1 Addiction & Trauma: The Complexity of Treating the Young AdultThe Meadows Senior Fellow/Clinical Architect of Claudia Black Young Adult Center

2 Autonomic Nervous SystemOn a daily basis, our nervous systems experience periods of increasing arousal and periods of decreasing arousal. Each one of us has a “Window of Tolerance” or an “Optimal Arousal Zone” where we can experience nervous system fluctuations while still having the capacity to regulate ourselves. Optimal Arousal Zone Present, embodied, open, curious, tolerable feelings, relaxed yet alert, able to think, relational Adapted from the works of P. Levine, Porges, & P. Ogden

3 Sympathetic Hyperarousal Parasympathetic HypoarousalAnxious, panic, restless, hyperactive, hypervigilant, exaggerated startle, emotional flooding, impulsivity, risk-taking, poor judgment Dysregulated Arousal Regulated Arousal Optimal Arousal Zone Present, embodied, open, curious, tolerable feelings, relaxed yet alert, able to think, relational Parasympathetic Hypoarousal Flat affect, depression, lethargy, numb, disconnected, dissociation, despair, self-loathing, hopeless, full of shame, victim identity

4 If we are chronically dysregulated long enough, we tend to become “stuck” in a dysregulated state, regardless if the original “pain” is still present or not.

5 The more severely we are dysregulated, and/or the longer the dysregulation lasts, the greater the chance we subjectively experience unbearable discomfort, or difficulty staying “within our own skin”. Many of us begin self-medicating in order to move away from the pain, and move towards pleasure.

6 Now 2 HUGE problems! A dysregulated nervous system Addictions, with all of their complications

7 When overwhelmed by a threat and not able to successfully defend self, one becomes stuck in a survival mode. This continual state, hypo or hyper, of arousal over time can begin to form the symptoms of trauma.

8 Trauma “stress that causes physical or emotional harm from which you cannot remove yourself” (SAMHSA)

9 Families that experience trauma…Addictive Abusive Rageful Chronically less than nurturing families of extreme: — disconnection to enmeshment ― rigid to permissive Rigid ►Emotionally isolated ►Denial ―creating shame-based beliefs Common Denominator — Loss

10 Experiences that fuel traumatic responsesShame Humiliation Being left out Bullied Unrealistic expectations Adoption – Attachment disruption Acrimonious divorce Absent parenting

11 Emotional AbandonmentHaving to hide a part of who you are in order to be acceptable and/or to protect yourself When you have to hide: Your mistakes/vulnerability Your feelings Your needs Your accomplishments/successes

12 When children are treated as peers with no parent child distinction.When someone is disappointed with you they attack your whole being, worth, and value versus what you did or did not do. When another expects you to be an extension of themselves, fulfilling their dreams. When another is not willing to take responsibility for their feelings, thoughts, and behaviors but expects you to take responsibility for them. When parents’ esteem is predominantly derived through child’s behavior. When children are treated as peers with no parent child distinction. Automatic fills in 4 more points

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15 Children of Affluence Perfectionism (achievement pressure) IsolationFather hunger – Dad’s not involved in a manner that the young person feels validated or supported Mother enmeshment – fused relationship

16 Shame Control Addictive Disorders Perfectionism AnxietyThe painful feeling that comes with the belief that who I am is not okay Control Victimization Depression Self harm, cutting Rage Procrastination Perfectionism Addictive Disorders Suicide Anxiety Hurtful Partner Relationships

17 Core Elements to TreatmentGrounding/emotional regulation

18 Mindfulness is the ability to cultivate awareness of the present moment while putting aside our lenses of judgment. It is being in connection with the direct experience of the present moment, the here and now.

19 Benefits of Mindfulness MeditationReduced rumination Stress reduction Boosts working memory Focus Less emotional reactivity More cognitive flexibility Relationship satisfaction Health benefits such as: ▪ increased immune functioning ▪ reduced psychological distress ▪ increased information processing speed

20 Core Elements to TreatmentGrounding/emotional regulation Trauma therapies

21 Trauma Therapy PracticesTai Chi Yoga Expressive Arts Song Drumming Chanting Meditation Labyrinth EMDS Somatic Experiencing (SE) Sensorimotor Psychotherapy (SP Emotionally Focused Therapy (EFT) Neurofeedback Action Based Psychodramatic Techniques

22 Core Elements to TreatmentGrounding/emotional regulation Trauma therapies Experiential

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24 Core Elements to TreatmentGrounding/emotional regulation Trauma therapies Experiential Community Gender responsive programming Life skills Fun in recovery Family treatment

25 Addicted Son 18 yrs old Addicted to alcohol & crystal meth / Lies & steals Verbally abusive to Mom & sisters Sister 19 yrs old Parties with him Angry Mom Overworks Stays away Avoids issues Overprotects kids Makes excuses Blames her husband IMPAIRED FAMILY Sister 16 yrs old Is also using Doesn’t tell the truth Dad Doesn’t listen Doesn’t show much interest in kids Minimizes drinking & smoking pot Brother 14 yrs old Silent anger Hides in his room

26 Moving to Greater Family HealthAddicted Son 18 yrs old Commit to recovery via NA Work with sponsor on steps Make verbal amends and behavioral with family, will be specific Mom Go to Alanon and/or Naranon Only put in 8-9 hour work days Not lie to my husband about the kids Look for the positive in my husband Support each of my kids in finding positive outlets for their feelings, be it a 12 Step group, a school activity, etc. Sister 19 yrs old Agree to participate in family meetings Read more about boundaries and practice them Willing to go to therapy Willing to get assessment for own drug and alcohol abuse Moving to Greater Family Health Sister 16 yrs old Talk at family meetings Commit to not using Join school group that supports drug & alcohol abstinence Dad Really work at listening, practice active listening Not start sentences with “You…” Look for good behavior and not seek out the negative Compliment and state appreciation Work with wife on our marriage, start with couples workshop Brother 14 yrs old Eat dinner with whoever is eating at home Keep door to my room open For now, use computer just for school reports Talk at family meetings

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