This is the view of Bianca Hansen-Hamburger, an intern counselling psychologist at Wedge Gardens Treatment Centre just outside of Johannesburg.
“People often ask if working with substance abuse is difficult.
“My reply to their question is that I am not working with substance abuse, but everything that came before it.
“By this I don’t mean to say the physical addiction is not relevant or needs to be addressed, I mean unhappy and dysfunctional childhoods, neglect, rape, loneliness and other forms of trauma that occur over the course of an individual’s life are often the causes of substance abuse,” she said.
One of the most critical aspects of recovery from addiction is identifying those experiences that lead to the unpleasant and overwhelming emotions that the addict feels.
It is the view of Hansen-Hamburger and her fellow therapists at the Rand Aid Association treatment centre that these emotions are often ‘dealt with’ by engaging in substance usage and/or consequently addictive behaviour.
“In my work with addiction, three key themes frequently arise.
“The first is the loss of a parent when a child is still young.
“The second theme is a violent or dysfunctional family.
(Research has indicated that teenagers who have been physically (or sexually) assaulted are three times more likely to report past or current substance abuse than those without a history of trauma1.)
“A third theme is sexual abuse, either as a child or adult.
“Often forms of trauma experienced are not considered as causes of drug use by families and individuals and the impact is disregarded,” said Hansen-Hamburger.
The relationship between trauma and addiction is a two-way process2.
A traumatic experience leads to unmanageable emotional states.
In an attempt to manage the distressing feelings, people turn to addictive behaviours, for example, using alcohol to alleviate stress and loneliness, using cocaine to elevate a depressed mood, the use of heroin for a sense of overall wellbeing and gambling for excitement.
“However, addictive behaviour also leads to trauma, for example, alcohol disinhibits a person sexually and they place themselves at risk of contracting STDs, gambling leads to debt and often addicts, notwithstanding the obvious health dangers, may land up living on the streets as they have nowhere to go.”
“And so the vicious cycle continues,” said Hansen-Hamburger.
Hansen-Hamburger also added that in the treatment of addiction problems, it is imperative to address past traumas and the impact they have on an individual to properly find a long-term solution.
“By treating the cause, not the effect, a long-term solution can be found,” she said, adding that the acknowledgement of the trauma is the first step.
“From there, with the help of a qualified psychologist or counsellor, together the patient and therapist work through the feelings and thoughts attached to the trauma.
“This is done at a pace that is set by the patient in order to ensure they are not overwhelmed during the process.
“Thereafter, a healthier way of dealing with overwhelming emotions is learnt.
“Eventually, the memories of the trauma no longer overwhelm the individual and feelings associated with the trauma become bearable, thus reducing the need for addictive behaviour or substance abuse.”
Frequently, patients display resistance to discussing past trauma and believe that what is in the past should stay there.
Traditionally, services directed at addressing addiction have targeted the addictive behaviour only and not the underlying issues.
An integrated approach that explores underlying issues, as well as addictive behaviour, is imperative for the treatment of substance abuse and associated issues2.
“As the psychological process is often slow and arduous, results are not immediately forthcoming.
“For this reason we work as a multidisciplinary team at Wedge Gardens Treatment Centre.
“Our occupational therapists are able to engage in work with clients that provides immediate results, thereby increasing self-confidence and building motivation.
“However, with respect to psychotherapy, by the end of the three-month programme, clients are able to see the benefits.
“As described by a patient when discussing his trauma, ‘The first time you discuss the incident it is like a photocopy – very black and white and vivid; however, each discussion of the incident is like making a photocopy of the photocopy. The intensity of the emotions associated with the trauma begins to fade’.
“In summary, to address addiction requires the recognition and accurate identification of past trauma/s.
“Therapists working in addiction should be adequately trained to work with both addiction and trauma in a comprehensive, integrated manner in order to maximise the individual’s chances of sobriety.”2
Wedge Gardens can be reached at 011 430 0320. You can also ‘like’ Wedge Gardens on Facebook (www.facebook.com/WedgeGardensTreatmentCentre) or follow them on Twitter (@WedgeGardens)
References:
- Kilpatrick, D.G., Saunders, B.E., and Smith, D.W. (2003). Youth Victimization: Prevalence and Implications. Washington, D.C.: U.S. Department of Justice, Office of justice Programs, National Institute of Justice on Drug Abuse. Retrieved April16, 2008 from https:// ncjrs.gov/pdffiles1/nij/194972.pdf
- “Making the Connection: Trauma and Substance Abuse.” National Child Traumatic Stress Network – Child Trauma Home. National Child Traumatic Stress Network – Child Trauma Home, 1 July 2008. Web. 15 Apr. 2015.
