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Trauma treatment: Special issues

Treatment for trauma and substance use

Current models for treating substance use and treating trauma suggest that they should be treated simultaneously. For an overview, see "Treating Problem Substance Use and Posttraumatic Stress Disorder Concurrently" from Highs & Lows: Canadian Perspectives on Women and Substance Use (CAMH).

Treatment models

Seeking Safety is a therapeutic model developed and evaluated by Lisa Najavits to help people who have experienced trauma or post-traumatic stress disorder and substance use problems. The treatment is available as a book, providing both client handouts and guidance for clinicians.

The Trauma Recovery and Empowerment Model, researched and developed by Maxine Harris, is used extensively by addictions programs in the United States.

Toolkits developed by the U.S. National Child Traumatic Stress Network aim to train providers and educators about the needs of youth with traumatic stress and substance use problems, and to promote evidence-based practices. 

Cross-cultural considerations in trauma treatment

The way people react after a traumatic event is largely influenced by their cultural values, norms and beliefs. Consequently, the treatment and support that people receive need to be relevant to their culture.

Here are some articles, courses and publications related to this topic.

Individual versus group therapy

There are pros and cons to either individual or group therapy approaches. Issues for group therapy include comfort with disclosures and confidentiality, which is legally binding for a therapist in individual therapy but not for group members. On the other hand, issues with trust can be addressed well in a group format.

Mixed gender versus women-only groups

Some first-stage trauma treatment grounding techniques can be taught in mixed groups. However, many women may feel unsafe and may have trauma responses triggered by second stage work that explores sexual abuse memories in mixed groups. Trust and anger issues can be addressed in a mixed group format if participants are stable and ready for this.

Does treatment need to involve revisiting the traumatic experience?

There is a debate in the trauma treatment field as to whether revisiting traumatic memories is therapeutic or instead retraumatizes the person and so is counter-productive.

Vicarious traumatization

Therapists working with people who have experienced trauma can listen to horrific personal stories of abuse and violence day after day and in so doing are bearing witness to the violence themselves. This can lead to vicarious traumatization. 

For more information, Headington Institute's "Understanding and Addressing Vicarious Trauma" provides some useful tips on this topic.

Secondary Trauma Issues for Psychiatrists provides a brief overview of what we know about secondary trauma—frequently called compassion fatigue or vicarious trauma.