In the field of addiction, it is rare that I meet a client who does not also suffer from trauma. When we are first taught about trauma, we are introduced to “Big T trauma” and “little t trauma”. This is a concept to move past and to address trauma for what it is. Trauma is defined as an event that is the source of tremendous distress and dysfunction. This can be any life event that challenges one’s sense of safety: mentally, physically, or emotionally. When an individual has experienced trauma of any kind, their mind and body shift to an alarm state. The reptilian part of their brain, the limbic system, is turned on and they are in survival mode. At Spearhead Lodge we see various forms of trauma, from parental divorce to sexual abuse. Many of these traumas have taken place before the addiction started. It was the need to cope with the feelings of being unsafe that drove the underlying need for drugs and alcohol use. In this place of survival, many of our clients report feeling different, lonely, and isolated from others, mentally, physically, and emotionally. In the addiction field, we have found many clients have co-morbidity of Post-Traumatic Stress Disorder (PTSD) and addiction.
The American Society of Addiction Medicine (ASAM) defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences”. It states “People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences”. Many clients’ brains have shifted into alarm state, survival mode, because of the traumatic events that threatened their safety, and now, to cope, their brain circuits have rewired and the way they use substances has become unhealthy, despite negative consequences. Research has shown that 5% of males report having PTSD. Of that five percent, 51.9% report having alcohol use disorders, and 34.5% report having drug use disorders, excluding nicotine (Kessler et al. Arch Gen Psychiatry 52:1048-1060). At Spearhead Lodge we also find co-morbidity of addiction and other mental health diagnosis such as anxiety disorders (panic and social phobias), major depression disorder and dysthymia, psychotic disorders, borderline and antisocial personality disorders, and dissociative disorders. When looking at the neurobiology of the traumatic brain and the addicted brain, we see a lot of similarities.
The limbic system is the part of the brain responsible for the fear response. That is your fight, flight, or freeze. The two main parts of the limbic system are the hippocampus and the amygdala. Both areas are where fear is conditioned, and association is learned. In clients with PTSD, we find that these areas light up with an increased responsiveness to traumatic and emotional stimuli. The hippocampus is responsible for declarative memory, which is related to facts and events. So when a person is traumatized, it inhibits the part of the brain that is responsible for storing memory. This manifests as memory loss, memory distortions, memory suppression, and re-experiencing symptoms of PTSD. The amygdala, the center responsible for emotional regulation, is inhibited as well. This is where hyperarousal and emotional dysregulation manifests. So what does all of this mean? In addiction studies, we find that when people are traumatized their ability to regulate emotions and to process the memories in a healthy way have been greatly affected; the result is a great need for numbing and avoiding which is found in substance use. The clients that come in for treatment are not bad people with low self-will, and should just say no to drugs, or only have one drink. No, these clients are living with restructured brains and they are struggling to cope. This makes for complex cases which need complex clinical approaches. So the question remains, which do we treat? The answer is both.
The multi-disciplinary approach has proven to be the most effective. Here at Spearhead Lodge, each client is assigned a licensed counselor and a 12 step mentor. We use some of the most proven clinical modalities to treat PTSD, such as Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Cognitive-Behavioral Therapy (CBT). Clients are provided a safe, structured environment where they can learn to build healthy connection with others, while challenging some of their most distorted belief systems. The clinical team works to address the underlying issues to the addiction, while the 12-step team offers each client a different solution to life. We take each client through all 12-steps of the program of Alcoholics Anonymous. Our 12-step mentors support them in first admitting that they are powerless and that their lives are unmanageable. Then they are encouraged to connect to a power greater than themselves. We challenge each client to explore their resentments and to face the defects of their own character. I believe one of the most important pieces of healing that Spearhead Lodge provides is a space for unity and fellowship. Clients learn to feel safe in their own skin again.
Written by: Brittney Lollis, LCSW, LCDC, CDWF-C