PTSD and the Opioid Dependent Client

Angel Landrum, M. A.

Licensed Professional Counselor

Angel Landrum, MA LPC

◦Angel Landrum, M.A. LPC

◦Worked in substance dependence field for over 6 years

◦Narcotic Treatment Program over 3 years


Identify:◦Stress◦Trauma◦PTSD

Dependence as Trauma Techniques to help clients



Stress is the body’s reaction to an event that excites, frightens, confuses, or endangers the individual

Coping mechanism

Important and essential


Trauma is a set of physiological, cognitive, emotional, behavioral and spiritual symptoms that result from events that overwhelm the nervous system’s ability to cope


Can happen in any situation due to individual perception of the situation

Any situation can be potentially traumatizing if it is perceived to be: Life threatening Life altering Life diminishing Life deadening


The CNS (Central Nervous System) is overwhelmed and becomes dysregulated during a traumatic event

Individuals can lose the capacity to stabilize and regulate themselves

Results in feelings of helplessness, hopelessness and sense of being out of control


Where the body holds trauma:

◦Peripheral Nervous System consists of:

◦Autonomic Nervous System Circulatory, respiration, digestion, reproduction

◦Somatic Nervous System (Sensory-Motor) muscles reflexes proprioceptors


Loss of Self-Regulation over time is the core of PTSD

Traumatized people have to go from stimulus to a response without being able to assess the cause of the stress

Trauma disorganized the Nervous System


Trauma is in the nervous system---It’s NOT the event

Symptoms arise when the residual energy from the experience is not released from the nervous system


Posttraumatic stress disorder, or PTSD, can occur after someone goes through, sees, or learns about a traumatic event like:

Traumas

• Combat exposure •Child sexual or

physical abuse • Terrorist attack • Sexual/physical

assault • Serious accident • Natural disaster • Jury Duty• Dependence

traumas

• Job Related Stress

• Relationship Stress

• Fender Bender • Financial Stress


About 60% of men and 50% of women experience at least one traumatic event in their lifetime

Of those who do, about 8% of men and 20% of women will develop PTSD



Person must have both of these elements:

◦Event involved actual or threatened death or serious physical injury to the patient or to others AND the person felt intense fear, horror or helplessness

◦Person repeatedly relives the event in at least one of these ways: Intrusive, distressing recollections Repeated distressing dreams


Acute: If duration of symptoms are less than three months

Chronic: If duration of symptoms are three months or more

Specify if: With or without delayed Onset Onset of symptoms at least six months

after the event


Fear and Anxiety (Sympathetic Nervous system)

◦Feel tense or afraid

◦Agitated and jumpy

◦Must be on alert


Sadness/Depression

◦Sadness after a trauma may come from a sense of loss---of a loved one, of trust in the world, faith, or a previous way of life

◦Crying spells-lost of interest in things they used to enjoy- want to isolate feeling tired, empty, numb


Guilt and Shame

◦Clients may feel ashamed because during the trauma they acted in ways that they would not otherwise have done

◦Survivors guilt


Anger and Irritability

◦Anger may result from feeling of being unfairly treated (Misconceptions of OST)

◦Behavior changes or repeated attempts to manage opiate Dependence and distance themselves from treatment


Reliving the event or re-experiencing the event

Nightmares

Flashbacks

Seeing a person or being in similar place


Avoidance Trying to avoid situations or people that

trigger memories of the traumatic event

Resists talking about the event


Feeling numb ◦Cannot express what they feel

Feeling keyed-up (hyper-arousal) ◦Always on alert and on the lookout for

danger


Lengths to feed their Dependence Seeing a friend/family member overdose

or die Overdosing themselves Judgment from society and family- OTP


Withdrawal - not being able to fix during active drug use

Withdrawal - brought on self◦Not able to pay for services◦Not being complaint with rules of program◦Jail (if no services are available for dosing)


Withdrawal - In Opiate Treatment Programs, this can be a real event that is played out repeatedly

Withdrawal - In the Legal System with no access to medication when incarcerated


Remember - Even if the client doesn’t meet criteria for PTSD…

Traumatic events that remain stuck in the CNS can cause havoc

How can you help?


Client starts to disassociate…now what?

Put on your Oxygen Mask and Ground


Grounding

Connect

Contain

Calm


Grounding

Grounding is a connection between the person/space/thing and the earth

Establishes physical, emotional and spiritual safety


Connect

Establishing a connection that creates safety in the present moment

Reminding them to breathe and be in the moment


Contain

Containment exercise

Visualization works great

Educate the client


Calm

Breathing is back to normal

Can you feel your feet?

Stabilize


Important to know when to refer a person to a higher level of care if it is beyond our expertise

Outside Agencies may specialize in this area◦ Safe Place or YWCA◦ www.211.org

Private Clinicians who specialize in Trauma EMDR www.emdria.org

http://www.211.org/

http://www.emdria.org/

A reaction experienced by counselors who suffer trauma from the event(s) that have traumatized their patients.

Also called “Vicarious Traumatization” and “Secondary Trauma


Bystanders GuiltRageGriefDreadAnxietyDifficulty ConcentratingDepression

Numbing- “Have nothing left to give.”Panic AttacksDisturbed Sleep NightmaresChronically Late to WorkCrying Spells


Signs and Symptoms


Recovery from Fatigue Accept support and non-judgmental listening when offered Avoid negative peopleExercise, get out doorsTake turns with the most stressful tasksStaff Support GroupsGet Support


Traumatic events can cause relapse in our clients

Educate on how the body holds these traumatic events and that there is a solution

Anyone has the ability to help ground someone in the here and now


?


For copy of the presentation, please email me:

[email protected]

www. AngelLandrum.com

mailto:[email protected]

Trauma First Aide◦ www.traumafirstaide.com


http://www.traumafirstaide.com/

Documents

PTSD and the Opioid Dependent Client