Research confirms that addiction and trauma disorders are often inextricably linked–with alcohol and other drugs being used to self-medicate against the effects of trauma. Many trauma survivors turn to alcohol or other drugs to manage painful memories and other negative symptoms associated with trauma. The converse is also true: those who abuse alcohol or other drugs find themselves in dangerous or unsafe situations where they experience traumatic events or situations. The focus of the integrated addiction treatment program at Hazelden Betty Ford in Newberg introduces individuals to the tools and resources they need to stop the devastating cycle of a traumatic experience in order to experience a transformed life. "Up to this time, many individuals involved in the treatment process were being mislabeled as 'resistant' or 'defiant,'" said Bobby Trihub, PsyD, a senior clinician in the Newberg trauma program. "As a team, we realized that these were human beings who were really struggling with trauma, and unless we addressed and treated that issue, they were not going to get better." The program effectively addresses the negative symptoms of trauma, such as: anxiety, fear; insomnia, guilt, shame, and self-blame. For new patients, a comprehensive screening assessment helps identify possible trauma triggers in their lives. "There are many people who have a misunderstanding of trauma. It's possible to have the symptoms of Post-Traumatic Stress Disorder (PTSD) and not have gone to war," said Bobby. "We walk with the patient through a Life Events Checklist and discuss the impact of what it meant for them to go through various life-changing events such as the loss of a loved one or an assault, abuse, or other events violating one's sense of safety and control, and then identify the issues that need to be incorporated into their treatment and recovery." Experiencing a difference from other programs In the mental health community, Newberg staff members work to provide an environment to help individuals with trauma symptoms to stabilize. Among other co-occurring mental health conditions, approximately 30% of the patients at Newberg identify with trauma-related issues. "Helping to connect these patients with each other in our treatment programming provides a support network. It is a tremendous benefit to have patients helping patients, and we can connect those who have been through similar situations," said Bobby. "There is something freeing about being able to step out of the shadows of shame and into healing and wholeness. And there is a strong sense of community and belonging here which contributes to creating a safe environment." In the treatment of trauma, there are three stages of healing: safety, mourning, and reconnection. Of these three, a primary focus within residential treatment is on helping patients make the positive changes within their lives to bring them to a sense of safety—understanding that chemical abuse is not safe; learning to set boundaries; defining ways to handle "traumatic intrusions," and developing effective coping skills and healthy living patterns. "Taking the time to establish a safe environment for these individuals is critical. Jumping into an individual's past trauma narrative too quickly opens the door to risk re-traumatization and relapse because they don't have the appropriate skills to deal with going through the trauma again," Bobby said. It takes a team While there are several reasons for Newberg's success in treating patients with co-occurring disorders like trauma, a key factor is the presence of a qualified mental health team who understands trauma. "The treatment of trauma has become part of the fabric of our center and a common language of compassion and support diffused among our clinicians," said Bobby. "This helps to create an awareness and increased sensitivity as to where the individual patient is at and encourages longer term engagement." Through Day Treatment and outpatient services, patients are able to access essential treatment and transition back into their life. The majority of patients choose to live on campus; however, if their primary residence is nearby, some of them may decide to live at home and return to campus for day treatment services. For patients in Newberg, care coordinators work hard to connect patients to essential support resources in their community. "Our focus is on meeting people right where they are at, identifying and educating on these issues, and then working to providing a comprehensive continuing care program which includes long-term interventions and support. This allows us to continue the trauma work as patients stabilize in other areas of their life," said Bobby. Mental health groups Integral in the treatment path is a broad spectrum of mental health groups. Most of the programming and groups are gender specific, which can aid in facilitating a sense of safety and enhance treatment for many patients. Working toward safety is the first step in recovery from trauma, and the Seeking Safety Group is a core group that provides an orientation and overview of what trauma is and information on how one recovers from trauma. The Seeking Safety Group also explores a variety of other topics, including how trauma impacts lives and recovery. In addition to safety, learning and implementing foundational coping skills and being surrounded by supportive people is essential to sustaining sobriety. "Building a healthy support network is essential for ongoing recovery and for restorative healing around the relational issues often associated with past traumas," said Bobby. Beyond Seeking Safety, other mental health groups are tailored to meet individual needs, including: Coping Skills, Co-occurring Disorders, Relationship Skills, Body Image, and LGBTQ support groups. As part of the integrated treatment team, skilled clinicians can provide individual mental health therapy to address specific elements of trauma, and psychiatric medication services are also available onsite. "It is not uncommon to meet with a patient for their initial mental health assessment and learn that they have been through other addiction rehabilitation programs or had multiple relapses, yet their trauma needs have never been identified or addressed. Providing trauma treatment isn't about a specific group, therapist, or therapy; rather, it's about having an integrated approach to treating trauma. We have this at Hazelden Betty Ford in Newberg," said Bobby.