Academic journal article Journal of Alcohol & Drug Education

Addressing Trauma in Substance Abuse Treatment

Academic journal article Journal of Alcohol & Drug Education

Addressing Trauma in Substance Abuse Treatment

Article excerpt

ABSTRACT

Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious trauma. Additionally, we present the results of a study exploring trauma prevalence rates and gender differences among a sample of 121 adults in outpatient substance abuse treatment. Our findings indicated that 85.12% of the sample experienced at least one traumatic event in her or his lifetime. We also found significant gender differences in that more women reported experiencing sexual abuse and more men reported witnessing violence.

Keywords: trauma, substance abuse, addictions counseling

ABSTRACT

The experience of trauma is multifaceted and can refer to one acute event, a series of events, or responses to sociocultural factors such as poverty or oppression (Briere & Scott, 2013). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychological Association [APA], 2013) defines a traumatic event within Post Traumatic Stress Disorder (PTSD) criteria (Criterion A) as, "exposure to actual or threatened death, serious injury, or sexual violence" (p. 271). According to the DSM-5, individuals may directly experience or witness the trauma, hear of a loved one's traumatic event, or repeatedly hear of or see trauma (e.g., in one's occupation). Although Criterion A supplies a unified definition of trauma, many researchers describe the definition as too restrictive, due to the subjective experience of a potentially traumatic event and the number of different stressors that could constitute a trauma (Anders, Fraizer, & Frankfurt, 2011; Weathers & Keane, 2007). For example, Anders et ah, 2011 examined PTSD prevalence rates among those who experienced traumatic events that met Criterion A and those who experienced traumatic events that did not meet the Criterion. Using a sample of 884 women, the researchers found that both Criterion A events and non-Criterion A events led to PTSD symptoms. Moreover, non-Criterion A events were associated with slightly higher current PTSD symptoms than Criterion A events.

Thus, the definition of trauma as proposed by the DSM-5 may be helpful for diagnostic purposes, yet may not capture all experiences of trauma. Alternative definitions, such as the one purported by Briere and Scott (2013), offer a broader scope of trauma. Specifically, these authors defined events as traumatic if they are temporarily overwhelming, exceptionally distressing and create lasting psychological symptoms for the individual.

The many types of events that could be considered traumatic make it difficult to determine trauma prevalence, yet researchers generally posit that experiencing trauma over the course of the lifespan is more of the norm rather than the exception. Indeed, among a non-clinical sample of 2,953 United States adults, Kilpatrick et al, 2013 found 89.7% were exposed to one or more Criterion A traumas. Most commonly, individuals experienced physical or sexual assault (52%), accident or fire (50%), death of a close family member or friend due to violence (49%), natural disaster (48%), threat or injury to a close family member or friend (32%) and witnessing physical or sexual assault (31%). Differences in prevalence of trauma also exist between genders. Researchers have found that women experience more trauma related to interpersonal violence and the sudden death of a loved one, while men experience more trauma related to natural disaster (Hetzel-Riggin & Roby, 2013). Additionally, the authors noted that women reported more PTSD symptoms than their male counterparts.

Beyond the general population, evidence suggests that the experience of trauma is prevalent among those seeking mental health services (Mauritz, Goosens, & Van Achterberg, 2013). …

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