While many addiction treatment providers may not feel equipped to deal with the depths of trauma work with patients, Jamie Marich, PhD, LPCC-S, LICDC-CS, REAT, RYT-200, offered a word of caution to NCAD attendees in a Saturday session: Pandora’s box is already open.
“Yes, a lot of treatment centers are incredibly under-resourced,” said Marich, the founder and director of the Institute for Creative Mindfulness in Warren, Ohio. “It might be a quick assessment, a little bit of group therapy, not enough individual therapy to really give people the one-on-one care they need to go into the full scope of what trauma care may require. But the reality is this: You cannot shut down trauma. If that is the attitude you are conveying as a clinical supervisor, a director or a treatment center, I ask you to take a good, hard look at what I’m about to present.”
Early in her career, Marich said she fought back against the suggestion she heard from some providers that it “isn’t their job” to address trauma in treatment and that doing so only serves to “muddy the waters,” adding that she takes exception to some of the more rigid views on addiction held by some programs.
“What we have really learned since the 1930s and even in the last 20 or 30 years is this idea that addiction is a primary disease in and of itself really needs to be looked at,” she said. “That might be the case for some patients, but by and large, unhealed trauma is at the root of most addictive disorders.”
Marich’s working definition of trauma is that it is an unhealed wound—physical, emotional, spiritual, sexual and/or financial. Wounds can come in all shapes and sizes, she said, and those that aren’t given the resources to properly heal can continue to fester and infect, which cause ongoing problems not only for the person experiencing them, but also for those nearby.
If trauma isn’t given a chance to heal, Marich said anything that feels similar can trigger similar reactions.
Marich then discussed practices for helping patients deal with unhealed trauma. Talking reason to someone in crisis generally doesn’t work because the area of brain you’re appealing to isn’t online to receive message, she said. Instead, having clients engage in physical activity, validating, conducting breathing exercises, and listening to them are among the activities that can have a more positive effect.
Marich explained that trauma treatment is more than catharsis, and she outlined a three-stage consensus model for treatment:
- Stage 1 focuses on stabilization, symptom-orient treatment and preparation for the liquidation of traumatic memories, and teaching people skills to work with trauma within the body.
- Stage 2 includes identification, exploration and modification of traumatic memories.
- Stage 3 deals with relapse prevention, relief of residual symptomology, personality reintegration and rehabilitation.
Lastly, she shared mindfulness techniques that have been associated with improved treatment outcomes, including mindful breathing, body scanning, mindfulness of craving (i.e. being aware of signs within your body), and everyday informal mindfulness activities, such as brushing your teeth at home.
“That’s easier said than done,” Marich said. “I’m the kind of person when I’m brushing my teeth, I’m also picking out clothes and checking my phone. How can you be fully present in what you’re doing? … Dance, expressive arts, listening to music and making music all can be ways we can practice mindfulness. It doesn’t have to be sitting meditation if we can appreciate the purpose of mindfulness is to help people renegotiate their relationship with the present moment.”