted suicide

• Traumatic stress

(Messina & Grella, 2005)

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Slide 33


Childhood Traumatic Events

Largest Effect-Mental Health

980% increase in odds if exposure to 7

Childhood Traumatic Events (CTEs)

(Messina & Grella, 2005)

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Slide 34


Critical and Interrelated Issues

• Substance Abuse

• Mental Health

• Trauma

• Physical Health

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Slide 35


Trauma: Stages of Recovery

Syndrome Stage One Stage Two Stage Three

Hysteria

(Janet 1889)

Stabilization,

Symptom-

oriented

treatment

Exploration of

traumatic

memories

Personality

reintegration,

rehabilitation

Combat trauma

Scurfield (1985)

Trust, stress-

management

education

Re-experiencing trauma

Integration of

trauma

Source: Herman, 1992, 1997

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Slide 36




Complicated

post-traumatic

stress disorders

Stabilization Integration of

memories

Development of

self, drive

integration


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Slide 37




Multiple personality disorder

(Putnam 1989)

Diagnosis, stabilization, communication cooperation

Metabolism of trauma

Resolution, integration, development of post-resolution coping skills

Traumatic

disorders

(Herman 1992)

Safety Remembrance

and mourning

Reconnection


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Slide 38


Trauma

Three Group Models

Group

Recovery

Stage One

Recovery

Stage Two

Recovery

Stage Three

Therapeutic

taskSafety

Remembrance

and mourningReconnection

Time

orientationPresent Past Present, future

Focus Self-care TraumaInterpersonal

relationships


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Slide 39


Trauma

Three Group Models

Group

Recovery

Stage One

Recovery

Stage Two

Recovery

Stage Three

Membership Homogeneous Homogeneous Heterogeneous

BoundariesFlexible,

inclusiveClosed

Stable, slow

turnover

Cohesion Moderate Very high High


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Slide 40


Trauma

Three Group Models

Group

Recovery

Stage One

Recovery

Stage Two

Recovery

Stage Three

Conflict

toleranceLow Low High

Time limitOpen-ended or

repeatingFixed Limit Open-ended

Structure Didactic Goal-directed Unstructured

ExampleTwelve-step

programsSurvivor group

Interpersonal

psychotherapy

group


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Slide 41


Areas of Separation

• Training

• Treatment

• Categorical Funding

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Slide 42


Key Elements(Staff and Clients)

• Learn what trauma/abuse is

• Understand typical responses

• Develop coping skills

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Slide 43


Trauma

Gender Differences

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Slide 44


Definition: Gender-Responsiveness

Creating an environment through site selection,

staff selection, program development, content, and

material that reflects an understanding of the

realities of the lives of women and girls and that

addresses and responds to their strengths and

challenges.

(Covington and Bloom)

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Slide 45


Trauma-informed Materials

• Women and Addiction: A Gender-Responsive Approach

• Helping Women Recover

• Voices: A Program for Girls

• Beyond Trauma: A Healing Journey

• Women in Recovery

• A Woman’s Way through The Twelve Steps

• Beyond Violence: A Prevention Program for Women

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Slide 46


Trauma Materials

• ATRIUM (Dusty Miller)

• Beyond Trauma (Stephanie Covington)

• Seeking Safety (Lisa Najavits)

• TREM (Maxine Harris)

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Slide 47


Five Senses

5 things you can see

4 things you can touch

3 things you can hear

2 things you can smell

1 thing you can taste

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Slide 48


From the manual In Our Best Interest: A Process for Personal and Social Change.

Available through Domestic Abuse Intervention Project, 206 W. 4th St., Duluth, MN 55806

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Slide 49


Self - Soothing

Alone With Others

Daytime

Night Time

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Slide 50


Feeling Okay Chart

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Slide 51


What does the prevalence

data tell us?

• Many people with trauma histories have overlapping problems with mental health, substance abuse, physical health and are victims or perpetrators of crime.

• Victims of trauma are found across all systems of care.

(Source: NASMHPD 2008)

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Slide 52


Therefore…

We need to presume the clients we serve have a history of traumatic stress and exercise “universal precautions.”

(Source: NASMHPD 2008)

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Slide 53


Emerging Paradigm

Values-Based Services

• Gender-responsive

• Trauma-informed

• Culturally competent

• Recovery-oriented

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Slide 54


Sanctuary

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Slide 55


What is Sanctuary?

• Sacred place

• Place of refuge/protection

• Shelter

• Oasis

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Slide 56


What Makes a Difference?

• Creating a safe environment

• Listening to her story

• Empathy

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Slide 57


Upward Spiral

Trauma

(constriction)

Healing

(expansion)

Transformation

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Slide 58 For More Information:

Dr. Stephanie S. Covington, PhD, LCSW

www.stephaniecovington.com

www.centerforgenderandjustice.org

7946 Ivanhoe Avenue, Suite 201B

La Jolla, CA 92037

Phone: 858-454-8528

Fax: 858-454-8598

Email: [email protected]


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Slide 59

A Woman's Way through the

Twelve Steps

• Facilitator's guide for 13 group sessions

• 65-minute DVD

• 10 Softcover books,

• 10 Client workbooks

Price: $395.00

Resources from Stephanie Covington


A Woman's Way through the Twelve Steps

“helps clients explore spirituality, powerlessness, and

the emergence of a feminine soul. This practical and

powerful program integrates the most current research

and best practices regarding women and recovery.”

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Slide 60

Beyond Trauma: A Healing

Journey for Women

• 11-Session Curriculum

• Facilitator’s Guide

• 3 DVDs

• 10 Client Workbooks

Price: $549.00


Beyond Trauma helps clients understand the dynamics of

abuse in the family, power and abuse, and the connection

between alcohol and other drug use and trauma.

Beyond Trauma is extensively annotated and includes

research by the Center for Gender and Justice and the National

Institute of Corrections.© S. Covington, 2011

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Slide 61


Women and Addiction A Gender

Responsive Approach

• Downloadable 104 page manual

• 75 Minute DVD

• CE test with 10 CE hours granted

Price: $175.00Print and online versions available

Now available as an online course at

www.hazelden.org/professionaled


Women's treatment involves more than simply providing

women-only group settings.. In this program, Stephanie S. Covington presents

how to create effective recovery services for women and girls--services that reflect an

understanding of the realities of their lives and address their unique challenges and strengths.

Dr. Covington's comprehensive, integrated approach is based on years of theory, research,

and clinical experience.

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Slide 62 Visit the Behavioral

Health Evolution site:

BHEVOLUTION.orgInnovative resources for treating

substance use, mental health and

co-occurring disorders.

Sign up for Funding

Alerts and our

e-Newsletter

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Slide 63

Please use your Q&A feature on the

bottom right of your screen to send

questions to Stephanie!

For more information about Stephanie

Covington’s materials or to order call

1-800-328-9000

Participants in this web conference

will receive a 20% discount on any

of Stephanie Covington’s materials

Use this code to order: TRAUMA20

Time for discussion with

Stephanie Covington

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Slide 64

1) Go to www.hazelden.org/professionaled

2) Click on “Course Catalogue”

3) Search for the course: Women, Addiction and Trauma

4) Pay the administrative fee ($20.00) for the assessment

5) Take the assessment

6) Print your certificate!

Submit your certificate to your credentialing body to receive:

Two credits from NAADAC

One credit from APA

Continuing Education Credit

from NAADAC and APA

is available for this web conference

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Documents

Women, Addiction and Trauma