June 11, 2018

From Mandy Davis, LCSW, PhD, Director, Trauma Informed Oregon

This newsletter (a special thanks to Corrie Halladay, our guest editor) is focused on substance abuse treatment and specifically the intersections with trauma informed care (TIC). There has been much attention in the headlines this year about opioid use and the need for research, treatment, and education. All of this (and more) is needed to be successful but only if we learn from and repair our previous failures in response to the use of substances such as crack/cocaine that resulted in the criminalization and incarceration of people of color. Addictions are not treated equally in our society and this needs to be considered as we plan solutions.

A newsletter cannot adequately represent the complexity of substance use, dependency, addiction, impact, and treatment. To fully understand means learning about the role of oppression, poverty, prison industrial complex, physiology, biology, pharmacology, and sociology. As with most things we talk about here, it requires us to resist the desire to minimalize the issue or find a simple one-size-fits-all solution. The relationship between trauma and substance use is dynamic and ever changing. For some, substances are used as coping mechanisms to deal with trauma, for others using substances led to experiences of trauma, and for some substances were used to harm others.

Relationship Between Trauma and Substance Use

The one size fits all was what I was exposed to growing up and in my early professional training. In high school, I watched ABC Afterschool Specials about the perils of drinking alcohol and learned to “just say no.” I dismissed these interventions as I watched friends and friends’ parents struggle with addiction. In my professional training, I learned to recognize the impact of substance use, with an emphasis on codependency, and to refer them to twelve-step programs.

My best teacher was a dear friend I went through undergraduate and graduate school with and had 20+ years of sobriety. We spent many hours debating the troubles of the world and ideal solutions (while drinking too much coffee). I argued that substance use services did not acknowledge trauma and were activating. He argued that the mental health profession did not understand the power of addiction and the need for peer support.

He gave me the Big Book to read and I gave it back with passages underlined that I felt devalued women. I heard him talking about addressing safety for sexual assault survivors in twelve-step recovery groups. As our relationship developed I also got to witness the support he provided as a sponsor and I wanted that support for those I served in the mental health field.

I think of the relationship between mental health and substance abuse when I think about integrating TIC in substance use related services. It is a developmental process. We started with not acknowledging each other to the point where we wouldn’t value each other’s work. Mental health providers thought substance abuse providers were to “in your face.” Addiction service providers thought mental health providers were pushovers. As we developed our knowledge about co-occurring disorders, we started to have parallel play—we were willing to get in the sandbox together but stayed on our own sides. It used to be, if I was working with a sexual assault survivor who was actively using substances we were encouraged to refer them to substance use services. When they had achieved six months of sobriety we could resume therapy. As you might have guessed this was unsuccessful for the systems and re-traumatizing for the service user. I don’t think we are at integrated recovery . . . yet. But I think we realize the need, respect each other’s knowledge, and are trying new ways to figure this out.

My friend from school taught me about the power of addiction, the complicated relationship our society has with substances, and the healing that happens when we work together. I also witnessed the toll substance use had on his health years into his sobriety. We can do better and the work and innovation shared by the blog contributors bring me hope.

Helpful Blog Posts

What’s Going on at TIO

Trauma Informed Oregon (TIO) is interested in hearing your thoughts. Priorities identified by 250+ people in a recent survey included training opportunities about the relationship between trauma and addictions/substance use, best practices for integration, culturally specific trauma informed addiction services, and workforce wellness. Please let us know if you have ideas, experiences, and resources.

We had a successful forum in The Dalles, OR with 182 people attending. I was excited to provide this with simultaneous translation in Spanish (a special thanks to The Next Door, Inc.). We tried out epolling, a way to answer questions via text and see live data. Thanks for helping us work through the kinks!

Through the Northwest Addiction Technology Transfer Center, we provided a Trauma Informed Care Foundations training. This was the first of three trainings we’ll provide.

A roundtable discussion on the effects of the opioid crisis on Oregon’s youth was held by Congresswoman Bonamici. We were glad to attend and share in the discussion about solutions, challenges, and support.

I got to hang out with some amazing folks at the Mental Health Hero Award ceremony.

Where We’ve Been:

Since the last newsletter, we had the opportunity to visit Seaside, Fairview, Oregon City, Ashland, Bend, Silverton, and Seattle, WA. Lee Ann Phillips, Project Manager at TIO, attended Peerpocalypse and we are excited about the connections and suggestions received. We also attended the Overcoming ACEs Panel featuring Dr. Nadine Burke Harris hosted by Oregon Public Broadcasting’s (OPB) Dave Miller.

To Do List:

  • For more information about substance use, industrial prison complex, and race watch the documentary 13th
  • Check out OPB’s Think Out Loud for the discussion with Dr. Nadine Burke Harris.
  • We welcome your input on ways we can best support TIC efforts in substance use and addictions services. Please take two minutes to complete this 3 question survey