By: Bayle Shreve
AmeriCorps VISTA at Butte County Department of Behavioral Health
In the past, new discoveries of both the physical and social sciences were isolated. Today, medical advancements are made each day and we are now utilizing our colleagues throughout the scientific world by making connections and visualizing patterns like we never have before. The link between childhood trauma and substance use is a perfect storm of collaboration between all medical professionals, sociologists, psychologists and anthropologists.
According to SAMHSA’s Concept of Trauma and Guidance, trauma is the result of neglect, abuse, violence, loss, disaster, war and any other experience that is emotionally harmful to an individual. Trauma is being recognized as a public health problem without any boundaries regarding age, sex, class, race, ethnicity and socioeconomic class. Although trauma is widespread and harmful, public services can alleviate some of these behavioral health and trauma-related issues.
With understanding what trauma is and the capability it has to affect any individual, we can understand how having a traumatic experience as a child leads to an increased risk to use substances; such as alcohol, marijuana, nicotine, methamphetamine, cocaine, and opioids, within their lifetime. Traumatic experiences prior to the age of 18 have been characterized as adverse childhood experiences (ACEs) and are used to measure the number of traumatic events or experiences an individual has had during their first eighteen years of life. The scale begins with one and ends at four or more. For each traumatic event, you would score one point. For example if your parents had gotten a divorce before you were eighteen you would score a one. ACEs are incredibly common, so common that 67% of people identify at least one adversity and 1 in 8 people have four or more.
Understanding that the events that happened to us at a young age can have lifelong, physical effects on our bodies is groundbreaking. This exposure to severe trauma and stress at a young age affects the development and growth of a child’s brain, which can in turn lead to more health risks as an adult. Specifically, three of our biggest response centers in the brain are deeply impacted. The nucleus accumbens is the pleasure center of the brain and is heavily implicated by substance use. Our prefrontal cortex, also becomes impacted, and that area of the brain handles impulse control and is our executive function center, this is extremely critical to learning new information. Lastly, the amygdala, which most people know as the fear response center. In this area of the brain, physical changes can be seen through MRI scans, and show changes in these structures in a person who had zero adversities as a child to someone who has had just one.
I know you’re probably reading this thinking “as long as I don’t participate or expose myself to high risk behaviors I should be fine”. That sounds like a valid solution, although it is false, individuals are still more likely to develop heart disease and cancer in their lifetime, even if they don’t drink, smoke or use substances. This new information can be startling, but there are solutions for coping with trauma and adversaries. SAMHSA’s Concept of Trauma and Guidance Manual has introduced the “Six Key Principles Fundamental to a Trauma-Informed Approach.” These key principles focus on enhancing the trauma survivor’s perception of themselves, their relationships built in and out of the organization, and strengthening their resilience. The first principle of safety ensures those served feel physically and psychologically safe within their environment and interpersonal interactions. Secondly, trustworthiness and transparency entails that all operations and decisions are made with the goal of maintaining the clients trust. Third, peer support is extremely necessary for peers or trauma survivors, to utilize their stories and lived experiences to promote a safety group to promote recovery and healing. Fourth, collaboration and mutuality focuses on partnering and leveling out power between all levels of staff and clients. This ensures that all relationships matter and everyone has a role throughout the trauma-informed approach. Fifth, empowerment, voice and choice are operations throughout the workforce development that are organized to empower both staff and clients alike. Giving the trauma survivors the opportunity to voice their concerns, questions and fears. Finally, cultural, historical and gender issues allows the client and staff relationship to move past cultural differences, biases, and stereotypes and introduce both policies and protocols that meet the ethnic and culture needs of the client while addressing historical trauma.
We now understand how trauma and the connection to health outcomes is a significant, unaddressed public health threat which can be treated and prevented before the high risk behaviors and coping mechanisms begin. Simple strategies like remembering the 6 Key Concepts, and remembering that it is highly likely for individuals in the primary care setting to be experiencing, coping with, or attempting to cope with trauma, helps us remember that the physical health issue may also be masking something underneath. For more information on substance use, how to support patients in accessing treatment, and how to care for trauma survivors, please visit the Butte-Glenn County Medical Society webpage.
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Suarez-Morales, et al., Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Journal of Substance Abuse Center for Substance Abuse Treatment (20000. SAMHSA/CSAT Treatment Improvement Protocol (TIP) Series, No. 29 Rockville, MD: Substance Abuse and Mental Health Services Administration
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Hello, my name is Bayle Shreve and I am the newly recruited Butte County's Americorps VISTA member with the California Opioid Safety Network (COSN) for 2019-2020. To learn more about COSN and what AmeriCorps VISTAs do, please visit Anna's previous blog post. My host site is theButte County Department of Behavioral Health, specifically as a member of the opioid coalition within the Treatment and Prevention Court of the Substance Use Disorder Department. I recently graduated from a small liberal arts college located in Latrobe, Pennsylvania in May of 2019 with a bachelor of arts in Anthropology with a concentration in Public Health and minor in Sociology. I decided to dedicate my year of service with COSN because of my longtime passion for social issues and the hope to one day implicate real social change within underprivileged communities. As a sociocultural anthropologist I feel a strong connection to help serve those who are deeply affected by epidemics such as opioid use and homelessness. I am looking foward to work with community partners.