Trauma Theory and Trauma-Informed Care in Substance Use Disorders: A Conceptual Model for Integrating Coping and Resilience
National data of children’s exposure to traumatic experiences are alarming. Research asserts the interconnectedness between experiencing childhood trauma (CT) or adverse childhood experiences (ACE) and developing substance use disorders (SUDs) in later adulthood. Trauma definition and contemporary trauma theory (CTT) provide the foundation for trauma informed care (TIC) in social work practice with co-occurring trauma and SUDs. TIC re-conceptualizes SUDs as a mechanism to cope with the effects of trauma. Coping and resilience are relevant factors to the ramifications of CT on SUDs, and are the manifestation of key TIC principles. Integrating TIC practices aimed at enhancing coping and resilience into treatment for co-occurring trauma and SUDs is needed in order to negate the devastating impact of trauma and propel recovery. Conclusions and implications to social work practice are discussed.
Armstrong, A. R., Galligan, R. F., & Critchley, C. R. (2011). Emotional intelligence and psychological resilience to negative life events. Personality and Individual Differences, 51, 331-336. doi: https://doi.org/10.1016/j.paid.2011.03.025
Back, S. E., Killeen, T. K., Teer, A. P., Hartwell, E. E., Pederline, A., Beylotte, F., & Cox, E. (2014). Substance use disorders and PTSD: An exploratory study of treatment preferences among military veterans. Addictive Behaviors, 39, 369-373. doi: https://doi.org/10.1016/j.addbeh.2013.09.017
Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York: W. W. Norton.
Banducci, A. N., Hoffman, E., Lejuez, C. W., & Koenen, K. C. (2014a). The relationship between child abuse and negative outcomes among substance users: Psychopathology, health, and comorbidities. Addictive Behaviors, 39, 1522–1527.
Banducci, A. N., Hoffman, E. M., Lejuez, C. W., Koenen, K. C. (2014b). The impact of childhood abuse on inpatient substance users: Specific links with risky sex, aggression, and emotion dysregulation. Child Abuse & Neglect, 38, 928-938. doi: https://doi.org/10.1016/j.chiabu.2013.12.007
Beauvais, F., & Oetting, E. R. (1999). Drug use, resilience, and the myth of the golden child. In M. D. Glantz & J. L. Johnson (Eds.), Resilience and development: Positive life adaptations, (pp. 101-107). New York: Kluwer Academic/Plenum Publishers.
Becker-Blease, K. A., & Freyd, J. J. (2005). Beyond PTSD: An evolving relationship between trauma theory and family violence research. Journal of Interpersonal Violence, 20(4), 403-411. doi: https://doi.org/10.1177/0886260504269485
Bloom, L. B., & Farragher, F. (2011). Destroying sanctuary: The crisis in human service delivery system. New York: Oxford University Press.
Bombardier, C., Blake, K., Ehde, D., Gibbons, L., Moore, D., & Kraft, G. (2004). Alcohol and drug abuse among persons with multiple sclerosis. Multiple Sclerosis, 10(1), 35-40. doi: https://doi.org/10.1191/1352458504ms989oa
Brown, S. M., Baker, C. N., & Wilcox, P. (2012). Risking connection trauma training: A pathway toward trauma-informed care in child congregate care settings. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 507-515. doi: https://doi.org/10.1037/a0025269
Brucker, D. (2007). Estimating the prevalence of substance use, abuse, and dependence among Social Security Disability benefit recipients. Journal of Disability Policy Studies, 18(3), 148-159. doi: https://doi.org/10.1177/10442073070180030301
Chou, C. C., Robb, J. L., Clay, M. C., & Chronister, J. N. (2013). Social support as a mediator between internalized stigma and coping behaviors of individuals with substance abuse issues. Rehabilitation Research, Policy, and Education, 27(2), 104-107. doi: https://doi.org/10.1891/2168-66220.127.116.11
Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86-100. doi: https://doi.org/10.1037/1942-9681.S.1.86
Courtois, C. A., & Ford, J. D. (2016). Treatment of complex trauma: A sequenced, relationship-based approach. NY: Guilford Press.
Covington, S. S. (2008). Women and addiction: A trauma informed approach. Journal of Psychoactive Drugs, 5, 377-385. doi: https://doi.org/10.1080/02791072.2008.10400665
Cowell, R. A., Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2015). Childhood maltreatment and its effect on neurocognitive functioning: Timing and chronicity matter. Development and Psychopathology, 27, 521-533. doi: https://doi.org/10.1017/S0954579415000139
Dickey, B., Azeni, H., Weiss, R., & Sederer, L. (2000). Schizophrenia, substance-use disorders, and medical co-morbidity. Journal of Mental Health Policy and Economics, 3, 27-33. doi: https://doi.org/10.1002/1099-176X(200003)3:1<27::AID-MHP67>3.0.CO;2-P
Downey, L. A., Johnston, P. J., Hansen, K., Birney, J., & Stough, C. (2010). Investigating the mediating effects of emotional intelligence and coping on problem behaviors in adolescents. Australian Journal of Psychology, 62(1), 20-29. doi: https://doi.org/10.1080/00049530903312873
Driessen, M., Schulte, S., Luedecke, C., Schaefer, I., Sutmann, F., Ohlmeier, M., …the TRAUMAB-Study Group. (2008). Trauma and PTSD in patients with alcohol, drug, or dual dependence: A multi-center study. Alcoholism Clinical and Experimental Research, 32(3), 481-488. doi: https://doi.org/10.1111/j.1530-0277.2007.00591.x
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences Study. Pediatrics, 111(3), 564-572. doi: https://doi.org/10.1542/peds.111.3.564
Elwyn, L., & Smith, C. (2013). Child maltreatment and adult substance abuse: The role of memory. Journal of Social Work Practice in the Addictions, 13, 269-294. doi: https://doi.org/10.1080/1533256X.2013.814483
Erozkan, A. (2013). Exploring the relationship between perceived emotional intelligence and coping skills of undergraduate students. International Journal of Human Sciences, 10(1), 1537-1549.
Farrugia, P. L., Mills, K. L., Barrett, E., Back, S. E., Teesson, M., Baker, A.,…Brady, K. T. (2011). Childhood trauma among individuals with co-morbid substance use and post- traumatic stress disorder. Mental Health and Substance Use, 4(4), 314-326. doi: https://doi.org/10.1080/17523281.2011.598462
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,… Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (Ace) Study. American Journal of Preventive Medicine, 14(4), 245-258. doi: https://doi.org/10.1016/S0749-3797(98)00017-8
Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth. Jama Pediatrics, 42, 614-621. doi: https://doi.org/10.1001/jamapediatrics.2013.42
Finkelhor, D., Turner, H., Shattuck, A., Hamby, S., & Kracke, K. (2015). Children’s exposure to violence, crime, and abuse: An update. U.S. Department of Justice: Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention. Retrieved from https://www.ojjdp.gov/pubs/248547.pdf
Franken, I. H. A., Hendriks, V. M., Haffmans, J., & van der Meer, C. W. (2003). Coping style of substance-abuse patients: Effects of anxiety and mood disorders on coping change. Journal of Clinical Psychology, 59(10), 1125–1132. doi: https://doi.org/10.1002/jclp.10205
Handley, E. D., Rogosch, F. A., Guild, D. J., & Cicchetti, D. (2015). Neighborhood disadvantage and adolescent substance use disorder: The moderating role of maltreatment. Child Maltreatment, 20(3), 193-202. doi:https://doi.org/10.1177/1077559515584159
Harris, W. W., Lieberman, A. F., & Marans, S. (2007). In the best interests of society. Journal of Child Psychology and Psychiatry, 48(3), 392-411. doi:https://doi.org/10.1111/j.1469-7610.2007.01732.x
Heffernan, K., Cloitre, M., Tardiff, K., Marzuk, P. M., Portera, L., & Leon, A. C. (2000). Childhood trauma as a correlate of lifetime opiate use in psychiatric patients. Addictive Behaviors, 25, 797-803. doi: https://doi.org/10.1016/S0306-4603(00)00066-6
Henderson, N., & Milstein, M. (1996). Resiliency in schools: Making it happen for students and educators. Thousand Oaks, CA: Corwin Press.
Herman, J. L. (1992). Trauma and recovery: The aftermath of violence - from domestic abuse to political terror. New York: Basic Books.
Jung, H., Herrenkohl, T. I., Klika, J. B., Olivia-Lee, J. O., & Brown, E. C. (2014). Does child maltreatment predict adult crime? Reexamining the question in a prospective study of gender differences, education, and marital status. Journal of Interpersonal Violence, 30(13), 1-20. doi: https://doi.org/10.1177/0886260514552446
Khantzian, E. J., & Albanse, M. J. (2008). Understanding addiction as self-medication: Finding hope behind the pain. Lanham, MD: Rowman & Littlefield.
Keyser-Marcus, L., Alvanzo, A., Rieckmann, T., Thacker, L., Sepulveda, A., Forcehimes,…Svikis, D. S. (2015). Trauma, gender, and mental health symptoms in individuals with substance use disorders. Journal of Interpersonal Violence, 30(1), 3-24. doi: https://doi.org/10.1177/0886260514532523
Kuper, L. E., Gallop, R., & Greenfield, S. F. (2010). Changes in coping moderate substance abuse outcomes differentially across behavioral treatment modality. The American Journal on Addictions, 19, 543-549. doi: https://doi.org/10.1111/j.1521-0391.2010.00074.x
Laplanche, J., & Pontalis, J. B. (1973). The language of psycho-analysis. London: Hogarth Press.
Levendosky, A. A., & Buttenheim, M. (2010). A multi-method treatment for child survivors of sexual abuse: An intervention informed by relational and trauma theories. Journal of Child Sexual Abuse, 9(2), 1-19. doi: https://doi.org/10.1300/J070v09n02_01
Levenson, J. S. (2014). Incorporating trauma-informed care into sex offender treatment. Journal of Sexual Aggression, 20(1), 9-22. doi: https://doi.org/10.1080/13552600.2013.861523
Levenson, J. (2015). Adverse childhood experiences and subsequent substance abuse in a sample of sexual offenders: Implications for treatment and prevention. Victims & Offenders, 11(2), 199-224. doi: http://dx.doi.org/10.1080/15564886.2014.971478
Levenson, J. (2016). Adverse childhood experiences and subsequent substance abuse in a sample of sexual offenders: Implications for treatment and prevention. Victims & Offenders, 11(2), 199-224. doi: https://doi.org/10.1080/15564886.2014.971478
Levenson, J., & Grady M. (2016). Substance abuse, violence, and childhood adversity: Implications for trauma-informed social work practice. Journal of Social Practice in the Addictions, 16(1), 24-45. doi: https://doi.org/10.1080/1533256X.2016.1150853
Lewis, J. D. (2012). Towards a unified theory of trauma and its consequences. International Journal of Applied Psychoanalytic Studies, 9(4), 298-317. doi: https://doi.org/10.1002/aps.1305
Liu, Y., Wang, Z., & Lü, W. (2013). Resilience and affect balance as mediators between trait emotional intelligence and life satisfaction. Personality and Individual Differences, 54, 850-855. doi: https://doi.org/10.1016/j.paid.2012.12.010
Lizeretti, N. P., Extremera, N., & Rodriguez, A. (2012). Perceived emotional intelligence and clinical symptoms in mental disorders. Psychiatric Quest, 83, 407-418. doi: https://doi.org/10.1007/s11126-012-9211-9
Lyvers, S. L. M., & Edward, M. S. (2008). Childhood sexual abuse and substance abuse in relation to depression and coping. Journal of Substance Use, 13(5), 349-360. doi: https://doi.org/10.1080/14659890802211077
Mészáros, J. (2010). Building blocks toward contemporary trauma theory: Ferenczi’s paradigm shift. American Journal of Psychoanalysis, 70, 328-340. doi: https://doi.org/10.1057/ajp.2010.29
Mikolajczak, M., Nelis, D., Hansenne, M., & Quoidbach, J. (2008). If you can regulate sadness, you can probably regulate shame: associations between trait emotional intelligence, emotion regulation and coping efficiency across discrete emotions. Personality and Individual Differences, 44, 1356-1368. doi: https://doi.org/10.1016/j.paid.2007.12.004
Montgomery, J. M., Schwean, V. L., Burt, J-A. G., Dyke, D. I., Thorne, K. J., Hindes, Y. L.,…Kohut, C. S. (2008). Emotional intelligence and resiliency in young adults with Asperger's disorder challenges and opportunities. Canadian Journal of School Psychology, 23(1), 70-93. doi: https://doi.org/10.1177/0829573508316594
National Center for Mental Health Promotion and Youth Violence Prevention. (2012). Childhood trauma and its effects on healthy development. Retrieved from http://sshs.promoteprevent.org/sites/default/files/trauma_brief_in_final.pdf
Nijenhuis, E. R. S., & van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations. Journal of Trauma & Dissociation, 12(4), 416-445. DOI: 10.1080/15299732.2011.570592
O’Connor, M., & Elklit, A. (2008). Attachment styles, traumatic events, and PTSD: A cross- sectional investigation of adult attachment and trauma. Journal of Attachment and Human Development, 10(1), 59-71. doi: https://doi.org/10.1080/14616730701868597
Oshri, A., & Rogosch, F. A. (2013). Child maltreatment and mediating influences of childhood personality types on the development of adolescent psychopathology. Journal of Clinical Child & Adolescent Psychology, 42(3), 287-301. doi: https://doi.org/10.1080/15374416.2012.715366
Perera, H. N., & DiGiacomo, M. (2015). The role of trait emotional intelligence in academic performance during the university transition: An integrative model of mediation via social support, coping, and adjustment. Personality and Individual Differences, 83, 208-213. doi: https://doi.org/10.1016/j.paid.2015.04.001
Ringel, S., & Brandell, J. R. (Eds.). (2012). Trauma: Contemporary directions, theory, practice, and research. Thousand Oaks, CA: Sage. doi: https://doi.org/10.4135/9781452230597
Roberts, A. C., Galassi, J. P., McDonald, K., & Sachs, S. (2002). Re-conceptualizing substance abuse treatment in therapeutic communities: Resiliency theory and the role of social work practitioners. Journal of Social Work Practice in the Addictions, 2(2), 53-68. doi: https://doi.org/10.1300/J160v02n02_06
Ross, C. A. (2000). The trauma model: A solution to the problem of comorbidity in psychiatry. Richardson, TX: Manitou Communications.
Saklofske, D. H., Austin, E. J., Galloway, J., & Davidson, K. (2007). Individual difference correlates of health-related behaviors: preliminary evidence for links between emotional intelligence and coping. Personality and Individual Differences, 42, 491-502. doi: https://doi.org/10.1016/j.paid.2006.08.006
Salovey, P., & Sluyter, D. J. (Eds.). (1997). Emotional development and emotional intelligence. New York: BasicBooks.
Schneider, T. R., Lyons, J. B., & Khazon, S. (2013). Emotional intelligence and resilience. Personality and Individual Differences, 55, 909-914. doi: https://doi.org/10.1016/j.paid.2013.07.460
Schutte, N. S., Malouff, J. M., & Hine, D. W. (2011). The association of ability and trait emotional intelligence with alcohol problems. Addiction Research and Theory, 19(3), 260-265. doi: https://doi.org/10.3109/16066359.2010.512108
Shapiro, R. (2010). The trauma treatment handbook: Protocols across the spectrum. New York: W. W. Norton.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. NY: Rodale Books.
Siegal, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford.
Siegal, D. J. (2010). Mindsight: The new science of personal transformation. NY: Bantam Books.
Smyth, N. J., & Wiechelt, S. A. (2005). Drug use, self-efficacy and coping skills among people with concurrent substance abuse and personality disorders: Implications for relapse prevention Journal of Social Work Practice in the Addictions, 5(4), 63-80. doi: https://doi.org/10.1300/J160v05n04_05
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2012).Trauma definition. Part one: Defining trauma. Retrieved from http://www.samhsa.gov/traumajustice/traumadefinition/definition.aspx
SAMHSA. (2015). Trauma-Informed approach and trauma-specific interventions. Retrieved from: http://www.samhsa.gov/nctic/trauma-interventions
Suleiman, S. R. (2008). Judith Herman and contemporary trauma theory. Women's Studies Quarterly, 36, 1(2), 276-281. doi: https://doi.org/10.1353/wsq.0.0016
Tarren-Sweeney, M. (2013). An investigation of complex attachment- and trauma-related symptomatology among children in foster and kinship care. Child Psychiatry and Human Development, 44(6), 727- 741. doi: https://doi.org/10.1007/s10578-013-0366-x
Toker, T., Ti̇ryaki̇, H., Ozçürümez, G., & Iskender, B. (2011). The relationship between traumatic childhood experiences and proclivities towards substance abuse, self-esteem and coping strategies. Turkish Journal of Psychiatry, 22(2), 83-92.
Torchalla, I., Nosen, L., Rostam, H., & Allen, P. (2012). Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 42, 65-77. doi: https://doi.org/10.1016/j.jsat.2011.09.001
Toth, S., Gravener-Davis, J. A., Guild, D. J., & Cicchetti, D. (2013). Relational interventions for child maltreatment: Past, present, and future perspectives. Development and Psychopathology, 25, 1601-1617. doi: https://doi.org/10.1017/S0954579413000795
Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38(3), 323- 330. doi: https://doi.org/10.1016/j.amepre.2009.11.012
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS.
Valtonen, K., Sogren, M., & Cameron-Padmore, J. (2006). Coping styles in persons recovering from substance abuse. British Journal of Social Work, 36, 57-73. doi: https://doi.org/10.1093/bjsw/bch247
van Dam, D. V., Ehring, T., Vedel, E., & Emmelkamp, P. M. G. (2013). Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: A randomized controlled trial. BMC Psychiatry, 13, 172-185.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Group, LLC.
Van der Kolk, B., McFarlane, A. C., & Weisaeth, L. (2006). Traumatic stress: The effects of overwhelming experiences on mind, body, and society. NY: Guilford.
Weiland, B. J., Nigg, J. T., Welsh, R. C., Yau, W-Y. W., Zubieta, J-K., Zucker, R. A., & Heitzeg, M. M. (2012). Resiliency in adolescents at high risk for substance abuse: Flexible adaptation via subthalamic nucleus and linkage to drinking and drug use in early adulthood. Alcoholism: Clinical and Experimental Research, 36(8), 1355-1364. doi: https://doi.org/10.1111/j.1530-0277.2012.01741.x
Williams, W. I. (2006). Complex trauma: Approaches to theory and treatment. Journal of Loss and Trauma, 11, 321-335. doi: https://doi.org/10.1080/15325020600663078
Wu, N. S., Schairer, L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35, 68-71. doi: https://doi.org/10.1016/j.addbeh.2009.09.003
Zeidner, M., Kloda, I., & Matthews, G. (2013). Does dyadic coping mediate the relationship between emotional intelligence (EI) and marital quality? Journal of Family Psychology, 27(5), 795-805. doi: https://doi.org/10.1037/a0034009
Zeidner, M., Matthews, G., & Roberts, R. D. (2012). The emotional intelligence, health, and well-being nexus: What have we learned and what have we missed? Applied Psychology: Health and Well-Being, 4(1), 1-30. doi: https://doi.org/10.1111/j.1758-0854.2011.01062.x
Copyright (c) 2017 Revital Goodman
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright to works published in Advances in Social Work is retained by the author(s).
Beginning with Volume 17 Number 2, all articles published in this journal are licensed under a Creative Commons Attribution 4.0 International License.