by Stephen Dansiger, PsyD, LMFT & Holly Daniels, PhD, LMFT
C4 Events was fortunate to have Dr. Dansiger and Dr. Daniels present at the 10th annual WCSAD. If you missed WCSAD, we hope to see you next year, May 28-31.
Addiction, the art of surviving existence while paradoxically dying a slow death, begins long before one picks up a drug. The ACE study (1998) reveals that adverse childhood experiences are at the root of physical, psychological, and behavioral negative outcomes such as medical conditions, substance use disorders (SUD), and early death. Relational trauma, a common adverse childhood experience, results in a lack of connection and serves as a predictor of SUD, which upon deeper inspection are disorders of isolation. Perhaps this is why involvement in peer support groups leads to recovery for so many people: connection is an antidote for SUD.
Science continues to inform us that the philosophical underpinning of SUD is no longer a question of nature or nurture, but rather how nurture dances with nature. Despite popular belief, heritability is only part of the complex portrait of addiction. The complicated foundation of SUD is further intensified through the effects of repeated drug use. Neuroadaptations, which occur as a result of substance abuse, are progressive changes in the structure and function of the brain, enduring long after an individual stops using substances. Melded together, trauma, genetics, and changes in brain structure and function resulting from repeated and prolonged drug abuse indicate that the bedrock of successful addiction treatment is long-term, trauma-focused care.
Executing clinical care with a trauma-focused philosophy assumes that unhealed trauma plays a major role in presenting issues. It has always been our conviction that to treat addiction, one must treat trauma. Research reveals that the effects of trauma, which were once thought to be invisible, actually leave lasting, detectable imprints on the brain and body. Considering that the roots of SUD have been sustained over time, the logical treatment response must be prolonged as well. Treatment for SUD and other addictive behaviors continues to evolve. Accreditation and government agencies now mandate that treatment include trauma-informed modalities. Although this is a positive step forward, progress still needs to be made if we are ever going to provide evidence-based treatment with integrity.
Relapse rates are another form of evidence that indicate the critical need for long-term treatment. The Surgeon General’s Report on Alcohol, Drugs, and Health (2016) concludes that more than 60 percent of people treated for a substance use disorder experience relapse within the first year after they are discharged from treatment, and a person can remain at increased risk of relapse for many years. This evidence continues to pile up, clearly indicating that short-term
treatment is a tragic mismatch for SUD. The Surgeon General’s Report (2016) states that even after a year or 2 of remission is achieved—through treatment or some other route—it can take 4 to 5 more years before the risk of relapse drops below 15 percent, the level of risk that people in the general population have of developing a substance use disorder in their lifetime. Despite these sobering relapse rates, individuals with SUD achieve recovery as long as they have access to evidence-based treatments and responsive long-term supports.
Nonetheless, no complete treatment system exists to address the long-term support that is recommended by the Surgeon General’s (2016) report and informed by the ACE Study (1998). Executed from this evidence-informed framework, the following has been designed: a traumafocused, full system of treatment that uses a systemized protocol, (the eight phases of EMDR therapy) embedded in a Buddhist mindfulness approach, and augmented with clinically informed life skills coaching for long-term support that is fully integrated with the treatment system. The reason why CBT and DBT work so well and why this new protocol is promising is because a full system of treatment that is rooted in a systemized protocol is guiding the treatment. Additionally, the adoption of a Buddhist mindfulness approach moves beyond simply teaching mindfulness exercises for relapse prevention, and implements Buddhist mindful lifestyle training, creating a lived experience of Right Action, Right Thought, Right Livelihood. The long-term component of this treatment system centers around a 5-year treatment plan, which is clinically indicated for the treatment of SUD with co-occurring mental health and trauma symptoms.
However, before the adoption of a long-term treatment model can be effective, a critical treatment component that is often overlooked and neglected needs to be addressed. No matter how long treatment is offered for, recovery will not sustain as long as the individual seeking treatment maintains mistrust. Survivors of trauma, who make up 90 percent of clients in public behavioral health care settings, understandably feel alienated and disconnected from people and reality. One of the main reasons for this mistrust is that trauma can rupture a person’s ability to trust and it can disrupt the attachments that allow for connection. Relational trauma prevents clients from engaging in treatment, directly as a result of the diagnoses that led the clients to treatment in the first place. With the application of a systemized protocol, clients are asked to trust the protocol, not the human. And as treatment goes on, the human trust builds as well. The implementation of a systemized protocol circumvents the relational distrust that envelops the client as trust is being put in the logic of the protocol not the human.
Integrating a trauma-focused, systemized protocol with long-term lifestyle support will not only solve the trust issue that haunts survivors of trauma, but it will address SUD as the chronic conditions that they are and help clients capitalize on gains that would otherwise be unethically expected in short-term, trauma denied treatment. Sustained recovery, the art of no longer simply surviving, but resilient thriving in the face of continued adversity, is what can result when treatment aligns with the integrity of the nature of SUD.
Stephen Dansiger, PsyD, LMFT is an EMDRIA Approved Consultant and Senior Faculty for the Institute for Creative Mindfulness. He has developed and incubated the MET(T)A Protocol, a design for addictions agency treatment using Buddhist Mindfulness and EMDR Therapy as the anchor. When he is not speaking about Buddhist Mindfulness and EMDR therapy at events around the world, he gives regular Dharma talks at local and international meditation centers, sees patients, and supervises and guides young clinicians. At all other times, he is wrangling and entertaining his 8 year old daughter. Dr. Steve’s books, including Mindfulness for Anger Management and Clinical Dharma: A Path for Healers and Helpers are available in paperback and Kindle.
Holly Daniels, PhD, LMFT is a private practice therapist and therapeutic educational consultant who specializes in substance use disorders, eating disorders, relational trauma and family systems work. She is a state board member for the California Association of Marriage and Family Therapists (CAMFT), supporting over 32,000 clinicians, a member of the International Educational Consultants Association (IECA), and an EMDRIA trained therapist. Dr. Holly works with clients of all ages but holds a special place in her heart for adolescents and young adults. As the mother of two teenagers, she feels honored to get a first-hand daily glimpse into the zeitgeist of Generation Z.