by Wayne Munchel, LCSW   2 Comments

“We treat people’s solutions as problems.” Vincent Felitti MD, eminent author of the original ACE’s (Adverse Childhood Experiences) study, often makes this point when discussing how we focus on eliminating people’s desperate means of coping, without recognizing their adaptive functions. When addressing substance abuse (the most common method of tolerating overwhelming fear and pain) do we commit the same error of attempting to control the “solution” while largely ignoring the underlying core problems associated with traumatic exposures? For many people struggling with addictions, substance abuse represents their survival.

The linkage between ACE’s and trauma and substance abuse disorders (SUD’s) is compelling. In his paper, Origins of Addiction, Felitti reports that people who experience 4 or more ACE’s are 500% more likely to abuse alcohol. People who report five ACE’s or more are 7 to 10 times more likely to report illicit drug abuse. A jaw-dropping data point indicates that individuals who survive 6 or more ACE’s are 46 times more likely to be IV drug abusers than people who report no ACE’s. Trauma truly is the “gateway drug” to addictions.

Kanwarpal Dhaliwal and the youth at RYSE (Richmond Youth Services) have amplified the ACE’s pyramid to include the toxic impacts of social conditions and local contexts such as poverty, racism and historical trauma. This expanded view helps us recognize that it’s not just what has happened to you, but what environmental stressors and social conditions you are born and raised in. As attention has turned to the “opioid crisis,” it would seem to be no coincidence that the communities most affected are beset by high rates of unemployment, poverty, and social isolation. In contrast to the reductive medical model, the ACE’s trauma-informed approach encompasses neighborhoods as much as neurons, and it relates to zip codes more than just genetic codes.

Some substance abuse programs and mental health agencies have begun integrating the ACE’s questionnaire into their initial assessments. What might be the potential impacts of incorporating enhanced ACE’s informed perspectives into treatment?

  • Asking about childhood maltreatment, listening and offering empathy represents a significant intervention in itself. Simple, straightforward human compassion for “what has happened” to people, acknowledging human suffering and distress can be healing.
  • Inviting people who abuse substances to be “compassionately curious” about themselves and to connect the dots between their unseen wounds and their attempts to cope with overwhelming distress can provide relief and self-understanding. (“I use substances for understandable reasons, I’m not just crazy or stupid.”) This is often a long-term, life-time process.
  • Instilling hope for a better future is an essential ingredient for recovery. “What can be hurt can be healed” seems to illuminate this pathway much more than “you have an incurable, life-long brain disease.”
  • Empowering people to take responsibility for owning their own stories and writing (and rewriting) new chapters. Talk of genetic predispositions and chemical imbalances can engender passivity and resignation.
  • Supporting meaning making and setting the stage for post-traumatic growth.
  • Emphasizing the central need for social supports and human connection. In his enlightening TED talk, Johann Hari asks this challenging question: “What if the opposite of addiction is not sobriety, but the opposite of addiction is connection?” A key aspect of reducing substance abuse is how well we can help people develop their social networks and resilience.
  • This reminds us all that unless we also vigorously address issues such as social justice, poverty and racism, our progress will be limited.

Utilizing this broader, trauma-informed lens often seems at odds with the dominant medical model approach to addiction as a disease. Framing problems such as addiction as solely problems within an individual’s disordered neural circuitry are favored. We prefer our solutions to be fast-acting, cheap and to avoid discomforting questions about social conditions. In his book “In the Realm of Hungry Ghosts,” Gabor Mate makes the following observation: “We keep trying to change people’s behaviors without a full understanding of how and why those behaviors arise.” A trauma informed approach to substance abuse and dependence brings the potential of deep healing, not just for individuals but our communities as well.

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by Wayne Munchel, LCSW   0 Comments

Developing resilience may be one of the most important impacts providers can have on emerging adults, but what exactly is resilience and what the hell can we do about it?

Resilience has been defined as the ability to “bounce back”. When it comes to many youth and young adults, that bouncy quality has often been flattened by grinding adversities, toxic stressors, and repeated traumatization. Some experts focus on improving the personal, “internal” skills and qualities that contribute to resiliency, such as problem-solving, emotional regulation and positive self-talk. Others emphasize the quantity and quality of a youth’s social supports, adult allies and community connections. Several studies point out that the single most important factor that prevents tolerable stress from becoming toxic stress is the presence of positive, “buffering” relationships.

If marginalized, stigmatized, you-name-it-ized youth and young adults are discharged from TAY services with the same levels (or less) of social support as when they arrive, our impacts will likely be very limited and short-lived. It’s been noted that during this transitional period, social supports tend to decline – just as the social demands of finding housing, roommates, romantic partners and work increase. Those turbulent cross-currents can push vulnerable youth toward a life of poverty, isolation and disability. Many TAY programs identify their primary goals as increasing the independence and self-sufficiency of young people, but these objectives can be misguided and culturally incongruent. Except for some doomsday preppers living in Montana, we are INTER-dependent — we rely every day on others to get our basic needs met. We are wired for relationships and need to be needed.

Each TAY program should develop clear community integration strategies that create opportunities for youth to meet people and expand their circles of support with peers, allies and mentors. School and work remain the primary pathways for social inclusion and connectedness for youth (discussed in previous blogs), but a very low percentage of youth with serious mental health conditions are accessing these crucial, developmental experiences. We must redouble our efforts on building bridges to education and employment, but what additional pathways can be identified?

  • Finding faith communities — many youth may identify spirituality and religion as important to them, but have not joined any congregation or faith community. Mapping out what local churches, mosques, synagogues are available (and which offer Youth clubs, Movie and Spaghetti nights etc…) and providing coaching on introducing oneself and starting conversations (when needed) can be helpful.
  • Connecting interests, hobbies & passions to communities — whatever the interest or hobby may be, there are others who share it. MeetUp, Instagram and Internet searches can frequently identify where other like-minded people gather.
  • Exploring social media — recognizing that most youth can engage with a world of diverse communities, support groups and chat rooms through their SmartPhones and lap-tops. This can be an important consideration for agencies serving more rural, less densely populated communities. TAY agencies can play a helpful role by providing examples of youth-oriented web-sites, advocacy groups and Crisis Text lines.
  • Supporting housing (and neighborhoods) — building connection and community with neighbors can be a powerful (and risky) tactic. Inviting neighbors over for pizza, movies or board games has great potential (while learning to use good judgment). Many youth can find their first apartments to be very isolating and providers can coach ways to connect with neighbors.
  • Reinforcing families — care-givers, siblings and extended family represent key protective factors that can offer many opportunities for support, togetherness, meals and rides to the grocery store.
  • Joining social justice movements — getting politically active can empower and facilitate a sense of being part of something that is bigger than oneself.
  • Getting involved with arts, cultural/ethnic organizations — artistic expression from music and drama to visual arts and spoken word are powerful ways for youth to cultivate identity, find mentors and express themselves.
  • Volunteering — it’s been said that “helping helps the helper”, recognizing the value and how they can support others can greatly enhance resiliency in youth. Staff can assist by helping youth find opportunities to give back.

What ways have you found to help raise the resiliency in youth?

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