© 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group Women with Substance Abuse & Trauma Related Psychiatric Problems Resource Manual.

© 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

Women with Substance Abuse & Trauma Related Psychiatric Problems

Resource Manual Overview

Paulette Giarratano


Overview of Trauma Related Psychiatric Problems

1.Alterations in:Affect RegulationConsciousness (dissociation) Perception

2. Interpersonal issues 3. Substance Abuse 4. Anxiety5. Depression6. Anger7. Intrusive experiences


Overview of Trauma Related Psychiatric Problems

Trust issues

Unusual behavior & thinking

Reenacting trauma

Self-defeating behavior

Somatic problems

Alienation from others

Unhealthy attachment patterns


Indicators of Trauma related Psychiatric Problems

Relationship problems

Low self-esteem

Addictive & compulsive behavior

Self-destructive behaviors

Poor self-care

Risky Behavior


Additional Challenges

Poverty

Parenting

Adequate Housing

Domestic Violence

Isolation

Lack of Medical Coverage

Health Problems


Additional Challenges

Health problems

Risky Behaviors (HIV, Hepatitis, accidents)

Low self-esteem

Mental health

Substance Abuse


Mental Health

Qualify for multiple diagnoses Constellation of trauma reactions & Substance abuse

Interaction among various social, physical, & emotional problems

Impacts daily functioning

Parenting ability is highly compromised


Mental Health

Common Diagnoses:

Schizophrenia

Depression

Anxiety

Bi-Polar

Personality disorders


More Accurate Diagnoses for Trauma related Psychiatric Problems

Post Traumatic Stress Disorder (PTSD)Disorders of Extreme Stress (DES)Dissociative Disorders not otherwise Specified (DDNOS) Common Chronic Symptoms:

AnxietyDepressionSelf-injurious behaviorDissociationInterpersonal difficulties Cognitive Distortions


Example: Schizophrenia

Real cases of schizophrenia exist but symptoms are similar to those found in trauma survivors who could be diagnosed with PTSD or Dissociative Disorders.

Careful assessment is needed

Auditory hallucinations are characterized as “internal” in trauma related problems & “external” in schizophrenia


Substance Abuse

Interactive relationships between trauma symptoms & substance abuse

Trigger disorders

Perpetuate self-destructive cycle

Alterations in consciousness


Parenting & Substance Abuse

Reckless behavior

Lack supervision

Child Maltreatment

Inappropriate care takers

Hostility & Violence

Unresponsiveness


Substance Abuse Treatment for Women & Children: Core Program Components

Child Care

Prenatal Care

Women focused issues

Mental health services

Comprehensive programming

Women specific programs


Additional Services

Parent TrainingChild CareMedical CareTransportationEducation/Employment ServicesAdvocacy Housing AssistanceCase Management


Studies: Outcomes

Treatment completion Longer retention Decreased substance abuseReduced mental health symptomsImproved birth outcomesIncreased employmentImproved healthDecreased HIV risk


Barriers to Treatment

Feelings of shame, guilt, & inadequacy (stigma)

Lack resources: Medical coverage, child care, & transportation

Inexperienced/overloaded therapists

Lack of integrated trauma & substance abuse programs

Lack social support


Treatment Engagement & Retention Strategies

Outreach (Assertive Community Treatment; ACT)

Motivational Interviewing

Access to Health Care

Access to Integrated treatment services for trauma, mental health, & substance abuse

Ancillary Services

Child Care


Treatment: Mental Health & Substance Abuse

Integrated treatment modelsTrauma

Mental Health

Substance Abuse

Trained trauma, substance abuse, & mental health staff on assessment instruments & procedures & interventions


Integrated Treatment Models

Seeking Safety

TREM: Trauma Recovery & Empowerment

Triad

TARGET: Trauma Adaptive Recovery Group, Education, & Therapy

HWR: Helping Women Recover

ATRIUM: Addiction & Trauma Recovery Integration Model


Integrated Treatment Models

Core Elements of Model Programs

Safety

Stabilization

Skills Training: Affect regulation, Grounding, interpersonal & coping skills

Cognitive & Behavioral Interventions


Interventions for Trauma related psychiatric Disorders & Substance Abuse Interventions that can be target multiple

Areas:

Behavior

Affect

Cognitions

Interpersonal

Physiology


Interventions cont’d

Example: Dialectical Behavior Therapy (DBT)Researched & implemented mostly with Borderline Personality Disorder DBT Targets multiple areas using a range of techniques:Well integrated therapy for women with trauma & substance abuse issues


DBT: Dialectical Behavior Therapy Core Components

Affect regulation skills GroundingMindfulness Behavior AnalysisCoping skills Exposure based techniquesCognitive ModificationValidation


Results from studies on Trauma Interventions

Interventions with better outcomes address Trauma, psychiatric problems, & substance abuse

Affect regulation skills

Safety

Self-care

Behavior Modification

Interpersonal issues

Cognitive Reconstructuring


Results from Studies on Substance Abuse Interventions for Women

CBT: Cognitive Behavioral Therapy (adapted towards interactive nature of trauma & substance abuse)

Trauma Informed programs (Integrated treatment)

Services specifically for women

Peer support services

Advocacy


WCDVS: Women’s Co-Occurring Disorders & Violence Study

Evaluated the effectiveness of integrated programs for women

9 program sites were evaluated after incorporating trauma informed treatment into mental health & substance abuse programs

Compared to standard mental health & substance abuse treatment


Treatment Models Used

Seeking SafetyTREM (Trauma Recovery & Empowerment Model) Triad

Services: Peer run groupsAdvocacyTrauma CounselingSubstance Abuse Treatment


Results

Moderate overall improvement in treatment outcomes

Best outcomes were associated with the degree integrated counseling was incorporated into the program

Worse outcomes were associated with programs with high service components


Results

1 Program significantly produced good outcomes

The variables within the program that contributed to clients’ improvement have not been revealed

Future research may want to examine this finding more closely


Limitations

Amount of treatment varied across sitesComponents & services were not matched entirely across sitesInter-rater reliability of Methods?Staff training /treatment orientation across sites?Treatment/type of program prior to experimentation Client/Counselor relationships were not examined


Implications

Integrative programs for women need to focus on integrative counseling components due to the interactive nature of trauma reactions, mental health, & substance abuse Service components should be incorporated within the program sites because these women have a diversity of issues often as a result of social conditions & trauma histories Train Integrative Trauma staff/incorporate into Graduate educational programs/continuing education requirements


Implications

Women often do not engage or remain in treatment because of childrenConsequences may arise from seeking treatmentMany programs use standardized models of treatment that can worsen trauma related problems & unmeet needs Treatment providers need to Collaborate with Criminal Justice & Child Protective Services while maintaining trust & advocacy for clientsIncorporate programs especially for women & their children


Conclusion

Assessment: Train clinicians to identify trauma related psychiatric problems is an important precursor to treatment Treatment Engagement & Retention: Outreach, engagement & retention interventions need to be incorporated, along with providing access to resources (Medical coverage) Treatment: Integrated Programs, use innovative interventions to target trauma related psychiatric problems & substance abuse Services: Adjunct women specialty services

© 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group Women with Substance Abuse & Trauma Related Psychiatric Problems Resource Manual.

Documents

schizophrenia slide

substance abuse trauma

consciousness slide

compromised slide

emotional problems

trauma survivors

accurate diagnoses

interpersonal issues