Tim Shannon

1
Trauma and the Challenge of Substance Abuse
Disorders

• Tim Shannon
• MA, Licensed Professional Counselor
• Certified Advanced Addiction Counselor
• Certified Sexual Addiction Therapist
• Certified Multiple Addiction Therapist
• ICADAC - International Certified Alcohol and Drug
  Abuse Counselor
• Eye Movement Desensitisation Reprocessing 1
• frostcid_at_ comcast.net , tshannon_at_cssstclair.org

2
If all you have is a hammer then all your
problems are nails -Abraham Maslow
3
Core Assumption I

• In the context of trauma, chemical addiction
  arises not as a pleasure-seeking strategy but as
  a survival strategy
• To self-soothe and self-regulate
• As a way to numb hyperarousal symptoms
  intolerable affects, reactivity, impulsivity,
  obsessive thinking
• In the service of walling off intrusive
  memories
• As a way to combat helplessness by increasing
  hypervigilence and feelings of power and control
• To treat hypoarousal symptoms of depression,
  emptiness, numbness, deadening
• In the service of facilitating dissociation
• As a way to function or to feel safer in the
  world

Fisher, 2007
4
Core Assumption II

• How the addictive behaviors have helped trauma
  patients to survive that is, which trauma
  symptoms are they attempting to treat through
  their drinking, drugging, eating disorders, and
  sexually acting out behaviors. We need to know
  this information for a number of reasons
• First, we need to know because these are
  precisely the symptoms that will increase once
  the patient becomes sober or abstinent. EX
  12 yr old molested by grandfather, smokes
  cannabis and uses alcohol to forget. In
  recovery has numerous flashbacks including
  
  molestations at an earlier age she had
  suppressed.
• We need to know, too, so that we can begin to
  anticipate other coping strategies they will
  need in order to deal with those symptoms as
  they erupt and threaten to overwhelm them.

Fisher, 2007
5
Core Assumption III
Furthermore, we need to be able to predict
when and how the symptoms may potentially
trigger a behavior relapse so that we can help
them strengthen the addictions recovery program
they have chosen. And finally, we also need
to know so that we can help the survivor
appreciate their courageous attempts to cope
with the effects of the abuse and, from that
recognition, develop sufficient compassion and
self-respect to counteract the shame and guilt
that is the inevitable byproduct of their
addictions and trauma history.
Fisher, 2007
6
Feelings refers to psychology, how we
think about what is going on, both
externally and internally ie the
amygdala.  
Affect refers to instinctive biology, ie the
limbic system - the fight, flight, or freeze
center - that tends to be active in addiction and
other disorders. The individual receives
overwhelming primal messages about events that
can be way out of proportion to the actual
potential for threat.
7

• Emotion refers to the biographical story we tell
  
• ourselves about our experience, including
  the ability
• to remember and to project experience.
• Dominated by intrusions of the trauma,
  traumatized individuals begin organizing
  their lives around avoiding having them.
•  

8
Trauma

• Because the stress response disrupts general
  information processing, survivors of trauma live
  in a somatic world rather than a world of
  language.
• Alexander McFarlane

9
What is Trauma?
Trauma is experiencing too much, too fast, too
soon. Or The body remembers what the mind
forgets -Jacob Moreno
10
Movement from Chaos to Connection

• The deep digging in therapy is to make conscious
  these early wounds and convert them into words so
  that they can be felt and understoodto use the
  skills of emotional literacy.

11
We help them place the trauma in proper
perspective. Help give them a context (where,
when and how).Help integrate them back into
themselves with understanding as to what happened
and what meaning they made out of it.

• Movement from Chaos to Connection
• Our Tasks

12
Modulating Emotional Responses

• Intense Fear
• Rage
• Disassociation or Shutdown
• Addiction offers relief

13
Trauma Impacts relationships by creating

• 1. Enmeshment-part of trauma bonding.
• 2. Disengagement-avoiding skill building.
  
• 3. Chaos through impulsivity.

14
How do we help them?4 Steps to Emotional
Expertise

• Our clients need to know
• All emotions serve a function.
• Trauma and Addiction blunt our range of
  emotions.
• Self Efficacy comes as consciousness of
  emotions grows.

15
What is Trauma
Trauma is perhaps the most avoided, ignored,
belittled, denied, misunderstood, and untreated
cause of human suffering. Although it is the
source of tremendous distress and dysfunction, it
is not an ailment or a disease, but the
by-product of an instinctively instigated,
altered state of consciousness. We enter this
state - let us call it survival mode - when we
perceive that our lives are being threatened. If
we are overwhelmed by the threat and are unable
to successfully defend ourselves, we can become
stuck in survival mode. This highly aroused state
is designed solely to enable short-term defensive
actions but left untreated over time, it begins
to form the symptoms of trauma.
Peter Levine
16
Effects of Trauma(Dayton,2000)

• Long term fear of intimacy.
• Relational Commitment-Simultaneous fears of
• abandonment and being overwhelmed.
• Poor Communications-as the internal dictionary,
  listening,
• and seeking feedback are distorted.
• Boundaries are enmeshed.
• Deregulated emotions-high frequency, intensity
  and
• duration to complete shutdown.
• Distrust, unable to receive and lack of faith in
  others.
• Blunted play inability to move freely in a
  space.
• Unconscious patterns of disconnecting,
  reenacting,
• transference, splitting, hyper-vigilance and
  perfectionism.

17
Somatic Experiencing
Somatic Experiencing is a body-awareness
approach to trauma being taught throughout the
world. Based upon the realization that human
beings have an innate ability to overcome the
effects of trauma. -Dr. Peter Levine
18
Bessel van der Kolk

• The imprint of the trauma is in the limbic
  system and in the brainstem in our animal
  brains, not our thinking brains
• Survival responses based on the following
  criteria
• Severity of trauma.
• Genetic Predisposition.
• Developmental Phase when trauma occurs.
• A Social Support System.
• Prior traumas.
• 6. Preexisting phobias and maladaptive
  behavior

19
Pierre Janet 1859-1947

• Traumatized patients ... are repeatedly
  continuing the action, or rather the attempt at
  action, which began when the event happened, and
  they exhaust themselves in these everlasting
  recommencements.
• 1919/25, p. 663

20
Trauma and the Brain
21
The Triune Brain
x
22
Bottom-up, The Hi-Jacked Brain
Everyday experiences connected to the trauma will
trigger instinctive survival responses fight,
flight, freeze, collapse and numbing,
dissociation, re-enactment behavior. The clients
animal brain takes over, the ability to think
goes off line, acting out behavior takes
place without consciousintention or judgment,
even without awareness!
Janina Fisher, 2007
23
Trauma vs. Intimacy
Visual Cortex
Amygdala
Fight, Flight or Freeze Response
24
Peter Levine

• Trauma originates as a response in the nervous
  system, and does not originate in an event.
  Trauma is in the nervous system, not in the
  event.

25
Brief Overview of theAutonomic Nervous System

• The Polyvagal Theory
• by
• Stephen Porges, PhD
• www.stephenporges.com

26
The Parasympathetic Nervous System The Sympathetic Nervous System
Originates in the brain stem and lower part of the spinal cord opposes physiological effects of the sympathetic nervous system stimulates digestive secretions slows the heart constricts pupils dilates blood vessels. Trauma may result in the PNS staying on, which causes it to superimpose shutdown over the hyperarousal of the SNS, rather than discharging its energy. The SNS gets our whole body ready for action. It regulates arousal. It increases activity during times of stress and arousal whether positive or negative. It is active when were alert, excited, or engaged in physical activity. It prepares us to meet emergencies and threat.
The Parasympathetic branch acts like the brake pedal for our nervous system. It helps us to relax, unwind and ultimately discharge the arousal of sympathetic activation. The Sympathetic branch is like the gas pedal of our nervous system. It gives us energy for any action we plan, and it helps us prepare for threat.
27
The Polyvagal Theory By Stephen Porges
The Vagus
Nerve in three parts, all working
simultaneously Ventral Vagal System
Is part of the Parasympathetic
Nervous System (Social Engagement/frontal
cortex) Sympathetic Nervous System (Fight/Flight
, Freeze - Limbic Brain) Dorsal Vagal System
Is part of the
Parasympathetic Nervous System (Freeze/Immobility/
Brainstem)
28
(No Transcript)
29
Social Engagement
Fight, Flight, Freeze
Immobility
Safe
Danger
Life Threatening
Ventral Vagal
Sympathetic Nervous System
Dorsal Vagal System
30
Autonomic Arousal is Designed to Adapt to
Environmental Demands
Sympathetic Hyperarousal
sympathetic
easy charge
easy discharge
Window of Tolerance feelings can be tolerated,
able to think and feel
AROUSAL
parasympathetic
Parasympathetic Hypoarousal
Foundation of Human Enrichment Ogden and Minton
(2000)
31
Autonomic Adaptation to a Threatening World

• Hyperactivity
• Panic
• Rage
• Hypervigilance
• Elation/Mania

Stuck on ON
Sympathetic Hyperarousal
Window of Tolerance Optimal Arousal Zone
A R O U S A L

• Depression
• Disconnection
• Deadness
• Exhaustion

Stuck on OFF
Parasympathetic Hypoarousal
Foundation of Human Enrichment Fisher, 2006
32
How Chemical Addiction Modulates and Medicate
Complex PTSD to attempt Self-Regulation
Sympathetic Hyperarousal
Acting out
Window of Tolerance Optimal Arousal Zone
A R O U S A L
Acting in
Parasympathetic Hypoarousal
Foundation of Human Enrichment Fisher, 2006
33
The Challenge of Trauma and Chemical Addiction

• Treatment must address the relationship between
• the trauma and the addictive behavior
• the role of the addictive behavior in
  medicating traumatic activation
• C. the origins of both in the traumatic past
• D. the reality that recovering from either
  requires recovering from both.

Fisher, 2007
34
Modes of Inventions

• Cognitive Behavioral Therapy
• EMDR
• Somatic Experiencing
• Hypnotherapy
• Transactional Analysis

35
Provider Tasks

• Screening Assessing
• See trauma as a defining and organizing
  experience that can shape a survivors sense of
  self and others. (understanding ability to cope).
• Psycho-educational information on how intertwined
  SUDS and Trauma are during and after an event.
• Establish and maintain consumer support and
  developing coping skills. (Ex Learning
  communication and problem solving strategies such
  as healthy fighting. (cont.)

36
Addiction Labeling

• The goals associated with any problem are at
  least partially determined by the way the problem
  is assessed.
• What you do about something is influenced by what
  you call it.

37
Our Lens

• We tend to call ourselves objective but we
  interpret situations from their own particular
  theoretical, philosophical or ideological
  perspective.
• Do we need to transcend it?

38
Our Lens (cont.)

• We know clients dont see themselves as addicts
  but often seek to negotiate an alternative
  explanation to negate acting out behaviors or
  minimize having to change.

39
Provider Tasks

• Helping consumer understand the range of parallel
  connections between SUDS and trauma.
• Minimizing re-occurance of trauma
• Ensuring consumers physical and emotional safety
  where possible and avoiding shame inducing
  confrontations triggering trauma related
  responses.
• Helping with referrals for ancillary services
  such as legal, financial, vocational, housing and
  health care.

40
Resiliency

• Recognizing and Reinforcing Resiliency
• Definition-The process of bouncing back.

41
The Post Traumatic StressInventory

• The Inventory consists of 144 questions
  designed by David Delmonico, M.Ed. and Patrick
  Carnes, PhD. Questions fall into 1 of 8
  categories providing when tallied a strategic map
  on how the client can once again gain internal
  locus of control.

42
The Post Traumatic Stress Inventory

• 8 Specific Therapy Strategies

43
1.Trauma Reacting
Trauma Reacting- Experiencing current reactions
to trauma events in the past. Study ways client
is still reacting. EX projected anger out on
others. Write letters to perpetrator telling
them of the long-term impact you are
experiencing.

• Write amend letters to those you know you
  have harmed.
• Decide with therapist what information is
  appropriate to disclose and send.

44
2. Trauma Repetition

• Trauma Repetition Repeating behaviors or
  situations which parallel early trauma
  experiences.
• Understand how history repeats itself in your
  life experiences.
• Develop habits which center yourself- Ex.
  Breathing or journaling so you are doing what you
  intend not the cycles once used.
• Work on setting boundaries-using effective
  communication.
• Boundary failure is key to repetition compulsion.

45
3. Trauma Bonding

• Trauma Bonding- Being connected (loyal, helpful,
  supportive, enmeshed) to people who are dangerous
  shaming, or exploitive.
• Learn to recognize trauma bond by identifying
  those in your life.
• Look for patterns.
• Use detachment strategies for difficult people.
• Use a First-Step if necessary.

46
4. Trauma Shame

• Trauma Shame - Feeling unworthy and having
  self-hate because of the trauma experience.
• An acutely self-conscious state in which the self
  is split imagining the self in the eyes of the,
  other by contrast, in guilt the self is unified.
  (Gilliland, et al. 2011).
• Judgment of self by another whether real or
  imagined.

47
4. Trauma Shame (cont)
Goal Shame Reduction and resolution. Underst
and shame dynamics of family and family of
origin. Who was important to that you should
feel shameful? Do a list of problems, excuses
and secrets. Complete an inventory of
affirmations.
48
5. Trauma Pleasure

• Trauma Pleasure Finding pleasure in the
  presence of danger, violence, risk or shame.
• Do a history of how excitement/ shame are hooked
  to the past traumatic event (s).
• Note the costs and dangers to you over time.
• Do a First Step and relapse prevention plan about
  how powerful this is in your life.

49
6. Trauma Blocking

• Trauma Blocking- A pattern exists to numb, block
  out, or overwhelm feelings that stem from trauma
  in your life.
• Work to identify experience which caused pain or
  diminished you.
• Re-experience feelings and make sense of them
  with help.
• This will reduce the power they have had.
• Do a First Step if appropriate.

50
7. Trauma Splitting

• Trauma Splitting- Ignoring traumatic realities by
  disassociating or splitting off experience of
  parts of self.
• Learn that disassociating is a normal response
  to trauma.
• Identify ways you split reality and the triggers
  that cause that to happen.
• Cultivate a caring adult who stays present so
  you can stay whole.
• Notice any powerlessness you feel.

51
8.Trauma Abstinence

• Trauma Abstinence- Depriving yourself of things
  you need or deserve because of traumatic acts.
• Understand how deprivation is a way to continue
  serving perpetrators.
• Write a letter to the victim(s) that was you
  learning to tolerate pain and deprivation.
• Work on strategies to self nurture including
  inner child visualizations.

52
WHAT NEXT-30 Performables
1. Break through Denial 2. Understand Addiction 3. Surrender 4. Limit change 5. Establish Sobriety 6. Physical Integrity 7. Culture of support 16. Lifestyle Balance Building Support Exercise and nutrition Spiritual Life 20. Resolve Conflicts 21. Restore Healthy Sexuality 22. Family Therapy
8. Multiple addictions 9. Cycle of Abuse 10. Reduce Shame 11. Grieve losses 12. Closure to shame 13. Relationship with self. 14. Financial Viability 15. Meaningful work 23. Family Relationships 24. Recovery commitment Issues with children 26. Extended Family 27. Differentiation 28. Primary Relationship 29. Coupleship 30. Primary Intimacy Carnes,2011

53
Bibliography

• Carnes, Patrick, Delmonico, David. The
  Post Traumatic Stress Inventory. Carefree, Az,
  2008.
• Carnes, Patrick Stephanie, Bailey, John.
  Facing Addiction. Carefree, Az 2011. Gentle Path
  Press.
• Dayton, Tian, (2000), Trauma and Addiction
  Ending the Cycle of Pain through Emotional
  Literacy, Deerfield Beach, Fl., Health
  Communication.
• Gilliland, et al. The role of guilt and
  shame in Hypersexual Behavior. Sexual Addiction
  and Compulsivity The Journal of Treatment and
  Prevention. p 14-15.

54
BIBLIOGRAPHY (cont.)

• Fisher, Janina, (2008), Addictions and Trauma
  Recovery
• Levine, Peter, (1997), Waking the Tiger. Berkley,
  CA, North Atlantic Books.
• Ogden, Pat, (2006), Trauma and the Body. New
  York W.W. Norton Company, Inc.
• Porges, Stephen, 2006), How your nervous system
  sabotages your ability to relate.
  www.nexuspub.com
• Van der Kolk, Bessel, McFarlane,
  Alexander(1996) Traumatic Stress. New York The
  Guilford Press.

55
Anchor Consulting Services 1110 West Cross St.
Ypsilanti, Mi.48197 Phone [phone] http//a
nchortherapy.com/ frostcid_at_ comcast.net ,
tshannon_at_cssstclair.org

• Tim Shannon
• MA, Licensed Professional Counselor
• Certified Advanced Addiction Counselor
• Certified Sexual Addiction Therapist
• Certified Multiple Addiction Therapist
• ICADAC - International Certified Alcohol and Drug
  Abuse Counselor
• Eye Movement Desensitization Reprocessing 1