Individuals struggling with addiction who also work in a first responder capacity face unique challenges in addiction treatment and recovery. Often referred to as uniformed professionals, these individuals are very likely to work in high-stress environments with an increased risk of physical danger, exposure to trauma and resulting post-traumatic stress disorder (PTSD).
At Marworth Alcohol and Chemical Dependency Treatment Center, we take a specialized approach to treating uniformed professionals, many of whom are typically employed as correctional officers, emergency medical technicians, FBI agents, firefighters, police officers, probation officers and state department employees.
In these professions, trauma can happen in a variety of ways. For example, a police officer might be involved in a shooting, and that single event may have a profound traumatic effect. Or a firefighter may routinely see dead bodies after devastating fires, so the trauma builds gradually over many years. If the traumatic experiences manifest into PTSD, symptoms may include flashbacks, sweats and nightmares. By using drugs or alcohol to relieve anxiety, depression or flashbacks, the trauma survivor can often mask the presence of PTSD, but it becomes a dangerous path to addiction.
Addiction and trauma are not mutually exclusive, but for this population especially, the co-occurring disorders are common enough to necessitate specialized programming that integrates trauma treatment with substance abuse treatment.
Traditional substance abuse counseling emphasizes getting sober and developing skills to cope with cravings, but it does not always focus on learning skills for stabilization and containment of traumatic memories. Alternately, when mental health professionals work with a patient specifically on PTSD, they may underestimate the need for a person in recovery to develop coping skills before opening up about trauma issues. In either scenario, survivors may be re-traumatized and therefore, their vulnerability to relapse increases significantly. In an integrated program, counseling addresses both issues simultaneously and gives patients a higher likelihood of successful recovery.
A key component of integrating trauma and addiction treatment is training staff to identify behaviors that may indicate trauma history and appropriately approach the topic with the patient. Cues of trauma survivors might include frequently displaying extreme emotions without a specific stressor; involvement with abusive or emotionally unavailable partners; engaging in para-suicidal behaviors like cutting; or chronic relapse history. Once identified, staff can implement treatment techniques that help patients learn more adaptive means of containing traumatic memories, self-soothing and regulating emotion.
A common denominator for patients with trauma backgrounds is the basic human need to find or create safety, as outlined in Abraham Maslow’s Hierarchy of Needs. With this in mind, Marworth counselors follow the “Seeking Safety” model of treatment with this population. Developed by Lisa M. Najavits, Ph.D. (professor of psychiatry, Boston University School of Medicine; lecturer, Harvard Medical School; clinical research psychologist in the Veterans Affairs Healthcare System; clinical associate at McLean Hospital), Seeking Safety is an evidence-based counseling model that guides people to attain safety from trauma and substance abuse. It focuses on the present, meaning patients are not required to review any disturbing traumatic memories in their pasts.
The Seeking Safety philosophy incorporate both one-on-one counseling and group counseling. Intense group sessions with other trauma survivors can provide an environment especially conducive to opening up, connecting with others and healing.
Part of building safety is to detach from emotional pain, which is often called grounding. Grounding techniques can be mental, physical or soothing in nature. These techniques can be used when an individual has a painful memory or flashback and feels triggered to abuse drugs or alcohol, as well as in group therapy settings. For example, a therapy group may work on the mental technique of describing the room in which they are sitting in detail. A soothing technique may be to mindfully eat an ice cream cone and think about how it feels and tastes. An example of a physical technique is to go out for a walk or run, and again be mindful of how the activity engages the senses. By focusing on the present, the individual is distracted, and in 10 to 20 minutes, the memory and craving should pass.
Uniformed professionals with trauma backgrounds also tend not to recognize when they need help or understand how to ask for it. Counselors can provide guidance and strategies to patients on how to be aware of the need and ask for help from their support networks.
Anger is another common trait in those with co-occurring addiction and PTSD. By exploring anger as a valid and inevitable feeling, patients see that anger can become constructive instead of always destructive.
In group therapy, patients are also guided to change their thinking through exercises that make them re-envision their future in a positive way. For example, a patient facing a job interview may be inclined to assume that it will go poorly and that rejection is inevitable. Using the recovery thinking technique, that same person changes the scenario by envisioning how he or she will prepare for the interview, get a good night’s sleep, make a genuine effort to connect with the interviewer and be proud of those actions regardless of the outcome.
Other challenges that uniformed professionals contend with throughout recovery include complex family dynamics, the accepted subculture of their professions, losing some control as they transition from a position of leadership to one as a patient, learning how to normalize their responses to stressors and coping with death and dying. A well-balanced treatment program includes counseling and therapeutic activities for each of these topics.
The connection between addiction and trauma is not a new concept, but we now have a better understanding of how powerful that connection is and how to effectively treat it. To continue moving forward, addiction and mental health professionals should take advantage of opportunities to train in this integrated approach. With the guidance of trained professionals, individuals struggling with both addiction and trauma can learn to be aware of trauma symptoms as well as to develop effective coping skills in order to live a more peaceful, sober life.
Robert Olinits, MS, CADC, is the Inpatient Counseling Coordinator at Marworth. William Poray, LCSW, CAC, is the Outpatient Counseling Coordinator at Marworth. Marworth Alcohol and Chemical Dependency Treatment Center is located in Waverly, Pennsylvania. Visit us online at www.marworth.org.