1 / 33

Women with Substance Abuse & Trauma Related Psychiatric Problems

Women with Substance Abuse & Trauma Related Psychiatric Problems . Resource Manual Overview Paulette Giarratano . Overview of Trauma Related Psychiatric Problems . 1.Alterations in: Affect Regulation Consciousness (dissociation) Perception 2. Interpersonal issues 3. Substance Abuse

nishi
Download Presentation

Women with Substance Abuse & Trauma Related Psychiatric Problems

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Women with Substance Abuse & Trauma Related Psychiatric Problems Resource Manual Overview Paulette Giarratano © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  2. Overview of Trauma Related Psychiatric Problems 1.Alterations in: • Affect Regulation • Consciousness (dissociation) • Perception 2. Interpersonal issues 3. Substance Abuse 4. Anxiety 5. Depression 6. Anger 7. Intrusive experiences © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  3. Overview of Trauma Related Psychiatric Problems • Trust issues • Unusual behavior & thinking • Reenacting trauma • Self-defeating behavior • Somatic problems • Alienation from others • Unhealthy attachment patterns © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  4. Indicators of Trauma related Psychiatric Problems • Relationship problems • Low self-esteem • Addictive & compulsive behavior • Self-destructive behaviors • Poor self-care • Risky Behavior © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  5. Additional Challenges • Poverty • Parenting • Adequate Housing • Domestic Violence • Isolation • Lack of Medical Coverage • Health Problems © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  6. Additional Challenges • Health problems • Risky Behaviors (HIV, Hepatitis, accidents) • Low self-esteem • Mental health • Substance Abuse © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  7. Mental Health • Qualify for multiple diagnoses • Constellation of trauma reactions & Substance abuse • Interaction among various social, physical, & emotional problems • Impacts daily functioning • Parenting ability is highly compromised © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  8. Mental Health Common Diagnoses: • Schizophrenia • Depression • Anxiety • Bi-Polar • Personality disorders © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  9. More Accurate Diagnoses for Trauma related Psychiatric Problems • Post Traumatic Stress Disorder (PTSD) • Disorders of Extreme Stress (DES) • Dissociative Disorders not otherwise Specified (DDNOS) • Common Chronic Symptoms: • Anxiety • Depression • Self-injurious behavior • Dissociation • Interpersonal difficulties • Cognitive Distortions © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  10. Example: Schizophrenia Real cases of schizophrenia exist but symptoms are similar to those found in trauma survivors who could be diagnosed with PTSD or Dissociative Disorders. • Careful assessment is needed • Auditory hallucinations are characterized as “internal” in trauma related problems & “external” in schizophrenia © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  11. Substance Abuse Interactive relationships between trauma symptoms & substance abuse • Trigger disorders • Perpetuate self-destructive cycle • Alterations in consciousness © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  12. Parenting & Substance Abuse • Reckless behavior • Lack supervision • Child Maltreatment • Inappropriate care takers • Hostility & Violence • Unresponsiveness © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  13. Substance Abuse Treatment for Women & Children: Core Program Components • Child Care • Prenatal Care • Women focused issues • Mental health services • Comprehensive programming • Women specific programs © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  14. Additional Services • Parent Training • Child Care • Medical Care • Transportation • Education/Employment Services • Advocacy • Housing Assistance • Case Management © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  15. Studies: Outcomes • Treatment completion • Longer retention • Decreased substance abuse • Reduced mental health symptoms • Improved birth outcomes • Increased employment • Improved health • Decreased HIV risk © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  16. Barriers to Treatment • Feelings of shame, guilt, & inadequacy (stigma) • Lack resources: Medical coverage, child care, & transportation • Inexperienced/overloaded therapists • Lack of integrated trauma & substance abuse programs • Lack social support © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  17. Treatment Engagement & Retention Strategies • Outreach (Assertive Community Treatment; ACT) • Motivational Interviewing • Access to Health Care • Access to Integrated treatment services for trauma, mental health, & substance abuse • Ancillary Services • Child Care © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  18. Treatment: Mental Health & Substance Abuse • Integrated treatment models • Trauma • Mental Health • Substance Abuse • Trained trauma, substance abuse, & mental health staff on assessment instruments & procedures & interventions © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  19. Integrated Treatment Models • Seeking Safety • TREM: Trauma Recovery & Empowerment • Triad • TARGET: Trauma Adaptive Recovery Group, Education, & Therapy • HWR: Helping Women Recover • ATRIUM: Addiction & Trauma Recovery Integration Model © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  20. Integrated Treatment Models Core Elements of Model Programs • Safety • Stabilization • Skills Training: Affect regulation, Grounding, interpersonal & coping skills • Cognitive & Behavioral Interventions © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  21. Interventions for Trauma related psychiatric Disorders & Substance Abuse Interventions that can be target multiple Areas: • Behavior • Affect • Cognitions • Interpersonal • Physiology © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  22. Interventions cont’d Example: Dialectical Behavior Therapy (DBT) • Researched & implemented mostly with Borderline Personality Disorder • DBT Targets multiple areas using a range of techniques: • Well integrated therapy for women with trauma & substance abuse issues © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  23. DBT: Dialectical Behavior Therapy Core Components • Affect regulation skills • Grounding • Mindfulness • Behavior Analysis • Coping skills • Exposure based techniques • Cognitive Modification • Validation © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  24. Results from studies on Trauma Interventions • Interventions with better outcomes address Trauma, psychiatric problems, & substance abuse • Affect regulation skills • Safety • Self-care • Behavior Modification • Interpersonal issues • Cognitive Reconstructuring © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  25. Results from Studies on Substance Abuse Interventions for Women • CBT: Cognitive Behavioral Therapy (adapted towards interactive nature of trauma & substance abuse) • Trauma Informed programs (Integrated treatment) • Services specifically for women • Peer support services • Advocacy © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  26. WCDVS: Women’s Co-Occurring Disorders & Violence Study • Evaluated the effectiveness of integrated programs for women • 9 program sites were evaluated after incorporating trauma informed treatment into mental health & substance abuse programs • Compared to standard mental health & substance abuse treatment © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  27. Treatment Models Used • Seeking Safety • TREM (Trauma Recovery & Empowerment Model) • Triad Services: Peer run groups Advocacy Trauma Counseling Substance Abuse Treatment © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  28. Results • Moderate overall improvement in treatment outcomes • Best outcomes were associated with the degree integrated counseling was incorporated into the program • Worse outcomes were associated with programs with high service components © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  29. Results • 1 Program significantly produced good outcomes • The variables within the program that contributed to clients’ improvement have not been revealed • Future research may want to examine this finding more closely © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  30. Limitations • Amount of treatment varied across sites • Components & services were not matched entirely across sites • Inter-rater reliability of Methods? • Staff training /treatment orientation across sites? • Treatment/type of program prior to experimentation • Client/Counselor relationships were not examined © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  31. Implications • Integrative programs for women need to focus on integrative counseling components due to the interactive nature of trauma reactions, mental health, & substance abuse • Service components should be incorporated within the program sites because these women have a diversity of issues often as a result of social conditions & trauma histories • Train Integrative Trauma staff/incorporate into Graduate educational programs/continuing education requirements © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  32. Implications • Women often do not engage or remain in treatment because of children • Consequences may arise from seeking treatment • Many programs use standardized models of treatment that can worsen trauma related problems & unmeet needs • Treatment providers need to Collaborate with Criminal Justice & Child Protective Services while maintaining trust & advocacy for clients • Incorporate programs especially for women & their children © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

  33. Conclusion • Assessment: Train clinicians to identify trauma related psychiatric problems is an important precursor to treatment • Treatment Engagement & Retention: Outreach, engagement & retention interventions need to be incorporated, along with providing access to resources (Medical coverage) • Treatment: Integrated Programs, use innovative interventions to target trauma related psychiatric problems & substance abuse • Services: Adjunct women specialty services © 2004-2005 CDHS/Research Foundation of SUNY/BSC College Relations Group

More Related