Trauma. It Helps to Share

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting and the Kenosha County Substance Use Disorder Coalition. I'm Mike McGowan.

Mike: Trauma. It's a word you hear a lot today. Whether events that are caused naturally, or through human ineptitude and cruelty, studies have shown an increase in people dealing with trauma.

Mike: How to recognize it and what to do about it, is the subject of our conversation today. Our guest is Jim Scarpace, the Chief Clinical Officer and Interim Community Division President at Gateway Foundation, which is one of the nation's largest providers of behavioral health services for clients diagnosed with co occurring mental health disorders.

Mike: Jim has been our guest before, and if you remember, has over 25 years in administration, operations, and the treatment of mental health, substance use disorders, and criminal justice programs. He's also an assistant professor of clinical psychology at Benedictine University. Welcome back, Jim.

Jim: Thanks for having me, Mike. Happy to be here.

Mike: Well, I'm really glad you could do this. This is a topic that I hear all over the place, but I suppose it's important to start with asking you what constitutes trauma and what types there are.

Jim: That's a great question. You know, I think the most important thing to remember when we talk about trauma is trauma is subjective. Meaning there are designated definitions of trauma that of course, you know, people experience and connect with and understand when they hear the word trauma.

Jim: But trauma can be really anything that creates a negative experience and difficult follow up for individuals after the trauma incident occurs. And so at Gateway Foundation, we really want to make sure that people feel like, hey, I don't meet the classic definition of how I view trauma. But I'm having these struggles. What do I do?

Jim: What's most important is that they come forward and get some assistance, get an assessment, allow us to help them determine really, you know, is this a trauma incident and how do we help treat it most importantly. But to answer your original question, you know, trauma looks different, especially in this day and age.

Jim: You know, we're in the social media day and age. So there's trauma experiences that this generation has that, you know, previous generations wouldn't have had to struggle with. From bullying on social media, to community violence. And you know, other things that get organized sometimes around social media platforms that people get involved in or discrimination that occurs as a result of social media.

Jim: So that's a big one, a newer one that really has created a lot of difficulties for individuals just because of how accessible people are to each other now because of the digital world we're in and the social media world that everyone has access to. But trauma also can you know be tied to more traditional definitions, you know when people think of trauma a lot of people think about intimate partner violence or domestic violence, physical abuse, sexual abuse and those are you know, still very prominent trauma experiences that can create a lot of difficulties for individuals and take them down the road of increased depression or anxiety or substance use disorder.

Jim: But there's also things, you know, discrimination, there's medical trauma. And we've heard this on the news, you know, around things like sex trafficking, which has been a very prominent issue that has become more and more challenging and unfortunately prevalent in our country. And so really what's most important is that individuals who have a trauma experience recognize the signs and symptoms associated with it and seek assistance and support as soon as possible.

Mike: Well, okay so what are those and what does it do to the brain and the body?

Jim: Yeah. So a couple of things to know is, you know, trauma disorders or what's classified as a trauma disorder can have several negative effects on both the brain and the body, as you said. And I think that, you know, what we know about trauma is that it can create and sometimes exacerbate existing behavioral or emotional problems that someone might be struggling with.

Jim: So, for example. If I'm struggling with depression and I have a traumatic experience, my depressive disorder is going to get more acute and more extreme. If I'm struggling with anxiety and I have a trauma disorder, same thing. If I'm struggling with a substance use disorder and I have a trauma experience.

Jim: My ability to manage that substance use disorder is going to get more challenging and more difficult. And what we know about, and I'm sure we'll circle back to substance use disorder in a little bit. What we know about substance use disorder is 80%. of patients with a substance use disorder have a trauma trigger.

Jim: So we know there's such a strong connection between those two disorders. When someone experiences a trauma disorder, the brain's physiology changes. So neurotransmitters that used to fire, that help regulate emotions start to underperform. Mental health issues like depression and anxiety get exacerbated. So they get worse.

Jim: And what happens is it can stall emotional development when it's not dealt with. So people can start having relational problems. They could start having difficulties. What we call hyper arousal, meaning managing their emotions. They could have extreme emotional outbursts.

Jim: They start to have intrusive thoughts about the trauma experience, which sometimes is referred to as flashbacks. So they'll have images of the trauma experience that continue to cause problems for them in their day to day life because they're unexpected and very hard to deal with. And, you know, the other piece is from the physiological perspective, it can increase blood pressure issues if you're, for example struggling with hypertension.

Jim: Trauma experiences because of the increased anxiety and demand on the brain and body can create sleep disturbances. In some cases it can create situations that may need to lead to further evaluation or hospitalization. What's most important is that as soon as someone starts to experience these symptoms, they get help because the longer time between the traumatic event and getting treatment for it.

Jim: The harder it is sometimes to manage some of the secondary issues that have occurred as a result of the trauma. So it's a little bit more challenging to sort through. But what's most important is we've seen many many people recover from trauma experiences with the right help and with the right support.

Mike: You know, I think that bears repeating nine times over. We don't do that, or people generally don't do that. They're like, Oh, I'll just wait. I'll cope. I'll talk to my sister in law. I'll, you know I'll have a couple of drinks. I'll take some time off. We don't get help for it.

Jim: Absolutely. And that's part of that is what we talked about in previous conversations around stigma, right? And the shame and embarrassment with behavioral health disorders that don't occur with medical disorders and shouldn't occur with behavioral health disorders. And for a lot of individuals, they just, especially with trauma, they tell themselves things that are distorted.

Jim: And part of that is because of the way the brain's physiology has changed to support the trauma experience just like the way the brain changes that support substance use disorder or mental health disorders And so they don't seek help and and unfortunately with the trauma disorder just like the other disorders we've talked about in the past, those symptoms get worse and worse over time not better.

Jim: And so the sooner we can help someone connect to treatment the better chance they have of not only dealing with their trauma disorder, but any co occurring mental health or substance use disorders that have resulted.

Mike: I hear a lot of people today throwing around terms, and I hear this one a lot, Oh, I have PTSD, post traumatic stress disorder.

Mike: Well, that's a version of it, but not all trauma is PTSD.

Jim: No, and really, you know, post traumatic stress disorder has very specific signs and symptoms flashbacks being an example of one but trauma disorders really by definition is having a negative experience or interaction that has resulted in difficulties in coping with day to day life or managing day to day stressors.

Jim: And so when we talk about trauma disorder and we talk about treatment, what's most important is getting a thorough assessment and screening. So for example, at Gateway Foundation, we look at not only current trauma experiences, but something called ACEs, which are Adverse Childhood Experiences, and really doing a screening and assessment, because it's not uncommon to see many adults who've experienced trauma several years ago as a child or young adult or adolescent just coming forward and starting to share, because of their substance use disorder, this trauma experience. And at Gateway, we really take what we call a trauma responsive approach. And what that means is individualizing trauma treatment to each person and addressing what their needs are and really developing a plan for healing. Because you know a lot of people worry about talking about their trauma experience, because of fear, because of anxiety, sometimes because of shame. Where instead of being able to say this is not something for me to own, this is something that happened to me and it's not who I am, they still blame themselves.

Jim: And so they don't want to come forward and have those conversations. But really at Gateway Foundation, we want to encourage people to do that because the harm has already occurred. What now needs to occur is the healing. And healing can't start to occur from trauma until people are in a safe environment and they feel comfortable sharing their story.

Jim: And what we want to do is help them understand that relationship between trauma disorders, mental health disorders, and substance use disorders, so that they can manage these issues and, you know, understand that they connect back in many situations to the trauma experience. And in order to develop a recovery plan that's going to stick or something that they're going to be able to maintain, they really have to address all of those issues, including, you know, working through their trauma.

Mike: You know, I work a lot with young people and I'm in a lot of schools and the buzzword in the last couple of years is trauma sensitive schools. But what you just said, I don't see a lot of it being, honestly, put into action. Like for the non therapist who's probably trained in this, how do lay people, how do family members, friends, teachers help the healing?

Jim: That's a great question. I think the first piece is to create an environment where discussions can happen around trauma or around difficult experiences that young people or adults for that matter have. It's sometimes really difficult for families to talk about these types of things or for individuals to go to their families who've experienced any kind of trauma or have a trauma disorder.

Jim: Because again of that fear of being judged or being looked at differently and so they keep it to themselves. And schools sometimes, you know, especially in schools where young people are facing bullying and other types of trauma experiences that can be very difficult to navigate or manage on their own.

Jim: For counselors to be asking questions, for teachers to be asking questions, I think that, for example gosh, this has probably been now about eight years ago, but the American Medical Association gave Illinois a grade of F. In assessing for trauma and it wasn't just Illinois. There were many states on that list and what they said is We know trauma experiences have substantial impact on both physiological health and mental health. They increase risk of suicide. They can increase risk of physiological illnesses like heart disease and cancer because of what happens to the fight or flight system in our bodies and how that impacts our bodies negatively when there's trauma experiences that get reactivated over and over again through flashbacks and other issues.

Jim: And what they basically said is. Every doctor's office, every school guidance counselor, every social worker, every therapist, whether you're in a substance use treatment center or mental health treatment center, every probation officer needs to be screening and assessing and asking questions and creating a safe environment where people can share if they've experienced trauma because again as we talked about earlier the sooner we know that the better chance we have of helping people manage that disorder and for healing to occur. And as a state we just weren't doing that in a doctor's office will ask you how much you drank. They'll ask you if you smoke, but they won't necessarily ask you if you've had any traumatic experiences whether it being as a child or currently. It's a conversation that's uncomfortable I think for people because their worried that if they have those conversations with someone, they're going to create some kind of harm.

Jim: And that's just really not true. The harms already occurred. It's the healing that needs to occur and healing can't occur until people start to share their stories.

Mike: Well, if left on our own devices, if we're experiencing stuff, we'll go to a coping mechanism that's easy, substance use disorder being one of them.

Mike: We have a bunch of other ones, the internet, pornography, shopping escapism, gaming, gambling. And once you have that, does it make it more difficult to treat? Like, the question I get asked all the time is. What comes first? Do you treat the substance use disorder or the trauma or can you do it concurrently?

Jim: Yeah, so really the answer is you need to do it together. You have to do it together. You have to help an individual. I tell our counselors, I think I might have mentioned this in a previous conversation with you maybe, but I tell our counselors our job is to provide patients with ESP. That's not extrasensory perception.

Jim: It stands for Educate, Skill build and Practice. We have to provide them with knowledge and information about the relationship between their trauma disorder and their substance use disorder to help them connect the dots so they understand what's happening in their brain. And how the brain's physiology is impacted negatively by that trauma experience and not, and not treating it and how it exacerbates depression and anxiety and substance use disorder and mood disorders, how it impacts relationships.

Jim: That's all tied to this concept of illness or disease education. Helping individuals become experts in their condition or in their behavioral health disorder, just like we would with a medical disorder. And then once they understand it, and families included, making sure families or support systems are experts as well, once they understand it, now they need skills to manage those disorders and understand how do I move forward.

Jim: And so we have things, for example, at Gateway Foundation, like trauma focused cognitive behavioral therapy, healing trauma and managing trauma through programs and skill building, both through groups and individual counseling, as well as making sure medication wise, we're addressing any deficits as a result of the trauma that impact the brain.

Jim: So if depression increases, getting people on the right medications to manage that. At the same time, giving them opportunities both in an outpatient setting and a residential setting to practice those skills. So when they're faced with a situation where they have a flashback, or they're having intrusive thought, or they're having these negative experiences as a result of their trauma, they have other options other than turning back to drugs or to alcohol.

Jim: Because as you said earlier, that's the easiest way to handle it. But the most destructive way as well. And so then you end up having two disorders that are causing a lot of problems in your life. I think the last thing I would say answer your initial question is what comes first. It really doesn't matter.

Jim: We know that trauma disorders can exacerbate depression and substance use disorders. As we talked about, we also know that people involved with using substances sometimes can put themselves in high risk situations which can create trauma experiences or trauma risk. What's most important is not what came first, but managing those together in treatment.

Mike: You may not have an answer for this, but it seems like such a easy thing to do to teach, to skill build, to teach coping skills and provide protective factors. Why isn't there more of an emphasis other than lip service on those?

Jim: You know, I think that in the treatment world, there's still this belief sometimes that, you know, I need to send this person to a trauma expert, or I shouldn't have this person share their story because of risk that they won't be able to manage the experience and be at higher risk, for example, for suicidal ideation. And although I will not say that will never occur on a bell curve, when you look at treatment and recovery from trauma, the overwhelming majority of people get better by sharing their story. And there really aren't. I mean, there's, there's some providers that specialize in trauma, but this idea of sending someone to a trauma expert that's going to solve all their trauma issues.

Jim: So therefore in substance use treatment or mental health treatment, we're not going to deal with it. We're not going to touch it is really not beneficial, you know, helping individuals share their story does a couple of things. It not only connects the dots between trauma and their mental health or substance use disorder. But it causes that trauma experience to lose power over them.

Jim: Because when we don't talk about it, our brain distorts what happened to us. And it grows and grows and becomes so overwhelming that we're not able to separate ourselves from the trauma. It becomes or makes us feel like it's a part of who we are and it's our fault. And we continue to turn unhealthy coping mechanisms like substances or other things.

Jim: And so, really the message I want to get out and what's important to us at Gateway Foundation is. If you have a substance use disorder and a trauma disorder, we can help you. If you have a substance use disorder and a mental health disorder, we can help you. You don't need to go to separate places to try to address these things individually.

Jim: And in fact, doing that may make it more challenging to achieve recovery.

Mike: Now, you mentioned ACEs before. Is it more likely that a person develop an addiction growing up in an environment that is trauma centered?

Jim: The short answer to that is yes. I think the pieces that tie that together, that get a little bit more complicated in terms of the series of events is how long ago did that trauma experience occur?

Jim: But as a child or young adult, you know, our brains are still developing. And really the brain doesn't fully develop to age 26, our frontal lobe, the area where we have the best opportunity to make decisions, problem solve, deal with trauma or crisis situations. That part of the brain is still developing until we're an adult, you know, 26 years old, really, until it's completely developed in most cases.

Jim: And so as a child or young adult experiencing a loved one with a mental health disorder or substance use disorder. Experiencing sexual abuse or physical abuse, experiencing neglect. Having difficulties with relationships, parental relationships, and really not getting the nurturing and attention you need can have a substantial impact on not only the developing brain, but what we call the trauma reaction someone may have.

Jim: And yes, you know, in that time frame between really, you know, age one and age 18, but even going further talking about the brain not fully developing to 26, the impact of crises or trauma experiences can be much more substantial and create problems with substance use and mental health disorders at a rate that would be much higher than if you experienced that trauma as an adult.

Mike: You know, and like you said, everybody deals with this differently. Are there gender differences and cultural differences as well?

Jim: Yes, and sometimes those create barriers for people in accessing treatment and help because it's something that is sometimes from a culture or a family situation discouraged in terms of talking about, and, you know, people don't share as much in those situations.

Jim: And, you know, we've had many adults in treatment at Gateway Foundation that experienced substantial trauma issues as children that said, this is the first time I've ever talked about my trauma experience out loud, and it's been 10 years. It's been 12 years. It's been 15 years and, you know, they've been struggling with a substance use disorder for maybe a majority of that time and they've been in treatment before at other places possibly, or have gone to 12 step meetings, but only focused on their substance use disorder and never tied it back to their trauma because they've never been in a place where they've been encouraged or supported in talking about it. And in their family system there just was not the structure in place to help them have those conversations as well.

Mike: You know, I don't know if you agree with this. I don't think we've decided yet which side to fall on.

Mike: In my family I was told to suck it up, right? And I think that there's still a large segment of the culture, all culture, that admires Stoicism and bucking up. I'm in my head right now. I'm thinking about the comments made about Princess Kate in England, you know, not being seen for six months and coming up and stiff upper lip.

Mike: And that's at somehow admirable rather than dealing with it or saying, Hey, I'm coping. This is tough. I have cancer. You know, we sometimes it seems like we admire the thing that would make us more unhealthy rather than healthier.

Jim: Yeah, culturally, I think, as a society, we've always kind of had this mindset of, you know, you need to be resilient, you need to be strong, you need to be able to get through it. And for some situations, outside of, you know, when we're talking about trauma, and if people can do that, that's great, but when we talk about trauma disorders, you can't, just like when we talk about substance use disorders.

Jim: You can't suck it up and get through your brain's physiology changing and your neurotransmitter's not firing. You can't will that. to fix itself. It will get worse over time. And what people really need to hear is the sooner I can get into a treatment program and get help for that and get medication, counseling, help my family understand, you know, what I need in terms of a recovery plan.

Jim: The better chance you're going to have. And it's okay we all want people to be resilient and at Gateway we want to support resiliency, but that doesn't mean you don't still need support. I go back and I think I mentioned this to you in the previous podcast, if I had cancer I would not say to the doctor Yeah, no, thanks for the recommendations, but i'm just gonna take care of this on my own, I'm gonna will it away, I'll be good. I'm strong. I'm going to kind of suck it up and fix this problem on my own. No one would do that, but in the behavioral health area, because this disease affects the brain, and the brain looks like behavior, which then looks like choice, people still don't have accurate beliefs on how this works.

Mike: You know, it's, it's so funny you said that because I was recently at an event where there was a bunch of people and I just said, somebody asked how I'd been. I said, well, pretty good. I just had my knee replaced, had a knee replacement, which I wasn't expected to suck it up, by the way. And everybody turned and was like, Oh, how, how did it go?

Mike: You know, how's your scar, you know, or what are you able to do? I had a ton of questions and a little bit later, not five minutes later, somebody else in group. As the subject changed said, well, I was talking to my therapist, and the minute they said that, everybody turned like they had just said, and I've got a nuclear bomb underneath my jacket.

Mike: I mean, they're right together. Just fascinating.

Jim: Yeah, it's unfortunate, right? Because, you know, I think as a society, we still judge people who behavioral health disorders in different ways that in different ways we would never do with people who talk about medical disorders. And it's just so unfortunate because these are both medical conditions that impact different parts of our body and the behavioral health case, the brain, but those, obviously those disorders have ripple effects to the body as well, but we're just still not a place in society where we create a welcoming, safe environment for people to share those kinds of things. And it goes back to your earlier question. That's the big part of the problem with trauma disorders is there so much judgment and fear of judgment that people keep that secret.

Mike: You know, I'll give you a little walk off here and I know you probably don't... it's magic wand time. How do we turn it around so that that conversation ends up being the same, the knee replacement, the cancer, the diabetes, the mental health disorder, the substance use disorder.

Jim: You know, for me, I think it's about first educating ourselves and understanding what this disorder is and, and not perceiving it based on our experiences.

Jim: And I think that's part of the problem is people's reality is based on their experiences and their own perceptions, which a lot of times, quite honestly aren't accurate. But it just becomes how they see the world and how they see others. So the more that we can create environments where communication around these types of things are welcomed, you know, if we can get to a place in society where we can see behavioral health disorders as illnesses that impact the brain, the same way we see cancer. And heart diseases, illnesses that affect the body. We're going to create a healing environment. We're going to create a place, a forum where people who struggle with this, who need a knee replacement are as open to coming to their doctor and talking about that knee pain as open to coming to their doctor and talking about their trauma experience as they are talking about their knee pain.

Jim: And to do that though, as we talked about earlier, individuals in those environments and hospitals and primary care offices and schools have to create a place where they're asking those questions of people so that we can normalize. That this is okay, that this isn't just happening to you it happens to others. And we want to you know, create a place where you can tell us about that so we're going to ask you questions about it to let you know, it's okay to share.

Jim: I think if we can get there we'd be miles ahead of where we are now.

Mike: Perfect.

Mike: Jim, it's always such a pleasure to talk to you. I really enjoy these conversations and from your introduction, I know how busy you are, so I greatly appreciate you taking a half an hour out of your day for us.

Jim: No, and I mean, you're welcome, first and foremost.

Jim: Thank you for having me. I think the other thing I would say is if anyone listening to this just has questions, like, I'm not sure. If I need help or not, I'm not sure if treatment's right for me. Reach out. You know, our website has a lot of information about both co occurring disorders and trauma, gatewayfoundation.org.

Jim: And then we have our 24 hour call center. And you can call that call center, just ask questions, just say, look, here's what my loved one's going through. Here's what I'm going through. I'm not sure. And we can at least help guide you to what makes sense. And that's 877-505-HOPE or 877-505-4673.

Mike: And if you weren't quick enough to write that down, there are links at the end of the podcast to all of the Gateway Foundation's resources.

Mike: Jim, thanks a ton. Those of you listening, we really appreciate it. I hope you can listen in as often as you can. And until we meet you again, we hope you are able to stay safe and stay connected and talk out loud.