Learn more about how trauma and substance abuse co-exist, the importance of trauma-sensitive care (and where to find it) and what parents can do on their own at home to help.
“There are wounds that never show on the body
that are deeper and more hurtful than anything that bleeds.” Laurell Hamilton1
It's hard enough just navigating the everyday
turmoil of adolescence. It’s hardly surprising that for teens who experience
trauma, alcohol and drugs can become necessary self-medication.
If your son or daughter has survived a traumatic experience,
be on the lookout for lingering trauma stress symptoms, know that these won’t
necessarily go away on their own and that without healing, trauma stress
symptoms can snowball into life-long problems.
And if trauma co-occurs with substance abuse (and it often does,
for many reasons) know that alcohol and drugs impair a person’s ability to get
past trauma stress and that trauma stress complicate addiction
recovery.
Fortunately, effective treatments exist and the
quicker you address either trauma or trauma and substance abuse, the
better the prognosis.
Read on to learn more about
What causes teen trauma stress and the warning signs of a
problem to watch for.
Information on when to seek help.
Information on the importance of trauma-sensitive care
(trauma-insensitive care can actually worsen the situation) – what defines it,
where to find it and how to evaluate different programs.
What parents can do at home to help.
What Is Trauma?
Any situation in which a person fears for their life or
safety or for the life and safety of a loved-one can lead to traumatic stress,
for example: a car accident, a violent assault, the traumatic death of a loved one,
a life-threatening illness, natural disasters, war, sexual or physical abuse and
many others.
Trauma can be acute – such as a mugging, or chronic (several incidences occurring over a period of time). Some examples of chronic
traumatic stress include childhood neglect, chronic sexual or physical abuse or
ongoing domestic violence situations.
Some trauma-exposed teens experience few or no later
consequences, while others may develop PTSD. Therefore, parents need to learn what to watch for and be prepared to intervene with help if necessary.
Warning Signs of Adolescent Traumatic Stress
Post traumatic stress disorder symptoms generally fall into
three categories:
Re-experience – Flashbacks, nightmares, physical or
emotional responses to reminders (triggers).
Avoidance – Avoiding anything and anyone that reminds of the
event. This may also lead to feelings of disassociation.
Arousal – Feeling constantly on-guard, increased jumpiness
and agitation, being easily startled and quick to anger, having difficulty concentrating.
After trauma exposure, be on the lookout for the following
warning signs which may indicate traumatic stress:2
Starting to take unhealthy risks
Signs of depression
Increased irritability or jumpiness
Problems at school
Getting upset or angry more quickly and easily than in the
past
He or she feels like they’re going crazy
He or she feels different from everyone else
Sudden antisocial behavior change – becoming more
oppositional, ignoring social norms, risking the safety of self and others
Becoming suddenly sexually active
Talking about the traumatic event in exceptional detail
Avoiding places or people that remind of the traumatic event
Sleep disturbances
Numbing symptoms - saying that they have no feelings at all about the traumatic
occurrence
Using unhealthy coping mechanisms, like alcohol or drug use,
cutting or disordered eating
Traumatic stress symptoms usually start quickly after the
traumatic event but in some cases, symptoms may not emerge for months after the
fact. Symptoms that persist for more than 4 weeks without dissipating indicate
a serious problem.3
The Importance of Dealing with Traumatic Stress
Whether or not traumatic stress leads to substance abuse, if your child isn’t coping well after trauma, it’s important to
intervene. Unresolved trauma can cause emotional, cognitive and behavioral problems that
can worsen over time.
Adolescents who struggle with trauma may
experience delays and deficits in emotional and behavioral regulation, and this
can lead to a range of consequences, such as:
A diminished ability to consider the likely consequences (risks and dangers) of
an action – this can lead to reckless and dangerous behaviors.
Or the opposite reaction - becoming overly fearful and
unwilling to face any risks – this can delay maturation and psychological
growth.
Trauma can also derail academic and social performance.
Teens struggling to cope with traumatic memories may have
trouble focusing on schoolwork or attending to friends and forming normal
beneficial relationships.
How Are Trauma and Substance Abuse Linked?
If you have one, you’re more likely to have the other - for
example:
Teens with a history of physical or sexual abuse are 3 times
more likely to report past or present substance abuse than teens without any
history of trauma.
Some studies indicate that up to 59% of teens with PTSD will
develop a substance abuse problem.
A survey study of teens enrolled in addiction treatment
programs found that 70% had a history of trauma.4
Teens coping with trauma may turn to drugs or alcohol for
self medication or escape and teens who abuse alcohol or drugs tend to engage
in activities that increase the risks of trauma exposure (sexual assault, car accident, etc.) In fact, for more than half of teens with
trauma and substance abuse issues, substance abuse preceded trauma.
Teens with substance use disorders are also more likely to
develop PTSD after trauma than teens without substance use disorders.
The compromised emotional, social and cognitive functioning that co-occurs with
adolescent substance use disorders likely also reduces a teen’s ability to cope
with trauma exposure.
When to Seek Help
For substance abuse:
Though you’d never want to consider residential care until
you’ve fully explored progressive levels of stay-at-home interventions, you’d definitely want to consider some form of treatment should
(persistent) drug or alcohol use become problematic.
For trauma:
Though a person might experience severe trauma
stress in the first days after an incident, stress symptoms usually dissipate
and you start to feel better within a few days or weeks.
Seek help when an adolescent
experiences lingering trauma symptoms that worsen or don’t diminish in intensity
over time, when symptoms are severe enough to interfere with normal functioning
or when symptoms are highly distressing.5
So whenever you’re dealing with a situation where severe
persistent trauma symptoms co-occur with drug or alcohol abuse you should strongly consider professional help.
A person may be self-medicating severe symptoms with drugs
or alcohol, and since untreated stress symptoms may not go away on their own,
this can easily lead to serious addiction issues.
Alternatively, when substance abuse precedes trauma, the
drug or alcohol use can diminish a person’s ability to bounce back from trauma
and so the substance use worsens the situation.
In the next sections:
How trauma affects treatment needs
Finding a trauma-sensitive treatment provider
Elements of effective care for teens with trauma and
substance abuse issues
Beyond professional help – what parents can do at home to
help
How Does Trauma History Affect Treatment Needs?
A trauma history complicates the addiction recovery process.
Integrated treatment is important - When trauma and
substance abuse get treated separately, post-treatment relapse is more likely.
In general – a history of abuse worsens treatment outcomes.
Teens dealing with trauma and substance abuse are less
likely/able to heed warnings about the consequences of actions, change peer
groups and find other ways to have fun or manage stress or negative emotions.
Teens struggling with PTSD and substance abuse have more
difficulty maintaining recovery since trauma reminders increase drug and
alcohol cravings - Emotional and environmental triggers can spark traumatic
stress symptoms and drug or alcohol cravings.
The Importance of Integrated Treatment
While a drug abusing teen without a trauma history might
experience cravings when confronted with people, places or things that trigger
memories of using, a teen with a trauma history would also experience cravings
when exposed to anything that triggers reminders of past trauma. Unless a person can learn to manage these emotional trauma reminders, relapse is likely. For this reason, substance abuse treatment needs to also address trauma symptoms.
Take Home Message
Teens with traumatic stress benefit from integrated
treatment that addresses the linkages between substance use and traumatic
stress.
Because a trauma history complicates treatment outcomes, it’s important
to intervene early, to stay involved with treatment throughout the continuing
care phase and to be ready to re-engage with treatment should relapse occur.
Since trauma complicates treatment, a teen with trauma and substance abuse
issues will likely need more intensive treatment than a teen facing only one of
these significant challenges.6
Finding an Integrated Program – What to Look For
The importance of trauma-informed care.
The last thing you want to do is make the problem worse, and
unfortunately, treatment practices that aren’t sensitive to the needs of trauma-affected youth can do just that:
Imagine how forced transport to a treatment
facility or military style confrontation tactics at a boot camp could worsen feelings of mistrust and helplessness.
When looking for a treatment provider, one of the first
things you want to look for is ‘Trauma-Informed Care’. Programs offering trauma-informed care are different from conventional treatment programs in 2 important
ways:
1. They don’t worsen the trauma
Since certain treatment practices may trigger trauma
symptoms or even re-traumatize, trauma-sensitive programs strive to promote a
safe and welcoming atmosphere at all times and deliver interventions that provide hope and
empowerment to youth. All staff members are trained to be trauma-aware.
2. They offer trauma-specific interventions
These interventions address the trauma and help young people
learn to self regulate behaviors and emotions.
An effective trauma-sensitive treatment program will make emotional and physical safety an absolute top priority, be aware
and sensitive to client boundaries and work to promote client trust.7
Elements of Effective Trauma-Sensitive Treatment
OK – so you need to find a provider or program that will
treat trauma symptoms and substance abuse/addiction at the same time and you
should definitely prioritize finding a trauma-sensitive program – but beyond
this, what else should you look for when searching for an effective program
for your son or daughter?
Well, according to The National Child Traumatic Stress
Network (NTCSN), when looking for an adolescent trauma + substance use disorder
treatment program/provider, here’s what to look for:8
The provider offers more intensive treatment options for
youth and families dealing with trauma and substance abuse (so while youth in
an outpatient substance treatment program might attend 2 sessions per week,
youth with trauma issues might attend 3 and have an additional weekly family
session on top of that, for example.)
The provider strives to build a collaborative, open and
trusting relationship.
The provider emphasizes managing both substance abuse and
trauma symptoms right from the start of treatment.
Relapse prevention skills for both trauma symptoms and
substance use are taught early in the program.
The program includes skills training on stress management
(relaxation training, re-framing, etc.) and on dealing with negative emotions
(identifying emotions, communicating effectively, working to improve negative
emotions.)
Therapy staff use cognitive behavioral
techniques to teach ways to correct and overcome negative thinking patterns.
The program offers social skills training, if needed.
The provider links teens and family members to community
resources, such as mutual self-help groups.
The program offers an educational component, to teach youth and family members about
trauma and substance use disorders, and to encourage reasonable expectations.
Parents are encouraged to get involved in the treatment
process, hopefully to increase parenting, conflict resolution and communication
skills. Parental involvement is very important. When parents get actively
involved in treatment and are willing to work with treatment providers the odds
of a positive outcome go up.
Finding a Trauma + Addiction Treatment Program
One tool you can use to discover your local trauma-sensitive
programs is SAMHSA’s Mental Health Treatment Locator Tool.
Instructions:
Use the locator tool to find a list of all mental health
providers in your area
Once you have this list, click on the ‘Change Service
Selections’ button.
In the advanced search menu, click on the button linked to
the correct age group, the button next to ‘Individuals with PTSD’ and the
button next to ‘Individuals co-occurring mental and substance abuse disorders.’
Click submit and you’ll receive a list of trauma-sensitive
teen addiction treatment providers in your area.
Choosing a Trauma-Sensitive Treatment Program
Finding a program that uses evidence-based interventions.
When interviewing prospective providers or staff members at
prospective programs you should ask about trauma interventions.
Interventions with research proving their effectiveness are called evidence-based programs, and SAMHSA keeps a
registry of these programs that you can access.
Ask any provider
under consideration which evidence-based trauma programs they use.
Then
visit the evidence-based program registry to learn more and to evaluate for
yourself the appropriateness of the intervention for your situation.
Here is a
link to the evidence-based registry and to 24 evidence-based trauma interventions for youth
from ages 13 – 25.
Programs that make use of evidence-based interventions are
likely more effective than programs that do not.
What Can Parents Do at Home?
Teens dealing with trauma are at increased risk of substance
use and abuse, criminal activities, anxiety and other psychological disorders
and social and legal problems.9
The two things that help most to mitigate these increased
risks are:
Early professional intervention
Parental support
So when trauma symptoms persist for weeks and cause
significant distress, it’s important that you seek professional help, and since
the longer symptoms endure the greater the developmental damage (like a
snowballing effect) it’s important to act without delay.
But though professional treatment is essential, trauma-sensitive parenting practices can also help your teen cope with traumatic
stress. Given this, consider the following parenting practices:10
Help your teen deal with guilt – survivor guilt is a common
phenomenon after trauma. Talk to your child about feelings of guilt and work on
identifying what he or she is and is not responsible for. This can help your child to let-go of inappropriate guilt and shame.
Try to understand what triggers reminders and trauma
symptoms and know that triggers can lead to a loss of behavioral or emotional
control. Be patient and supportive.
Help your teen get past embarrassment that might block open
communication. Make sure your teen knows that their post-trauma emotional
reactions are normal and nothing to be ashamed of. Try to get them talking
about their feelings.
A traumatic event can cause a major shift in your teen’s
world view and this can lead to a lot of anger and disruptive impulses. Talk
about this and try to help your son or daughter find constructive ways to
express their emotions. Finding a constructive outlet reduces feelings of
helplessness and reduces the potential consequences associated with engaging in
antisocial acts as an alternative outlet.
Parents can also aid in recovery by:
Encouraging normal sleeping and eating habits and patterns.
Encouraging a reconnection with supportive friends and loved-ones in the community.
Encouraging participation in any personally relevant
spirituality or faith community.
Encouraging participation in community support groups.11
Image Copyright: Martinak15