Addressing trauma must become standard operating process

Being trauma informed in treatment matters. In fact, Stephanie S. Covington, PhD, LCSW, Institute for Relational Development/Center for Gender and Justice, said it doesn’t even make sense to provide treatment without understanding an individual’s trauma history.

“The biggest impediment [in treatment] is unresolved trauma because it impacts people’s capacity to truly recover,” she said in the opening plenary session for the 2015 National Conference on Addiction Disorders (NCAD) in St. Louis.

While trauma can stem from a single event or a series of ongoing, chronic and complex happenings, Covington said trauma is all about the specific individual’s response. It can often overwhelm people’s ability to cope, create changes in the brain that become chronic and impact functions via the brain-body connection, she added. This is why trauma can be an underlying cause for substance abuse.

Gender’s impact
Trauma also affects men and women differently, Covington said. For example, women attribute positive and negative experiences differently than men. And while humiliation is a man’s greatest fear, for a woman it is abuse and harm. Because of this, what feels unsafe for a woman may not be something a man would even acknowledge or consider as dangerous or harmful.  

On the other hand, she said, it’s harder for men to talk about trauma because everything in recovery and treatment goes against the messages received early on in childhood to be strong, to not ask for help and to go it alone.

According to Covington, long-term, female-only treatment models have shown a 49 percent success rate in recovery outcomes, including long-term abstinence, fewer mental health issues and staying out of the criminal justice system.

Truly trauma informed
For providers, being truly trauma informed means not only addressing and taking trauma into account during treatment, but also avoiding triggers in all aspects of service delivery. Covington said this needs to become the standard operating process in practice.

“We have to assume that trauma histories are there and deal with them in some universal way; changing how we provide services across the board has no effect for people who aren’t affected by trauma, but makes all the difference for people who are,” she said. For example, all patients are universally treated like they have HIV positive, and Covington says it should be the same way with becoming trauma informed.

While the mantra in treatment often is to address underlying trauma once a person is clean and sober, she said, “We can’t just shove this aside. This is possible to do.”

Steps to take 
There are five core values of being trauma informed: Safety, trust, choice, collaboration and empowerment, Covington explains. In order to determine how to address each of those values in an individual facility or organization, she recommends organizing a walk-through while role-playing staff interaction with a traumatized client. Putting yourself in their shoes might spark awareness of certain culture changes that need to be made or prompt the creation of a new routine, she said. For example:

• If a staff member’s mentality or actual words to a patient fall along the lines of “Your best thinking got you here, so let me show you what to do,” that doesn’t promote choice or collaboration;
• If group sessions start late regularly, your program may not be trustworthy to clients;
• If crisis appointments are only offered on certain days of the week, this takes away choice; and
• If lighting and navigation are poor in and around a facility, that neither empowers clients nor makes them feel safe. 

“The basics are what need to be addressed; we’re not even talking about service here,” Covington said. In order to implement successful shifts in culture, she added, everyone from administrators to food service staff needs to be on board.

Similarly, clients and staff alike need to learn what trauma and abuse is, understand the typical responses and develop coping skills, she said. Even providers can be susceptible to secondary traumatic stress, emotional burnout and vicarious traumatization.

“What makes a difference is creating a safe environment, actively listening and ultimately empathizing,” Covington said. “Studies say that the therapeutic process is most important, and while it is, people need a connection with someone who sees them and cares. The magic is not on the paper of any program materials that you write. The magic is in each one of you.”

Like broken bones that heal and become strong at the site of injury, trauma will always be present. Covington finished by asking attendees, “Can we help them become strongest at that broken place?”

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