Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
Interventions that include both the mind and body, such as physically based relaxation strategies, have been found to be more beneficial in the early stages of treatment as compared with cognitive processing strategies. Originally developed as a treatment approach for para-suicidal individuals and clients with borderline personality disorder, DBT is now used in many substance-use treatment centers to help clients cope and regulate their emotions. The research on DBT in the treatment of SUDs is limited to situations in which a borderline-like disorder or severe emotional dysregulation is present together with a SUD (Sanchet et al., 2021). SOLUTION-FOCUSED THERAPY Solution-focused therapy includes techniques related to problem solving that draw on the client’s strengths and past successes. Providers can help the individual find exceptions to substance use by asking when was the last time the individual was not engaging in substance use and why the substance use has changed over time. The provider can also ask the individual to rate his or her motivation on a scale of 1 to 10—a scale simi- lar to those used in motivational interviewing. Furthermore, providers can assess coping strategies that have worked in the past when dealing with difficult problems and use those strate- gies to help the individual cope with triggers for substance use (Shafer & Smock Jordan, 2014). TRAUMA-INFORMED CARE The previously mentioned Adverse Childhood Experiences (ACE) Study (Centers for Disease Control and Prevention, 2022a) has shown a positive association between the number of ACEs and negative health outcomes such as smoking, con- sumption of alcoholic, and drug abuse. Given the high rate of traumatic experiences among clients with SUDs, recogni- tion is growing that failure to consider the role of traumatic experiences and traumatic stress in the lives of clients results in poorer outcomes (Bailey & Stewart, 2014). Individuals may experience traumatic stressors such as serious injury or sexual violation directly, witness others experiencing such events, or learn about them occurring to a family mem- ber or close friend (American Psychiatric Association, 2023). Trauma may be a single event, series of events, or chronic condition. It can affect individuals, families, communities, and cultures; it can also be transmitted across generations (Straussner & Calnan, 2014; Substance Abuse and Mental Health Services Administration, 2022a). Individuals who experience traumatic events may develop trauma reactions that meet diagnostic criteria for trauma- and stressor-related disorders, such as posttraumatic stress disorder (PTSD), as well as other mental disorders (anxiety disorders, mood disorders, SUDs, dissociative disorders, eating disorders, somatization disorders, and personality disorders). Individuals may also experience medical problems and physical symptoms.
Trauma-informed care (TIC) is both an intervention and an organizational approach to delivering care. A program, orga- nization, or system that is trauma-informed: • Realizes the widespread impact of trauma and understands potential paths for recovery. • Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system. • Responds by fully integrating knowledge about trauma into policies, procedures, and practices. • Seeks to actively resist retraumatization . (SAMHSA, 2020a) • Although there are different models of TIC, the key components for TIC are the following: • Safety : Establish a physically and emotionally safe environment; protect individuals from abuse and potential retraumatization via insensitive processes; validate and express clients’ needs; teach clients skills for self-soothing and calming down. • Choice : Support choice autonomy and control; individuals choose when, where, and how and from whom they will receive treatment and services. • Collaboration : Engage clients in treatment planning, progress evaluation, and other decisions
that affect them; equalize power between staff and clients and between staff members and administrators.
• Trustworthiness : Hold appropriate interpersonal boundaries; be clear, consistent, and dependable; organizational processes and decisions should be transparent and facilitate trust among all who are involved with the organization. • Empowerment : Help individuals identify and apply strengths; provide skill building to increase opportunities; recognize and foster resilience. • Diversity : Consider and respect differences in gender, race, ethnicity, religion, culture, class, ability, sexual orientation, language, and socioeconomic status; recognize historical trauma; incorporate diversity-based resources into treatment planning. (Institute for Health and Recovery, 2020; SAMHSA, 2022a, 2022c)
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