| Excerpted from Social Work Today
Treating Addiction and Trauma in Women
By Jeanne Cantrell, PhD and Christine Kuehn Kelly
Treat the addiction first and then deal with emotional issues--that's the conventional wisdom on addictions treatment. But what happens when patients are no longer anesthetized by drugs or alcohol?
What happens when the removal of the chemical substance tears the thin membrane that veils horrific memories?
For many women who have experienced severe trauma in their young lives, the traditional addiction treatment approach often is not enough. Frequently, the emotional impact of the trauma worsens once they stop abusing drugs and alcohol. If the emotional pain is not addressed, the result can be relapse, and early treatment drop out related to the symptoms of untreated and worsening Posttraumatic Stress Disorder (PTSD).
The Women's Trauma and Addiction Program at Princeton House--a division of The Medical Center at Princeton--was specifically created to address the needs of women with a dual history of trauma and addiction. The need for the program become evident when therapists in the Women's Trauma Program identified a large number of patients with concomitant substance abuse issues.
Diane Altman, LCSW, an addictions counselor at Princeton House at that time had also noticed that her addicted patients often had a secondary diagnosis of PTSD. These independent observations resulted in collaboration between Altman, now the Coordinator of the Women's Trauma and Addiction Program, and Dr. Jeanne Cantrell. The result was the simultaneous, integrated treatment of addiction and the psychological ramifications of abuse.
Initially there was a great deal of skepticism from the treatment community about the approach, said Dr. Cantrell. "Now there is a good deal of support, as evidenced by the dramatically increasing numbers of referrals to the program every year. Because of our integrated program across the continuum, 85% of our clients continue as outpatients after an inpatient stay."
This is double the typical rate of follow up for dual diagnosis patients being discharged from traditional inpatient programs. And although Altman isn't aware of other integrated trauma and addiction programs in the region, she believes the trend is going in the dual treatment direction. "Our hope is that integrated programs become the model for women's addiction treatment.
Women's addiction is often intertwined with issues of trauma (Stewart, 1996). Many women report that they began using drugs after a specific traumatic event in their lives, particularly incest and rape (Hurley, 1991). In fact, as much as 75% women in treatment report sexual and physical abuse (Miller, 2000). Often, the abuse is repetitive. In women, the resulting PTSD is most commonly associated with substance abuse disorders and dependence
Yet despite the strong link between addiction and childhood abuse, women typically have to choose between treatment programs that focus either on addiction recovery or addressing Axis I symptoms arising from trauma, said Dr. Cantrell. When addiction programs don't fit the needs of women, the drop out rate is extraordinarily high. Therapists also have to deal with the reality that substance abuse typically has high relapse rates, despite the best psychotherapy. "Woman with trauma repeatedly relapse," said Altman. "As soon they quit 'using,' they can feel horrible." PTSD symptoms frequently surface, and can include anxiety, depression, panic attacks, self-mutilation and flashbacks. Without tailored treatment, the substance abuse cycle can start again, as the addict attempts to manage her painful symptoms.
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