Trauma and Substance Abuse

1. Trauma and Substance Abuse Karina Forrest-Perkins, MHR Gateway to Prevention and Recovery

2. Foundation • Understand how the brain was intended to develop • Directional growth patterns • Balance of neurotransmitters • Survival in tandem with experience/expectant maturation – ages 0-3 • Cortisol presence, intended and unintended • Effects of over-infusion of cortisol during threat • Interruption and maladjustment in development – ages 0-6, and 6-12 • Differences in early childhood trauma and adult trauma • Memory Storage maladjustments – Left and Right Brain • Amygdala, Thalamus

3. Spinal Cord/Pons/Limbic System/Frontal Cortex Development • What happens with introduction of trauma? • What is trauma? • Most would agree that trauma includes the following ingredients: • (1) seriously threatens the health or survival of the individual; • (2) renders the individual powerless in the face of overwhelming fear or arousal; • (3) overwhelms the individual's coping capacity; and • (4) violates basic assumptions about the environment's (human or physical) benevolence and safety (adapted from Eisen & Goodman, 1998)(Additional: DSM V planning Council, van der Kolk, 2005-7)

4. Left and Right Brain/Corpus Callosum Membrane • Trauma Memory Storage • Post Trauma Incident, cortisol reduction contributing factor to re-enactment • Long Term Hypervigilence – over development of survival mode and underdevelopment of cognitive functioning • Contributing factor to re-enactment. Where are the most advanced skills? Why drawn to high risk behavior? What activates skills?

5. Introduce Substance Use • Effects of substance use and abuse on the brain – consider age and brain development • Neurotransmitter imbalance • Reward system disruption

6. Statistics • Over 51% of all adolescents in co-occurring residential settings have trauma histories resulting in a diagnosis of PTSD • Over 79% of co-occurring clients nationwide have trauma histories they consider to be significant • ACES Study • NIDA • Duke University • NCTSN • SAMHSA

7. We do not know conclusively if the trauma history was always the pre-cursor to substance use or if the substance use put individuals in positions where trauma was likely to occur or both.

8. How do we address this issue? • Treatment? Do we treat one then another? Or Both? What is best for the client?

9. Consider the age of the client • Consider a trauma screen for all clients • Things to remember in co-occurring/treatment • SAFETY • NOT necessary to discuss details • SAFE exercises for re-integrating cognitive and body communication • MODALITITES that fit the individual • Best Treatment Centers: Screen staff and organizations for trauma history: provide resources for them as well.

10. RESOURCES • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Revised (DSMIV-R) 4th ed. Washington, DC: APA, 2000). • Lise Addario, Six Degrees from Liberation: Legal Needs of Women in Criminal and Other Matters (Research and Statistics Report) (Ottawa: Department of Justice, 2002). • Dr. Bruce Perry and www.childtraumaacademy.com. Please feel free to research this website and Dr. Perry’s online course in trauma and brain development. • childtraumaacademy.com

11. American Association of Neurological Surgeons • Prevent Child Abuse America 200 S. Michigan Avenue, 17th Floor Chicago, Illinois 60604-2404 (800) CHILDREN Tel: (312) 663-3520 Fax: (312) 939-8962 www.preventchildabuse.orgmailbox@preventchildabuse.org • Child Welfare League of America440 First Street, NW, Third FloorWashington, DC 20001-2085Tel. (202) 638-2952FAX (202) 638-4004http://www.cwla.org/ • APSAC407 South Dearborn Street Suite 1300Chicago, IL 60605http://www.apsac.org/ • The National Center for PTSDhttp://www.dartmouth.edu/dms/ptsd/

12. International Society for Traumatic Stress Study (ISTSS) The International Society for Traumatic Stress Studies (ISTSS), founded in 1985, provides a forum for the sharing of research, clinical strategies, public policy concerns and theoretical formulations on trauma in the United States and around the world. ISTSS is dedicated to the discovery and dissemination of knowledge and to the stimulation of policy, program and service initiatives that seek to reduce traumatic stressors and their immediate and long-term consequences. ISTSS60 Revere Drive, Suite 500Northbrook, Illinois 60062 USAPhone: 847/480-9028; Fax: 847/480-9282http://www.istss.org

13. Collaborative Family Healthcare Coalition (CFHC) is a diverse group of physicians, nurses, psychologists, social workers, family therapists and other health care workers, working in both primary and tertiary care settings, who study, implement, and advocate for the collaborative family health care paradigm. • CFHCC40 W. 12th StreetNew York, NY 10011-8604(212) 675-2477http://www.cfhcc.org NEW -  Childstats.gov offers easy access to federal and state statistics and reports on children and their families, including: population and family characteristics, economic security, health, behavior and social environment, and education. http://www.childstats.gov/ • AUTHORS • John Briere • Christine Courtois • Peter Levine • Sandy Bloom • Bruce Perry

14. Karina Forrest-Perkins, MHR Chief Operating Officer Gateway to Prevention and Recovery 405-273-1170 ext 113 405-788-2208 cell kforrest@gatewaytoprevention.org