Assessing for Addictions in Trauma Treatment by Gregory Hasek MA/MFT LPC
When a client or clients come to counseling, one of the things a therapist needs to assess during the intake process is the presence of both current and past substance use and possible addiction history. This is especially true in working with clients who have trauma in their history. Much of the research shows that substance use and abuse tends to go along with those that have experienced some form of trauma. In one study on addicted women and trauma, 74% of the addicted women reported sexual abuse, 52% reported physical abuse, and 72% reported emotional abuse (Covington & Kohen, 1984). For those clients that come to us with an abortion decision in their history we also know that the research shows a higher rate of substance use and abuse (Coleman, 2005). It would make sense that this would be one of the first things we screen for in both men and women who present with trauma in their history.
If we determine a client or clients have an active addiction, then this would become a high priority to address in the treatment planning process. It doesn't make sense to move forward with addressing trauma issues when a person is struggling with addiction. They are likely to actually increase their use of that substance as a way of coping with suppressed material being unearthed in therapy. In working with clients over the years who present with a process addiction such as sexual addiction, the first goal in treatment planning was to begin to work on the issue of sobriety. This often included an abstinence plan and a beginning process of teaching new healthier ways of coping with both affective and cognitive states. My clients would begin to learn tools that worked on teaching emotional regulation and changing cognition that supported the addictive behavior.
In summary, when working with clients with trauma in their history, it is important in the intake process to screen for past substance use and abuse and current addictions such as process addictions. If a client is struggling with an active addiction, the first goal would need to include developing a plan of treatment that would include establishing sobriety. If you don't think you are qualified to work with clients who present with active addictions, then ethically you would need to make a referral. You also may need to recommend your client access other services such as a support group in the community.
References
Coleman, P. (2005). Induced abortion and increased risk of substance abuse: A review of the evidence. Current Women’s Health Reviews, 1:21-34
Covington, S. & Kohen, J. 1984. Women, alcohol, and sexuality. Advances in Alcohol and Substance Abuse 4 (1): 41-56.
When a client or clients come to counseling, one of the things a therapist needs to assess during the intake process is the presence of both current and past substance use and possible addiction history. This is especially true in working with clients who have trauma in their history. Much of the research shows that substance use and abuse tends to go along with those that have experienced some form of trauma. In one study on addicted women and trauma, 74% of the addicted women reported sexual abuse, 52% reported physical abuse, and 72% reported emotional abuse (Covington & Kohen, 1984). For those clients that come to us with an abortion decision in their history we also know that the research shows a higher rate of substance use and abuse (Coleman, 2005). It would make sense that this would be one of the first things we screen for in both men and women who present with trauma in their history.
If we determine a client or clients have an active addiction, then this would become a high priority to address in the treatment planning process. It doesn't make sense to move forward with addressing trauma issues when a person is struggling with addiction. They are likely to actually increase their use of that substance as a way of coping with suppressed material being unearthed in therapy. In working with clients over the years who present with a process addiction such as sexual addiction, the first goal in treatment planning was to begin to work on the issue of sobriety. This often included an abstinence plan and a beginning process of teaching new healthier ways of coping with both affective and cognitive states. My clients would begin to learn tools that worked on teaching emotional regulation and changing cognition that supported the addictive behavior.
In summary, when working with clients with trauma in their history, it is important in the intake process to screen for past substance use and abuse and current addictions such as process addictions. If a client is struggling with an active addiction, the first goal would need to include developing a plan of treatment that would include establishing sobriety. If you don't think you are qualified to work with clients who present with active addictions, then ethically you would need to make a referral. You also may need to recommend your client access other services such as a support group in the community.
References
Coleman, P. (2005). Induced abortion and increased risk of substance abuse: A review of the evidence. Current Women’s Health Reviews, 1:21-34
Covington, S. & Kohen, J. 1984. Women, alcohol, and sexuality. Advances in Alcohol and Substance Abuse 4 (1): 41-56.
