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PTSD and the Opioid Dependent Client

PTSD and the Opioid Dependent Client . Angel Landrum, M. A. Licensed Professional Counselor. Angel Landrum, M.A. LPC Worked in substance dependence field for over 6 years Narcotic Treatment Program over 3 years. Overview. Identify: Stress Trauma PTSD Dependence as Trauma

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PTSD and the Opioid Dependent Client

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  1. PTSD and the Opioid Dependent Client Angel Landrum, M. A. Licensed Professional Counselor

  2. Angel Landrum, M.A. LPC • Worked in substance dependence field for over 6 years • Narcotic Treatment Program over 3 years Angel Landrum, MA LPC

  3. Overview • Identify: • Stress • Trauma • PTSD • Dependence as Trauma • Techniques to help clients Angel Landrum, MA LPC

  4. Stress Trauma PTSD Angel Landrum, MA LPC

  5. Stress Stress is the body’s reaction to an event that excites, frightens, confuses, or endangers the individual • Coping mechanism • Important and essential Angel Landrum, MA LPC

  6. Trauma 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 Angel Landrum, MA LPC

  7. System Overwhelm • 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 Angel Landrum, MA LPC

  8. Central Nervous System 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 Angel Landrum, MA LPC

  9. System Dysregulation • 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 Angel Landrum, MA LPC

  10. System Dysregulation, contd. • 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 Angel Landrum, MA LPC

  11. System Dysregulation, contd. • 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 Angel Landrum, MA LPC

  12. PTSD 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 Angel Landrum, MA LPC

  13. How Common is PTSD? • 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 Angel Landrum, MA LPC

  14. PTSD – Who’s Susceptible? Research has shown that certain groups are more susceptible: • Women • Minorities • Those with mental health problems • Those whose family members have MH problems • Those with a non-existent support system Angel Landrum, MA LPC

  15. Criteria for 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 Angel Landrum, MA LPC

  16. Criteria for PTSD, contd. • 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 Angel Landrum, MA LPC

  17. Common Stress Reactions of PTSD Fear and Anxiety (Sympathetic Nervous system) • Feel tense or afraid • Agitated and jumpy • Must be on alert Angel Landrum, MA LPC

  18. Common Stress Reactions of PTSD, contd. 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 Angel Landrum, MA LPC

  19. Common Stress Reactions of PTSD, contd. Guilt and Shame • Clients may feel ashamed because during the trauma they acted in ways that they would not otherwise have done • Survivors guilt Angel Landrum, MA LPC

  20. Common Stress Reactions of PTSD, contd. 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 Angel Landrum, MA LPC

  21. Symptoms of PTSD Reliving the event or re-experiencing the event • Nightmares • Flashbacks • Seeing a person or being in similar place Angel Landrum, MA LPC

  22. Symptoms of PTSD, contd. Avoidance • Trying to avoid situations or people that trigger memories of the traumatic event • Resists talking about the event Angel Landrum, MA LPC

  23. Symptoms of PTSD, contd. • Feeling numb • Cannot express what they feel • Feeling keyed-up (hyper-arousal) • Always on alert and on the lookout for danger Angel Landrum, MA LPC

  24. Dependence as a Traumatic Event • Lengths to feed their Dependence • Seeing a friend/family member overdose or die • Overdosing themselves • Judgment from society and family- OTP Angel Landrum, MA LPC

  25. Dependence as a Traumatic Event, contd. • 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) Angel Landrum, MA LPC

  26. Dependence as a Traumatic Event, contd. • 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 Angel Landrum, MA LPC

  27. Trauma/PTSD • 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? Angel Landrum, MA LPC

  28. Working with Trauma Symptoms Client starts to disassociate…now what? Put on your Oxygen Mask and Ground Angel Landrum, MA LPC

  29. Working with Trauma Symptoms, contd. • Grounding • Connect • Contain • Calm Angel Landrum, MA LPC

  30. Working with Trauma Symptoms, contd. Grounding • Grounding is a connection between the person/space/thing and the earth • Establishes physical, emotional and spiritual safety Angel Landrum, MA LPC

  31. Working with Trauma Symptoms, contd. Connect • Establishing a connection that creates safety in the present moment • Reminding them to breathe and be in the moment Angel Landrum, MA LPC

  32. Working with Trauma Symptoms, contd. Contain • Containment exercise • Visualization works great • Educate the client Angel Landrum, MA LPC

  33. Working with Trauma Symptoms, contd. Calm • Breathing is back to normal • Can you feel your feet? • Stabilize Angel Landrum, MA LPC

  34. Referring the Client • 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 Angel Landrum, MA LPC

  35. Compassion Fatigue • A reaction experienced by counselors who suffer trauma from the event(s) that have traumatized their patients. Also called “Vicarious Traumatization” and “Secondary Trauma Angel Landrum, MA LPC

  36. Compassion Fatigue Cond. Signs and Symptoms Angel Landrum, MA LPC

  37. Compassion Fatigue Cond. Recovery from Fatigue Accept support and non-judgmental listening when offered Avoid negative people Exercise, get out doors Take turns with the most stressful tasks Staff Support Groups Get Support Angel Landrum, MA LPC

  38. In Closing • 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 Angel Landrum, MA LPC

  39. Questions? ? Angel Landrum, MA LPC

  40. Contact Information • For copy of the presentation, please email me: • Angel.Landrum@gmail.com • www. AngelLandrum.com Angel Landrum, MA LPC

  41. Other Resources • Trauma First Aide • www.traumafirstaide.com Angel Landrum, MA LPC

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