Trauma Informed
Care and Addiction

​​ All right, so you might have read "The Hobbit" or "The Lord of the Rings," you have probably 00:03 seen them, you've definitely heard of them. But not everyone knows the story of their 00:07 author, J.R.R. Tolkien. Tolkien was an English World War One veteran. A reluctant solider, 00:13 he joined up with a sense of duty and he lived through the bloody battle of Somme suffering 00:18 tremendous shock, guilt, and loss during and after the war. 00:22 It took Tolkien years to processes his experiences. To help him do it he turned to writing fiction 00:27 and in time he constructed a world that helped him and all of us better understand war, human 00:33 nature, loss, and growth. His novels were the bi-product of trauma and they're among 00:37 the more beautiful reminders of how it can affect us. 00:39 Most of us will experience some kind of traumatic event in our lives and most of us will exhibit 00:44 some kind of stress related behavior because of it, these symptoms usually fade but for 00:49 some those reactions can linger and start of disrupt their lives or the lives of those 00:53 around them. These reactions can develop into full blown psychological disorders including 00:57 post-traumatic stress disorder and, in an effort to cope, sometimes addiction, but it doesn't 01:01 always have to be that way. 01:03 Ultimately, Tolkien was able to harness the effect of his trauma and shape them into something 01:06 important and to reclaim is own life because there is such a thing as post-traumatic growth, too. 01:12 As it does with many other things psychology approaches trauma related disorders with different 01:17 perspectives, but they all tend to ask the same questions. 01:20 How do you identify and diagnose these disorders? And how do you treat them, so that the patients 01:24 can recover? -- With the understanding that they might never be the same as they were 01:28 before the trauma, but they can still be healthy and happy. 01:31 In a way, psychology helps patients ask themselves, what Tolkien asks his readers, and what Frodo 01:36 asks when he is finally safe back in the shire: "How do you pick up the threads of an old 01:41 life? How to go on, when in your heart, you begin to understand that there is no going back." 01:57 It could be September 11 or a serious car accident or a natural disaster or a violent 02:02 crime that you survived but are still haunted by. Trauma comes in many different forms and 02:07 sometimes it can stick with you. 02:09 When it manifests as nightmares, flashbacks, avoidance, fear, guilt, anxiety, rage, insomnia, 02:15 and begins to interfere with your ability to function it can come to be known as post-traumatic 02:20 stress disorder or PTSD. 02:22 It was once call "shell shock" a term used to describe the condition of veterans, like 02:26 Tolkien in World War One but PTSD isn't limited to veterans. It's defined as a psychological 02:31 disorder generated by either witnessing or experiencing a traumatic event. Its symptoms 02:36 are classified into four major clusters in the DSM V. 02:40 One of these clusters involves re-living the event through intrusive memories, nightmares, 02:44 or flashbacks. The second involves avoiding situations you associate with the event, while 02:49 the third generally describes excessive physiological arousal like heart pounding, muscle tension, 02:54 anxiety or irritability, and major problems sleeping or concentrating. And finally we 02:59 have the fourth major symptom cluster: pervasive negative changes in emotions and belief, like 03:05 feelings in excessive guilt, fear, or shame -- or no longer getting enjoyment out of what you used to. 03:10 PTSD patients may also experience numbing, or periods of feeling emotionless or emotionally 03:15 "flat" and dissociation, feeling as if situations aren't real or are surreal, feeling like time 03:21 has slowed down or sped up, or even blacking out. 03:23 We have been discussing how anxiety or mood disorders can affect a person's ability to 03:27 function and how that impairment itself leads to more suffering and dysfunction. 03:32 When any of these disorders is left untreated suffers may start to feel desperate to find 03:36 some way to cope and one way may be substance abuse. Unfortunately, addiction and trauma 03:41 can go hand in hand and it can be hard to recover from one without also dealing with 03:44 the other. According to the US department of Veteran's Affairs more than 2 in 10 veterans 03:48 with PTSD also struggle with substance abuse problems and 1 in every 3 vets seeking 03:53 treatment for substance abuse also have PTSD. And across many studies, between a third to 03:57 a half of women in treatment for substance abuse have experienced rape or sexual assault. 04:02 For a long time most psychologists understood PTSD through the lens of fear conditioning 04:07 or the unshakable memory of being in mortal danger and the learned responses that stem 04:11 from that memory. But clinicians have also begun to recognize that for some the disorder 04:15 can also be a kind of moral injury, widening the focus to include hauntings not just of 04:21 violence done to a person but also what that person did or did not do to others. 04:26 Brandon was a combat drone operator in the air force he enlisted at 21 years old and 04:30 spent 6 years sitting in a bunker in the American South-West watching Iraq and Afghanistan from 04:35 surveillance drones. 04:36 He watched soldiers die and people get executed. He also watched kids play, people get married, 04:42 goats grazing -- and when the time came he ordered hell fire missiles to strike military 04:47 targets or people who had no idea they where even being watched. 04:51 Although he was half a world away from combat, he ultimately suffered the psychological trauma 04:55 felt by many on the ground soldiers. He was diagnosed with PTSD. Brandon suffers no fears 05:00 for his own safety, but still experiences the same intrusive memories, nightmares, depression, 05:06 anxiety, and substance abuse of many emotionally traumatized combat soldiers. So do a lot of 05:11 other drone operators. 05:12 But why do some victims or trauma suffer from PTSD while others seem able to move on? 05:18 Well, its psychology so the risk factors are complicated. Some findings suggest that there 05:22 may be genetic predispositions making some people more vulnerable than others. We also 05:26 know that context and environment matter, for instance, someone who has experienced 05:30 childhood abuse might feel on the one hand more ready to deal with difficult and traumatic 05:35 experiences. But on the other hand they might be more likely to default to the suppression 05:38 and avoidance in which PTSD suffers frequently engage, which as we've discussed in previous 05:43 episodes often makes psychiatric symptoms worsen over time. 05:46 As far as whats going on in the brain, PTSD shares some similarities with anxiety disorders. 05:52 For example the brains limbic system may flood the body with waves of stress hormones like 05:56 cortisol every time images of the traumatic event bubble up uninvited into consciousness. 06:01 And we've already talked a lot about how the amygdala and hippocampus are involved in those 06:05 classic fight or flight reactions, which when prolonged can be really rough on the body. 06:10 In fact, neuroimaging suggests that trauma -- or the chemical processes set into motion 06:14 by trauma -- might actually damage and shrink the hippocampus. Since this region is also 06:19 associated with how we consolidate memories, this might explain how memories associated 06:23 with trauma could fail to be filed away as long-term memories and instead remain vivid 06:28 and fresh through flashbacks and nightmares. 06:31 If there's any silver lining to all of this, it's that some people may actually experience 06:35 positive change after a trauma. Treatment and social support help some suffers achieve 06:40 post-traumatic growth, positive psychological changes resulting from the struggle with challenging 06:45 circumstances and life crises. 06:47 That's in part what Tolkien did. Though he suffered great trauma and loss on the battlefield, 06:52 he was eventually able to use those experiences to drive those powerful, allegorical stories. Stories 06:58 that helped not just himself, but many readers of all ages around the world. 07:02 It seems that while whatever doesn't kill you might not necessarily make you stronger, 07:07 sometimes it really does. 07:09 But suffering can feed on itself. Many victims of trauma try to cope through whats colloquially 07:13 called self-medicating and some can end up with substance abuse or dependence issues. 07:18 Psychologists define addiction or dependence as compulsive, excessive, and difficult-to-control 07:23 substance use, or other, initially pleasurable behavior that beings to interfere with ordinary 07:29 life, work, health, or relationships. 07:31 This could mean over-consuming drugs or alcohol, or compulsively gambling, eating, shopping, 07:36 exercising, or having sex. People with addictions may not even realize that they have lost control 07:40 of their behavior for some time. 07:42 Addiction can refer to a physical dependence, a physiological need for a drug, that reveals 07:47 itself through terrible withdrawal symptoms if the use stops or reduces. Or psychological 07:52 dependence, the need to use that drug, or complete that activity in order to relieve 07:56 negative emotions. 07:57 People with addiction can sometimes be stigmatized as pleasure-bound hedonists who have no self-control, 08:02 but people often compulsively use substances or do things in reaction to stress and other 08:07 psychological problems. For various reasons they have been prevented from coping in other 08:11 ways or maybe they just never learned how. 08:14 So in this way addiction itself is often secondary to the more complicated matter of how a person 08:19 deals with stress and difficult emotions, or what kinds of stressful situations they've survived. 08:24 Few will dispute that much of what makes addiction possible is chemistry, but people are different 08:29 -- from their life experiences to their biological sensitivities. So people respond in different 08:34 way to different drugs and behaviors. Many people can drink casually or gamble once in 08:39 a while without losing control. Others simply can't. 08:42 People in recovery from addiction may also have different needs. Some will need to be 08:46 completely sober and never again touch that drug or do that thing. While others may in 08:51 time be able to regain enough control to use again in moderation. 08:55 Likewise, some folks can kick the habit on their own while others do better with or need 08:59 support from professionals or support groups. 09:01 Researchers and groups like Alcoholics Anonymous debate whether addiction is a mental illness 09:06 -- like a "software problem" related to thoughts, and behaviors, and feelings -- or a physical disease 09:10 -- a "hard wire problem" related to biology and genetics -- or both, and even whether 09:15 addiction and dependence are the same thing. 09:17 Either way it can be hard to recover from an addiction if you don't get the underlying 09:21 problem treated. But some people believe that you can't treat the underlying problem without 09:26 first getting the addiction out of the way. 09:28 While this controversy too continues, many are moving toward a model of treating both 09:32 at at the same time. The so-called Dual Diagnosis Model of treatment. 09:37 Addiction that's rooted in deeper psychological issues -- especially in emotional trauma like 09:40 PTSD -- often require some version of dual treatment to untangle both issues. 09:45 The good news is while PTSD and substance dependence may be distressing and complex, 09:50 people can begin to heal given the chance and the resources. 09:53 We're amazingly resilient creatures. When nurtured with the proper support and practice, we can overcome a lot. 09:59 Today we talked about the causes and symptoms of PTSD and how trauma can affect the brain. 10:04 We also looked at addiction, physical and psychological dependence, the relationship 10:08 between trauma and addiction, and why they can require dual treatment, and we touched on 10:13 post-traumatic growth with the wisdom of Frodo Baggins. 10:16 Thanks for watching, especially to all our subscribers on Subbable who make this show 10:21 possible. To find out how you can become a supporter and help us do this thing just go to 10:25 subbable.com/crashcourse. 10:28 This episode was written by Kathleen Yale, edited by Blake de Pastino and our consultant 10:32 is Dr. Ranjit Bhagwat. Our director and editor is Nicolas Jenkins. The script supervisor 10:36 and sound designer is Michael Aranda, and the graphics team is Thought Cafe.