Trauma informed care

Prof. Edward Ogden PSM

Who Gets PTSD?

It depends on:

Severity

Duration

Proximity

PTSD is mitigated or worsened by:

Childhood experience

Personality characteristics

Family history

Social support

Prevalence of PTSD

• More men (61%) than

women (51%) experience

a trauma at some point in

their lives, but women

experience PTSD at

twice the rate of men

(10% vs. 5%)

Kessler, Ronald C., Amanda Sonnega, Evelyn Bromet, Michael Hughes, and Christopher B. Nelson. "Posttraumatic stress disorder

in the National Comorbidity Survey." Archives of general psychiatry 52, no. 12 (1995): 1048-1060.

Tolin, David F., and Edna B. Foa. "Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research." Psychological bulletin 132, no. 6 (2006): 959.

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LaCoursiere, R. B., Godfrey, K. E., & Ruby, L. M. (1980). Traumatic neurosis in the etiology of alcoholism: Viet Nam

combat and other trauma. The American Journal of Psychiatry, 137, 966–968.

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https://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp

• >20% of veterans with PTSD also have SUD.

• War Veterans with PTSD tend to be binge drinkers in response to bad

memories of combat trauma.

• ~30 % of veterans seeking treatment for SUD have PTSD.

• Smoking is almost double for those with PTSD (60%)

• ~10% of returning soldiers for Afghanistan and Iraq have SUD

Examined the health records of 565,024 veterans

48% of returned service personnel 2001 – 2009

11% substance use disorder

10% alcohol

5% drugs

3% both

75% had PTSD and/or depression

16% had a mental health diagnosis

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432 patients with SUD – 158 had PTSD (36.6%)

• I drank to stop my negative feelings and to not be burdened by them. I don’t allow myself to feel anything and I use alcohol as a means to get rid of my feelings.

• When I use, I think about nothing, not about the negative things, the things that happened, the memories… At that moment, I feel great! But it only lasts for a short time and I feel depressed when it’s over.

• … all the patients reported self-medicating behavior and craving after trauma intrusions. They declared that coping motives were the most important reasons they used substances and that relapse often happened when they perceived no other means of coping with a difficult situation.

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• At baseline, almost 95% of the sample (n=126) reported a trauma history

• 41% (n=55) met criteria for current PTSD.

• women 50%, n=34

• men 32%, n=21

Unremitted PTSD is a prognostic indicator for deleterious SUD outcome

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Trauma informed care

Practice

• Realises the impact of trauma &

Understands the paths to recovery

• Recognises the signs of trauma in

clients, families, staff and others

• Responds by integrating

knowledge into practice and policy

• Resists re-truamatisation

Principles

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Resources

• The Trauma Recovery Group: A Guide for Practitioners (2011), Michaela Mendelsohn,

Judith Herman, Emily Schatzow, and Diya Kallivayalil

• Seeking Safety (1998), Lisa Najavits

• http://www.seekingsafety.org

• Trauma Focused-Cognitive Behavioral Therapy : http://tfcbt.musc.edu

• International Society for Traumatic Stress Studies: http://www.istss.org

• http://www.motivationalinterview.org/ clinical/METDrugAbuse.PDF

• Motivational Enhancement Therapy Manual (1994), NIH Pub. No. 94-3723. Order from http://pubs.niaaa.nih.gov/publications/ match.htm.

• Self-assessment Mental Health screening http://www.militarymentalhealth.org/

• Computer-based Problem-solving therapy http://startmovingforward.t2.health.mil/

• Wellness resources http://afterdeployment.t2.health.mil/

Self-Help Mobile Applications

http://www.t2health.org/mobile-apps

PTSD Coach

T2 MoodTracker

Breathe 2 Relax

Tactical Breather

LifeArmor (includes family section)

Self-Help Mobile Applications

http://www.militarymentalhealth.org/ articles/media/

Virtual Hope Box

Positive Activity Jackpot

Provider Resilience