The Interplay Of Trauma And Addiction In The LGBT Community

1. The Interplay Of Trauma And Addiction In The LGBT Community Jeff Zacharias LCSW, CSAT, CAADC, BRI-I New Hope Recovery Center – Clinical Director Licensed Psychotherapist in Private Practice

2. Trauma and Addiction in the LGBT Community

3. What Is Trauma? • “Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional or spiritual well-being.” • SAMHSA’s Trauma and Justice Strategic Initiative (2012)

4. What Is Trauma? • “Trauma is experiencing too much, too fast, too soon” • OR • “The body remembers what the mind forgets” • Jacob Moreno

5. Cultural Considerations • Persons of color • Gay men vs MSM • Lesbians vs FSF • Bisexual • Transgender – MTF or FTM • Queer • Questioning • Intersex • Not sure • Multiple levels of trauma – racial/ethnic minorities combined with being in a sexual minority

6. Trauma and the LGBT Community • Homophobia • internalized, interpersonal, institutional • Biphobia • Heterosexism • Transphobia

7. Trauma and the LGBT Community • Relentless harassment • Physical violence • Verbal abuse • Terrorizing • Death Threats • Sexual Assault • Blackmail • Imprisonment • Destruction of Personal and Business Property • Cyber-bullying • Bullying • Oppression

8. Trauma and the LGBT Community • Threat of Harm to a Loved One • Death of a Loved One • Injury or Illness of a Loved One   • Suicide of a loved one • Adult Sexual Assault • Childhood Sexual Abuse • Combat & Military Sexual Trauma • Communal Rejection (Scapegoating, Shunning) • Threat of Harm to Other Things • Pets

9. Trauma and the LGBT Community Domestic Partner/Intimate Partner Violence • One out of three to four same sex relationships has experienced domestic violence • Gay or lesbian batterers will threaten “outing” their victims to work colleagues, family and friends • LGBT victims of crime less likely to report to legal authorities • LGBT victims less likely to report due to looking as if there’s a lack of solidarity in the community

10. Trauma and the LGBT Community • Domestic Violence • Physical Assault • Rape • Robbery • Sexual Harassment • Threat of Physical Violence • Torture • Victim of Crime • Victim of Violence • Witnessing Traumatic Event

11. Trauma and the LGBT Community • Discrimination in employment • Discrimination in housing • Discrimination in relationship recognition • Discrimination in health care • Lack of cultural competency in helping professions

12. The Impact of Bullying • Unwanted/aggressive behavior that involves a real or perceived power imbalance repeated over time • Violation of a person’s civil rights • Abusive behavior that targets someone’s gender, religion, race, sexual orientation or national origin • Hazing, harassment and stalking

13. The Impact of Cyber-bullying • Utilizes cell phones, computers, tablets • Takes form through social media sites, text messages, chat, websites • Examples are: mean text messages/emails, rumors spread by email or posted on social networking sites, embarrassing pictures/videos/websites used to humiliate a person, and fake profiles

14. The Impact of Cyber-Bullying • Can happen 24 hours a day, 7 days a week and reaches a wide audience quickly • Difficult to trace the source of the bullying as they are generally posted anonymously • Deleting inappropriate/harassing message, texts or pictures is very difficult once they are posted to the internet

15. Trauma and the LGBT Community 33% of LGB students reported attempting suicide in the previous year. 8% of their heterosexual peers reported attempting suicide. 84% of LGBTQ students were called names or had their safety threatened as a result of their sexual orientation or gender expression. 45% of LGBTQ youth of color experienced verbal harassment and/or physical assault in response to perceived sexual orientation and race/ethnicity.

16. Trauma and the LGBT Community 39% of LGB students and 55 percent of transgender students were shoved or pushed. Transgender youth were one-third more likely to endure physical harassment than LGB students. 64% of LGBTQ students feel unsafe at school. In the most recent month, 29% missed one or more days of school because they felt in danger. 25-40% of homeless youth may identify as LGBTQ. Parents or caregivers often throw them out of their homes after they discover or are told of their child’s sexual orientation. GLSEN

17. Social-Ecological Model of Trauma • Individual Factors • Age, biophysical state, mental health status, • Temperament, personality traits, education, gender, coping styles, socioeconomic status • Interpersonal Factors • Family, peer and other interaction patterns, parent/family mental health, history of trauma, social network

18. Social-Ecological Model of Trauma • Community/Organizational Factors • Neighborhood quality, school system and/or work environment, behavioral health system quality and accessibility, faith based settings, transportation availability, community socioeconomic status, community employment rates • Societal Factors • Laws, State and Federal economic and social policies, media, societal norms, judicial system

19. Social-Ecological Model of Trauma • Cultural/Developmental Factors • Collective or Individualistic norms, ethnicity, cultural subsystem norms, cognitive and maturational development • Period of Time in History • Societal attitudes related to military service, Same sex marriage

20. Addiction and the LGBT Community • Estimated that 40 percent of the LGBT community struggles with some form of addiction (alcohol, substances, process) • Gay and bisexual men appear to suffer from substance abuse at 2 – 3 X that of the general population • Age of first use of drugs/alcohol much younger in the LGBT community compared to the general population

21. Types of Substances Most Widely Used • Ecstasy • Opiates – Heroin, Vicodin, Oxycontin • Club Drugs – Ketamine, GHB • Prescription Drugs – Xanax, Ativan • Tobacco • Alcohol • Marijuana • Cocaine (Crack cocaine and powder) • Amphetamines (crystal meth/Ritalin/Adderall)

22. Populations in the LGBT Community Lesbians: • Few studies looking specifically at the community • Appears they have a higher rate of addiction than their heterosexual counterparts • Drugs include: alcohol, marijuana, opiates, depressants – Xanax/Valium

23. Populations in the LGBT Community Gay and Bisexual Men: • Gay Men: More likely to use drugs than their heterosexual counterparts • Drugs include: Marijuana, Crystal Meth, Cocaine, Crack Cocaine, Ecstasy, Ketamine and GHB • Bisexual Men: Very few studies done on this population, but more so than bisexual women Alcohol, ecstasy, Ketamine, GHB

24. Populations in the LGBT Community Transgender/Transsexual: • According to the National Center for Transgender Equality, Over a quarter of the respondents misused drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression

25. Common Process Addictions • Food/Eating Disorders • Sex • Gambling • Money • Internet • Porn • Exercise • Video Games • Television • Work • Relationships

26. The Link • Trauma and Addiction go hand in hand. • Root is often a trauma usually stemming from childhood • Recognizing the link between the two is vital. • Exposure to trauma increases the risk of substance abuse while the use of substance abuse increases the risk of experiencing trauma • Self medication with drugs/alcohol numbs (temporarily) the emotions associated with trauma • Drugs/alcohol then contribute to a worsening of mood/anxiety/psychotic disorders exacerbating the reactions to trauma – ex: alcohol as a depressant and cocaine stimulating hyper arousal

27. The Link Addiction - pleasure seeking strategy versus survival strategy: • To self-soothe and self-regulate • As a way to numb hyper arousal symptoms: intolerable affects, reactivity, impulsivity, obsessive thinking • In the service of walling off intrusive memories • As a way to combat helplessness by increasing its hyper vigilance and feelings of power and control • To “treat” hyper arousal symptoms of depression, emptiness, numbness, deadening • In the service of facilitating dissociation • As a way to function or to feel safer in the world

28. The Link • Addiction offers relief (albeit temporary) by: • Modulating emotional responses • Mitigation of intense fear • Keeping rage in check • Aids in dissociation or complete shutdown

29. The Link • 50% of all individuals will be exposed to at least one traumatic event during their lives • 10 million adults in the US experience alcohol/drug abuse and/or mental health disorders • Women 2X as likely to develop PTSD with longer symptoms • 55 – 99% of women substance abusers report being victimized in their lifetime (high rates of anxiety, panic disorder, major depression, personality disorders, dissociative disorders, psychotic disorders, somatization, eating disorders) • Clear correlation: rate of substance abuse among persons with PTSD is 60-80% and PTSD among substance abusers is 40-60% (self medication hypothesis)

30. Time frame • Research shows 6-18 months after a traumatic event, people may use drugs/alcohol to cope. • Non drinkers/users start to drink/use. • Current drinkers/users drink/use more. • People in recovery may return to full addiction – drinking/using

31. Types of Trauma • Acute • Chronic • Physical • Emotional/Behavioral • Sexual • Endurance – prolonged sense of feelings unsafe in one’s world esp. during childhood • Caused naturally • Caused by people: Accidents/technological catastrophes • Caused by people: Intentional acts

32. BIG vs. “Little t” Trauma • Psychological effects for both types are likely to be most severe if: • Human caused • Repeated • Unpredictable • Multifaceted • Sadistic • Undergone in childhood • Perpetrated by a caregiver

33. BIG T Trauma • A threat to physical safety be it sexual, mental, verbal or physical in nature • EX: severe car accidents, domestic violence, natural disasters, war experiences, childhood abuse (sexual, physical, emotional), rape

34. Little T Trauma • Common life events that are upsetting on the surface but not thought of as traumatizing long term • Equally as damaging as Big T trauma because they tend to occur over time and build upon each other. • Ex: Death of a pet, divorce, loss of a job, being bullied in school, ongoing emotional abuse/neglect, experiences of shame/humiliation/being left out/not feeling cared for

35. Post-Traumatic Stress Inventory (PTSI-R) • Post-Traumatic Stress Reaction • Individuals experiencing symptoms that are similar to Post Traumatic Stress Disorder (PTSD) • Distressing nightmares or uncomfortably vivid and startling or violent dreams • Experience difficulty falling or staying asleep • Seem to lead a “double” life, one part of which is generally kept secret or hidden from others • Use of drugs (opiates, benzos, alcohol)

36. Post-Traumatic Stress Inventory (PTSI-R) • Trauma Repetition • Individuals that continually/ritualistically seek to re-produce or duplicate the emotional level of arousal that they experienced during the original trauma or disaster • “Re-enacting” the original traumatic event • Accomplished because though you may not remember, your body does remember what happens to it when something traumatic or devastating happens to it, so your body tries to continually reproduce that feeling, until such time that you can heal from it • Self harm – cut, pull, burn, etc. • Engaging in self destructive behaviors – addicted to dangerous behaviors (bathhouses followed by stimulant use followed by increase in public health crisis)

37. Post-Traumatic Stress Inventory (PTSI-R) • Trauma Bonding • Attachment to another person that is not healthy and sometimes dangerous, because the attachment is based upon some form of shame, exploitation, danger, threat, or a combination of these things • Bonded to the other person based upon the type of bonding they experienced growing up, and so they unwittingly re-create the same type of attachments to others, that they experienced when they were young • Addicted to people who have been harmful to them

38. Post-Traumatic Stress Inventory (PTSI-R) • Trauma Shame/Self Perception • Unhealthy sense of self/have genuine difficulty seeing themselves/thinking about themselves with anything other than a critical and angry eye • Constant and chronic state of trying not to feel shame, while the least little thing will bring on an overwhelming sense of shame • Discrepancy between how they really are, or are perceived by others, and how they perceive of themselves • Early childhood abuse or traumatic family dynamic • Adults with eating disorders, those that have experienced early childhood sexual abuse, were raised by a narcissistic parent, and/or experienced a violent family life • Vicious chronic cycle of feeling bad, unworthy, unloved, and self-abased.

39. Post-Traumatic Stress Inventory (PTSI-R) • Trauma Blocking • Numbing, calming, anesthetizing, or satiation with neural pathways involved • Comfort food/compulsive eating, calming sex/ compulsive masturbation, or compulsive use of alcohol/depressant drugs uses to target reduction of anxiety • Numbing behaviors will often follow high arousal behaviors to provide relief from danger, intensity, and the rush of hormonal hyperactivity of the brain • Goal is to slow, reduce, or block the flow of the chemicals which stimulate the brain’s activity.

40. Post-Traumatic Stress Inventory (PTSI-R) • Trauma Arousal • Distorted or damaged affect regulation system • Childhood events that are repetitive/long-term basis and alter a young person’s biochemistry • Violent, raging, narcissistic, out-of-control, chaotic household • “Process” addictive disorders - eating disorders, sexual addiction, self-harmers, gamblers, love addicts, and “thrill junkies”/thrill seekers • High rates of alcoholics and drug addicts • Caffeine, amphetamines, cocaine, or diet pills • Diagnosed with Narcissistic or Borderline Personality Disorder • Disturbed or damaged system of arousal.

41. Post-Traumatic Stress Inventory (PTSI-R) • Traumatic Dissociative Avoidance • Seen by themselves and others as “avoidant”, have trouble being “present”, and seem to be disengaged in any close or intimate encounter • Tend to “split off” negative or upsetting parts of themselves into smaller “fragments” so that they do not have to deal with or face very uncomfortable situations, persons, places, or things • Skilled in avoiding conflict and difficult situations. This was probably a life-saving mechanism for them when they were young, but does not serve them well now • Workaholics

42. Post-Traumatic Stress Inventory (PTSI-R) • Traumatic Self Deprivation • Lead a lifestyle that is in someway “anorexic” to pleasure • Skilled in their ability to avoid any undue pleasure, positive feedback, compliments, and many things that would otherwise be pleasurable. • Eating disordered or sexually anorexic • Deprive themselves of any “extras” in life such as any luxuries or frivolities • Operates in life well below their level of expertise, often finding themselves working at jobs beneath their ability and in relationships with individuals well below their intellectual or social level • May vomit food or use diuretics to control weight • Hoards Money • Uses laxatives for overeating

43. Post-Traumatic Stress Inventory (PTSI-R) • Traumatic Organization • “Compartmentalizes” large aspects or chunks of their life into neat and tidy “folders” • A way to put difficult people, feelings, places, and things on perpetual “hold” so that they do not have to deal with the painful or uncomfortable feelings at that moment • One where people tend to “split off” parts of themselves that are painful, in order to continue living their lives as relatively pain-free as possible.

44. Post-Traumatic Stress Inventory (PTSI-R) • Traumatic Orbitohyperactivity • Appear hyperactive/immense amount of unbounded energy • Impaired relationships/the never-ending need to achieve higher & higher levels of energy. • Early childhood sexual abuse, or come from severely impulsive or out-of-control narcissistic family dynamics where rage, extreme and explosive anger, boundary violations, and objectification and exploitation of others were typical family interactions and style • Gamblers, high sex drive, uses stimulant drugs such as cocaine, crack cocaine and/or crystal meth • Have been told they have mania, OCD, Bipolar Disorder type, hyperactivity, ADHD, Borderline Personality Disorder, Impulse Control Disorder, Antisocial Personality Disorder

45. Post-Traumatic Stress Inventory (PTSI-R) • Traumatic Dorsodepression • Appear to lead a lifestyle that is most characteristic of depression and reduced energy. • Difficulty with abstract thinking concepts, being able to quickly shift from one thought to another, have shortened or lowered attention spans, and tend to be quite ritualistic as opposed to risk-taking. • Opiates, Benzodiazapines, Alcohol

46. Reactions to Trauma • Physical – The body attempts to give itself increased attention, energy and strength • Affective – emotional responses to trauma • Cognitive – thinking of the trauma or the level of capacity to think in an effective manner • Behavioral – actions taken or avoided

47. Reactions to Trauma • How a person reacts is based on: • The event itself (severity of threat, length of the event, how often does it occur) • Context of a person’s life at the time of the trauma (support vs lack of support), health, stress, fatigue, nutrition • Physical characteristics of the person (ability to be resilient?) • A person’s learned capabilities • A person’s sense of their capacity to meet danger (self confidence?)

48. Effects of Trauma • Distrust – unable to receive due to a complete lack of faith in others • Blunted play – inability to move freely in a space • Unconscious patterns of disconnecting, reenacting, transference, splitting, hypervigilance and perfectionism

49. Effects of Trauma • Long term fear of intimacy • Relational commitment – fears of abandonment and being overwhelmed • Poor communication skills – the internal dictionary/listening skills/the ability to seek feedback are all distorted • Boundaries are enmeshed • Deregulated emotions – high frequency/intensity/duration to complete shutdown

50. Therapies Used To Treat Trauma EMDR – Eye Movement Desensitization and Reprocessing • Proven efficacy in dealing with PTSD • Premise: Symptoms arise when traumatic events are not processed correctly and that these symptoms (PTCS, depression, addiction) can be eliminated when memory is fully/appropriately processed • Rapid eye movements to activate past memories of traumatic events, process the memories by bringing them into awareness and restructure the memory • Employs: bilateral stimulation, right/left eye movement and tactile stimulation • Repeatedly activates opposite sides of the brain to relapse emotional experiences that are “trapped” in the nervous system