Beyond the Shadows: A Reflective Deep Dive into Trauma-Informed Recovery

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Recovery Dialogues and Sober Stories.

Welcome back to another bonus episode of Recovery Dialogues and Sober Stories. Sober Stories. I'm your host, Antonio Matta. Today we're turning the spotlight back onto one of our most profound episodes from Season 2, "The Dance of Shadows: Confronting Dual Diagnosis and the Implications of Integrated Trauma-Informed Care." In this reflective deep dive, we'll revisit the powerful insight shared by our esteemed guest, Cynthia Kimberley Wing, Dr. Kelsey Latimer, and Dr. Thomas Franklin as we explore the intricate pathways of mental health, trauma, addiction, and the nonlinear journey of recovery. Whether you're new to our show or a longtime listener, this episode promises to shed new light on the complexities of healing and the transformative power of resilience.

Recovery is not linear. So when I do relapse or I feel like I'm going to relapse, it's part of the process, but the point is not to give up. And my faith definitely plays a role in that too, in that acceptance of not giving up. With therapy, I had— I've had some phenomenal therapists before, and looking back, there were times where I didn't always understand their approach. And I think of a few people specifically who were, who showed me some tough love. And at the time I thought it was just tough and I didn't like them for it. But then I realized they were just very smart and observant of my behaviors and they were responding to it in a very methodical way. Where I would have to be stuck with myself. There were times where it seemed like maybe they were ignoring me or they weren't reacting so dramatically, but that was part of the intervention, was to be low-key, and I had to deal with myself because they weren't dealing with it. And it allowed me to look in the mirror, look at what I was doing, look at if I was engaging in certain behaviors and things for attention, even though I felt like I got a high off of it. And when it came to the substances of medication, I had great support. I had one social worker one time escort me personally to a crisis respite center, and I was terrified to go and terrified to stay there, but being escorted there and That social worker stood with me until I got all signed in. It was really helpful.

Embracing the idea that relapse is a natural part of the recovery journey can profoundly impact a person's resilience and long-term success in overcoming addiction. This perspective fosters a compassionate and realistic understanding of what it means to recover, enhancing coping strategies and leading to better overall outcomes. When we recognize that relapse is a common occurrence, it helps reduce the stigma that often comes with it. This reduction in stigma can boost self-confidence and resilience. Research indicates that high levels of perceived social support are linked to lower relapse rates because supportive environments bolster self-esteem and motivation during recovery. Understanding that relapse might be part of the journey makes individuals feel less isolated and more empowered to seek help when they face challenges. This aligns with findings that effective addiction treatments incorporate social support mechanisms, which are crucial for preventing relapse. Acknowledging relapse also leads to more personalized and responsive treatment strategies. For instance, programs that integrate cognitive behavioral therapy have shown promise in helping people develop coping mechanisms to deal with triggers and stressors that may lead to relapse. By framing relapse as a learning opportunity rather than a setback, treatment programs can encourage individuals to reflect on their experiences and adjust their strategies accordingly, which is vital for long-term recovery. This approach is supported by evidence showing that a significant percentage of relapses occur within the first 6 months after treatment, highlighting the need for ongoing support and adaptable plans. Moreover, recognizing the role of relapse can enhance the overall success rates of addiction treatment programs. Studies have shown that structured aftercare and continuous monitoring can significantly decrease relapse rates. When individuals are prepared for the possibility of relapse and equipped with strategies to manage it, they're more likely to stay engaged in long-term recovery efforts. This proactive stance can lead to improved outcomes, as evidenced by programs that emphasize lifelong recovery goals and effectively Managing relapses.

Relapses.

Individuals who experience trauma are resilient as they continue to prevail after the trauma experience. Trauma is painful and individuals cope with pain in a wide variety of ways, including substance use. Trauma triggers toxic stress chemicals within the brain, causing damage over time. This can result in the rewiring of the brain, which can impact our emotions. There is a clear link between trauma and addiction. Environmental factors such as exposure to substance use as a coping mechanism during a trauma can increase these rates. Individuals who are engaging in substance use recovery plans should be engaged as a whole person, which includes their trauma history. If the trauma is not addressed and the substance use recovery plan is not holistically addressing the challenges, often individuals who struggle with addiction are engaged in behavioral activities that can be traumatizing within themselves, and individuals can fall into a cycle of trauma.

Dr. Franklin, what are some best practices for managing and treating dual diagnosis? Have you encountered any specific treatment methods or interventions that have shown promising results?

Best practices for treating co-occurring disorders, in my mind, are to aggressively treat the substance use disorder, but also at the same time, aggressively evaluate and treat the underlying psychiatric or psychological disorder that is almost always accompanying the substance use disorder. This is why it's been such a tragedy that substance use disorder treatment has been oftentimes split off from psychiatric and psychological treatment such that you have these parallel universes of treatment centers that are only looking at one part of the elephant. Somebody will go to a psychiatric hospital and maybe get to go to a 12-step meeting while they're there. Somebody might go to a drug and alcohol rehabilitation center and they might have a part-time psychiatrist on staff that sees people once a month and there's very little expert psychiatric treatment ongoing.

Experiencing trauma especially during childhood, can profoundly reshape the brain, and this often contributes to the development of substance use disorders, or SUDs. When someone goes through traumatic events, it can lead to changes in how their brain processes emotions, rewards, and stress. These changes might make substances like drugs or alcohol seem more appealing as a way to find pleasure or escape from painful feelings. Many individuals who have faced trauma develop post-traumatic stress disorder, PTSD, and there's a close and complex relationship between PTSD and SUDs. Sometimes people turn to substances as a way to cope with the distressing symptoms of PTSD, a concept known as the self-medication hypothesis. This coping mechanism while understandable, can lead to a challenging cycle where substance use makes it harder to heal from trauma. Research shows that those with SUDs often have imbalances in key neurobiological systems involving chemicals like dopamine and cortisol, which play important roles in how we respond to stress and experience rewards. These imbalances can worsen PTSD symptoms creating a vicious cycle that makes recovery even more difficult. Understanding this intricate interplay between trauma and substance use is crucial for developing effective treatments. Integrated treatment approaches that address both PTSD and SUDs at the same time have shown great promise. For example, cognitive behavioral therapy can help individuals challenge and change unhelpful thoughts, related to trauma while also addressing harmful substance use behaviors. Medications that target the specific neurobiological issues in both conditions can also enhance the effectiveness of treatment. Supportive therapies like psychoeducation and family therapy provide essential understanding and tools for both individuals and their loved ones. These approaches help everyone involved comprehend the complex relationship between trauma and substance use, fostering healthier coping mechanisms and stronger support systems. By recognizing and addressing the shared pathways between trauma and substance use disorders, we can create personalized interventions that truly meet the unique needs of each person. This tailored approach can lead to better engagement in treatment and more positive outcomes on the journey toward healing.

[FOREIGN] So I think that in itself is very important, is don't assume that trauma looks a particular way. Don't assume that somebody's going to come to you and say, this is trauma. Sometimes you're the one that's going to be helping them to validate an experience or a set of experiences or an overall kind of way of life that they've lived for a particular period of time. Now, I think it is so incredibly important in the light of co-occurring because a lot of times the trauma is maybe even a core foundational issue that then leads to the symptom that we might be seeing on the other side of it, which could be an abuse of substances, a, an eating disorder or cutting, and all of those, or even sexually acting out.

That's a big one as well.

There's a multitude of different things that people do, and we're trying to figure out why are they doing those things and giving a voice to that. They may not recognize, they might just think that they're an impulsive, out of control person. But then you dive more deeply into it and that it's actually performing something really important for them. Maybe it's numbing them from the experiences of pain and overwhelm that they cannot manage otherwise, or they don't think they can manage otherwise. Maybe it's giving them a sense of control over their body or their mind when they don't feel that otherwise. So there's a lot of different things that, that a trauma-informed experience can help somebody understand.

Integrating validation from clinicians and adapting trauma-informed approaches can significantly enhance the effectiveness of treatment for individuals facing both mental health challenges and substance use disorders. By recognizing the widespread impact of trauma, we emphasize the importance of sensitivity and understanding in every treatment setting. This compassionate approach is especially crucial for those with co-occurring disorders, as past traumatic experiences often intertwine with the mental health and substance use struggles. When clinicians provide genuine validation, they help build strong therapeutic relationships. By acknowledging and affirming a person's feelings and experiences, they can ease the feelings of shame and isolation that often accompany trauma. Research shows that when patients feel understood and supported, they're more likely to engage fully in their treatment and stick with it, leading to better overall outcomes. Trauma-informed approaches go beyond individual interactions. They involve creating safe and supportive clinical environments. This includes fostering a positive organizational culture, offering staff training on trauma sensitivity and implementing services that focus on healing trauma. Studies have found that organizations embracing these practices see improvements in patient satisfaction and reductions in symptoms relating to mental health and substance use disorders. By investing in training and development, clinicians become better equipped to recognize and respond to trauma, enhancing the effectiveness of the care they provide. There's also evidence that trauma-informed care can lead to better mental health outcomes and reduce the need for emergency services. Patient-centered care, which aligns closely with trauma-informed principles, has been associated with fewer emergency room visits and hospitalizations among individuals with complex needs. This is particularly important for those with co-occurring disorders who often navigate multiple care systems and may face barriers in accessing appropriate treatment.

[Speaker:KAYLA] I do remember feeling like I was watching a movie of my life and feeling things that I learned later on were classic, very textbook symptoms of dissociation. I just couldn't put a word or a phrase or a name to it at that time because I was so young. When I look back, I realize, oh, I was totally addicted to such and such. I was totally disconnected and dissociated. So I just didn't know. And then when I learned later on that certain things were happening, I was just, oh, that makes sense. Again, it really wasn't early intervention. It was more like going back, going in reverse. And saying, okay, what happened at this point in my life does happen as a trauma response. And it really just validated the things that I didn't know were going on, that I just was like, I'm not sure if there's something wrong with me. So the intervention that I did have really proved to be validation, and it made me want to continue in my recovery and having the conversations and asking for help. And I'm still doing that. I'm still seeking as much support as possible professionally and socially. And it's because I did realize a lot and I learned a lot looking back once I did start asking for help.

Navigating adolescence can be challenging. And for some young people, early dissociative experiences, often linked to trauma, add an extra layer of complexity. These experiences can sometimes lead to the development of addictive behaviors, creating a multifaceted relationship that is important to understand and address with compassion and care. Research indicates that dissociation, especially as a response to traumatic events, can serve as a precursor to maladaptive behaviors like substance use. Adolescents who frequently experience dissociation may feel psychological distress that makes them more vulnerable to turning to substances or other addictions as coping mechanisms. For instance, studies published in Psychological Trauma: Theory, Research, Practice, and Policy highlight that dissociation is a significant outcome of trauma and is associated with behavioral problems, including substance use disorders. Similarly, research from Psychiatry Investigation found that adolescents with higher levels of dissociation are at increased risk for self-injurious behaviors and suicidal tendencies. This suggests that without appropriate support, dissociative symptoms can escalate into more severe behavior issues like substance abuse. A study in Psychiatry and Clinical Neurosciences also shows a high comorbidity of dissociative disorders with substance use and other psychiatric conditions among adolescents, indicating that dissociation may play a role in the development of these behaviors. The Adolescent Dissociative Experiences Scale is a tool used to assess dissociative symptoms and their correlation with behavioral problems. Research using the tool reveals that adolescents with elevated scores often report higher instances of substance use and other externalizing behaviors. This reinforces the idea that dissociation can lead to maladaptive coping strategies such as substance use as a way to regulate overwhelming emotions. Both community and clinical studies suggest that these symptoms can manifest as attempts to escape dissociative states. However, there is hope and a path forward. Early intervention is crucial in mitigating the risk of addiction among adolescents experiencing dissociative symptoms. Trauma-informed care, psychoeducation, and therapeutic approaches that address both dissociative symptoms and substance use behaviors are effective strategies. For example, integrating mindfulness practices, can help adolescents manage their dissociative experiences, reducing the likelihood of turning to substances. Creating supportive environments that foster healthy coping mechanisms also play a significant role. Programs focusing on building resilience and emotional regulation skills have shown promise in decreasing the initiation of substance use among vulnerable youth.

[FOREIGN LANGUAGE] [Speaker:KRYSTALINA] Stigma also paints the picture that recovery is linear, and if someone has a setback, that they are not trying or putting in the effort. In addition, stigma often results in inaccurate stereotypes, such as believing individuals with co-occurring disorder are violent, lazy, or that they chose their current situation. A common stigma is that only certain people experience co-occurring disorders and that it doesn't affect all walks of life. Due to stigma, people are less likely to seek the support in communities, can become fearful of the development of supportive services, We could combat stigma by talking about substance use and mental health on a more regular basis, showing up in the world and being okay that these are aspects of all of our lives that affect everyone, and working within a preventative framework where we normalize these things just as we normalize going to the doctor for physical healthcare. We make people not feel shamed by their experiences and what they're going through. And we provide a sense of hope.

Dr. Latimer, how can individuals with dual diagnosis build resilience and develop coping strategies to manage their symptoms?

I think I've addressed some of this before in my other answers. In terms of resilience, here's what I'm going to say about it. This might even feel a little controversial because How I see people that, that have co-occurring, and again, not even co-occurring, just addiction, eating disorder, whatever it might be, okay, is that you're a survivor. Listen, if you survived something, if it helped you get through something, then you already have resilience, right? You just are not using it to help you. You're using it against you. You don't know how to hold on to your strengths and make them work for you. And that's the role of people on your coping team. That's the role of your therapist and your psychiatrist and your dietitian and your family and your support community. All those people to rally around you and lift you up and help you see everything that you don't already just know about yourself.

Stigmatizing beliefs about nonlinear recovery can profoundly affect individuals dealing with both mental health challenges and substance use issues. These misconceptions often lead to negative perceptions and discrimination, making it even more challenging for people to seek and engage with the treatment they need. For example, research published in the journal Stigma and Health highlights that perceived stigma and discrimination are linked to poorer mental health outcomes among women in substance abuse treatment. This indicates that stigma doesn't just hurt, it can actually hinder recovery efforts and worsen mental health symptoms over time. Similarly, studies in substance use and misuse point out that individuals facing mental health difficulties are often unfairly viewed as dangerous or peculiar, which can deter them from seeking help and participating in recovery processes. When individuals internalize this stigma, a phenomenon known as self-stigma, it further complicates their journey toward healing. Research in the BMJ Journal suggests that self-stigma mediates the relationship between perceived stigma and psychosocial outcomes, leading to lower self-esteem and reduced willingness to seek help. This internalized stigma can create a vicious cycle where people feel unworthy of treatment, perpetuating their struggles with with both mental health and substance use disorders. Additionally, the stigma associated with substance use can lead healthcare providers to misdiagnose or underdiagnose these individuals, as noted in studies from the Journal of Substance Abuse Treatment, further delaying appropriate care. To combat these stigmatizing beliefs and encourage treatment engagement, several effective strategies have been identified. Education and awareness campaigns that aim to dispel myths about mental health and substance use disorders are crucial. By providing accurate information about these conditions, we can reduce public stigma and improve attitudes toward those affected. Interventions that focus on enhancing coping skills and self-esteem among individuals experiencing self-stigma have also shown promise. By addressing and altering these self-defeating beliefs, we can empower people to seek the help they deserve. Creating supportive environments within healthcare settings is essential as well. Research from the Transactions of the Royal Society of Tropical Medicine and Hygiene discusses how stigma experienced within healthcare can deter individuals from accessing necessary services. This highlights the need for training healthcare providers to recognize and mitigate their own biases, By fostering a culture of acceptance and understanding, we can significantly improve treatment engagement for individuals with co-occurring disorders. Peer support programs that connect individuals with shared experiences are another powerful tool for reducing stigma and promoting recovery. These programs provide a sense of community and understanding that can counteract feelings of isolation and shame. When people realize they are not alone, it can make a world of difference in their recovery journey.

When I see somebody on a professional level that they walk the walk and now they turn their life around and they're helping others, it really has a huge impact on me.

What advice would you give someone struggling with co-occurring disorders and hesitant to seek help? How can they find the strength to take the first steps towards recovery?

I would say not to try to predict what'll happen and not to try to think about being judged or anything like that. Definitely do not predict negative experiences. Just keep it simple and leave it for what it is and just say, This is who I am. This is what I'm dealing with. I need help. And keep it as simple as that because I know for me, I definitely thought way too much about what could happen, what folks might say, and all kinds of things. But when I finally said something and I started receiving support, it was so much better than I thought. So either way, as a recovering addict, before we enter recovery, we're dealing with the addiction. After we enter recovery, the addiction is still there, but we learn how to manage it and how to deal with it and live life around it so that we don't have to succumb to that addiction. If you have to pick between one of the two, just being an addict and the addiction takes over you, or being a recovering addict and you can take over the addiction, which one would you pick? Because that's what it boils down to. It's going to be one of those two things.

Connecting with professionals and mentors who have lived through similar experiences can profoundly impact individuals hesitant to seek help for co-occurring disorders. Their firsthand knowledge helps build trust and relatability, offering personalized support that truly resonates with the unique challenges these individuals face. Peer support specialists, people who have personally navigated mental health challenges and substance use disorders, play a crucial role in enhancing treatment engagement and recovery outcomes. By sharing their own journeys, they establish strong rapport with clients who may feel alienated or stigmatized by traditional healthcare systems. Research shows that peer support can lead to better treatment adherence and reduced substance use among those with co-occurring disorders. The credibility and authenticity of these peers allow them to connect on a deeper level, fostering an environment where individuals feel genuinely understood and supported. Integrating peer support into treatment models has been associated with increased motivation for recovery. For example, peer recovery coaches can effectively encourage patient engagement and retention in treatment by providing both emotional and practical support. This is especially beneficial for underserved populations These coaches often share similar backgrounds with their clients, enhancing the relatability of their support and encouraging individuals to pursue treatment options they might otherwise avoid due to fear or skepticism. Their shared experiences not only inspire hope, but also offer practical insights into navigating the complexities of treatment and recovery. Moreover, social support networks, including peers, are critical in overcoming the barriers to treatment that individuals with co-occurring disorders often face. Studies have shown that strong social support can significantly reduce symptom severity and improve overall recovery outcomes. The presence of supportive peers can counteract feelings of isolation and despair, which are common among those reluctant to seek help. This sense of community is vital in motivating individuals to engage with treatment services and adhere to their recovery plans, ultimately leading to better health outcomes.

[FOREIGN LANGUAGE] I think the biggest challenge and impact simultaneously is having dissociative identity disorder because there are so many times where if I slip into an addiction, I can't really say what happened beforehand. I can try to piece together what happened based on what maybe somebody tells me, or if I might have been involved in a conversation via text message. There's just a lot of things that I depend on other people for, if they've witnessed it or been around me before I slipped into something. But a lot of things also happen when I'm by myself. So it makes it harder and more challenging to know what led up to it, to keep track of things. But in my experience, I try my best to go on what I do know instead of focusing on what I don't know and try to maintain sobriety the best I can.

When did you first realize you had co-occurring disorders? Did something specific happen that made you seek help?

That's a great question. I got diagnosed with dissociative identity disorder in 2018, and I had severe anxiety and depression probably my whole life in retrospect, but I got diagnosed in like 2008, 2009. So the DID came much later and realizing that it was a problem and I had all this stuff piling on top of each other came actually after my diagnosis, especially my diagnosis of DID.

Memory fragmentation and identity dissociation in individuals with dissociative identity disorder, DID, can make substance use treatment particularly challenging. DID is categorized by the presence of two or more distinct personality states and recurrent gaps in the recall of everyday events known as dissociative amnesia. These symptoms can interfere with a person's ability to engage effectively in treatment. The fragmented nature of memory often leads to difficulties in maintaining a coherent personal history, which is crucial for understanding and addressing substance use issues. Different identities may have varying levels of motivation, awareness, and willingness to confront substance use problems, leading to inconsistent engagement with treatment. The interplay between dissociation and substance use is complex. Individuals with DID may turn to substances as a coping mechanism to manage overwhelming emotions or to escape from traumatic memories associated with their difficult identities. Unfortunately, this maladaptive strategy can lead to a cycle of substance abuse that worsens dissociative symptoms, making recovery more challenging. The presence of co-occurring conditions such as post-traumatic stress disorder (PTSD) can further complicate treatment. These individuals often experience heightened dissociative symptoms during substance use, which can increase memory gaps and identity confusion. Tailored interventions are essential to improve recovery outcomes for individuals with DID who are also struggling with substance use. Phase-oriented psychotherapy, which includes stabilization, trauma work, and integration of identities, has shown effectiveness in treating DID. This approach allows for the gradual processing of traumatic experiences while addressing substance use in a supportive environment. By integrating substance use treatment with trauma-informed care, clinicians can better understand the underlying trauma that contributes to both dissociation and substance use. Interventions focusing on enhancing memory functioning and promoting identity integration can also be highly beneficial. Techniques like narrative therapy encourage individuals to construct a cohesive life story, helping bridge gaps in memory and fostering a sense of continuity across identities. Mindfulness-based strategies can assist individuals in grounding themselves in the present moment, reducing the likelihood of dissociative episodes during treatment. Managing co-occurring disorders, substance use along with depression, anxiety, PTSD, dissociative identity disorder. Managing co-occurring disorders, substance use along with depression, anxiety, PTSD, dissociative identity disorder, or other mental health conditions can make recovery especially challenging. The interplay of multiple conditions calls for a compassionate, comprehensive approach. Remember, healing is possible and you're not alone on this journey. Integrated care that addresses all aspects of your mental health can help individuals progress to managing co-occurring disorders, substance use along with depression, anxiety, PTSD, dissociative identity disorder, or other mental health conditions can make recovery especially challenging. The interplay of multiple condition— the interplay of multiple conditions calls for a compassionate, comprehensive approach. Healing is possible, and people are not alone on their journey. Integrated care that addresses all aspects of their mental health can help them progress toward wellness. Tailored interventions can foster effective coping strategies and give them greater control over their life. That does it for this introspective journey beyond the shadows. If you found this episode enlightening and valuable, we invite you to download it, share it with others, and continue the conversation. Your support means the world to us. We're gearing up for an empowering and transformative season mechanism 3, and we need your help to make it a reality. Visit our GoFundMe campaign at the link in the description. Even a donation as small as a dollar can make a significant impact in helping us bring more inspiring stories and insights to you. We're also seeking sponsors who share our passion for fostering recovery and mental wellness. If you're interested in partnering with us, please reach out for more details. Stay tuned for more bonus content leading up to the launch of the new season. Remember, recovery is like a phoenix rising from the ashes. It's not just about surviving but thriving, crafting a purpose-driven life that resonates with vitality and fulfilled potential. Until next time, take care and keep soaring.

Recovery is possible. Recovery is possible. Recovery is possible.

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