Into Oblivion – The Vortex of Trauma & Addiction
By Carrie DeJong, MC, RCC
Editors note: BCACC is pleased to welcome Carrie DeJong, MC, RCC, as a presenter at Wired Together: Self, Science, Society conference. Taking place in Richmond from November 1-3, 2019, this exciting conference brings together Registered Clinical Counsellors, counselling therapists and allied professionals for discussion and exchange of the most cutting-edge knowledge, insights, issues and ideas in the world of counselling therapy. Carrie’s presentation, titled “Into Oblivion – The Vortex of Trauma & Addiction“, takes place on Day One of the conference. Early bird registration is available until July 5, 2019. Learn more here.
I am excited to share a model of trauma and addiction I have developed over my 20 years as a clinical counsellor. Before getting to the model itself, it’s important to set the groundwork. Many of my previous posts have focused on the connection between trauma and addiction. I have written a 4-part series Trauma & Addiction: The Link We Can’t Ignore that discusses many different aspects of the connection between these two areas of clinical concern:
- Research demonstrates that someone with a PTSD diagnosis is four times more like to also have a problem with substance misuse than someone without PTSD.
- While trauma is not always a contributing factor for everyone with a substance use disorder, painful life experiences are known to contribute to the development of SUDs. The Adverse Childhood Experience Study (ACE Study) demonstrates a strong correlation between traumatic childhood experiences and addiction.
- Our clients face more negative impacts when trauma and addiction are not addressed together – dual diagnosis leads to greater struggles for both trauma and substance use disorders. Treatment programs tend to be less successful, and the chances of relapse are higher when both not included as part of the treatment plan.
- Substance use often starts as a way of managing the overwhelming symptoms of trauma including anxiety, shame, physical activation and intrusive thoughts. Mood-altering substances and behaviours offer a way to numb these painful symptoms.
This model of addiction draws from the work of many well-known researchers and clinicians in the fields of trauma, neurobiology, and neurophysiology. The work that strongly influences my understanding of trauma and addiction include:
- Research demonstrating the strong correlation between a history of trauma and the development of addiction such as the ACE Study by Drs. Felitti and Anda.
- Somatic approaches to trauma therapy including the work of Peter Levine (Waking the Tiger), Bessel van der Kolk (The Body Keeps the Score), and Pat Ogden (Sensorimotor Psychotherapy).
- Stephen Porges’ Polyvagal Theory, a complex theory about the human nervous system, our biological responses to safety and danger as well as how our nervous system operates in a hierarchy of responses (some more adaptive than others) to ensure our survival in the face of threat.
- The “Window of Tolerance” introduced by Daniel J. Siegal and further developed by Pat Ogden describing a zone of optimal nervous system functioning. This model provides a perspective for understanding the move out of the window of tolerance into a state of either hyper or hypo arousal.
- The Defense Cascade Model (Schauer and Elbert, 2010) describing a theoretical framework for understanding the human response to threat including fight, flight, freeze, and tonic immobility. Researchers use this as a model for understanding the dissociative response often associated with trauma.
Even though there is so much more to be said about the theoretical underpinnings of my model, here is a brief introduction to The Vortex of Trauma and Addiction:
A State of Calm
People function best when most aspects of their lives are manageable, and they demonstrate self-regulation across all major domains of life: physical, emotional, relational, cognitive, and behavioural.
Individuals who can easily access a state of calm are those who actively address issues in their lives. They generally take care of themselves. They participate in meaningful relationships, social, academic, or vocational endeavours. They tend to possess a healthy repertoire of coping skills and are good at reaching out for support when they need to. As clinicians (especially those who work with trauma and/or addiction), we seldom see clients who function in such healthy ways.
A Little Stress
We all know life does not remain in a blissful state of calm. Our modern lives are far too complicated for that. There are numerous sources of increased stress or anxiety: deadlines, traffic delays, minor illnesses, or a quarrel with a loved one. There are daily situations that place higher demands on our self-regulatory processes. Frustration, work pressure, excitement, and performance all require a higher output of physical, emotional, or cognitive energy. It’s important to note that not all stress or activation is negative. Delivering a speech, training for a marathon, or falling in love all increase the demands on our system but are not necessarily unwanted or unpleasant experiences.
People who are well-regulated find ways of engaging in activities that are more challenging or taxing but are not overwhelmed by these demands. At the end of a more stressful situation, they can decompress and find a way back to a state of calm. Perhaps a good meal, connection with a loved one, exercise, or a good sleep helps “reset” their nervous system enabling them to return to a state of calm and manageability.
Overwhelmed & Shutdown
If only life remained in such general states of manageability – but it clearly doesn’t. Our therapy practices and treatment programs are full of people for whom aspects of their lives have become overwhelming or unmanageable. Traumatic and stressful circumstances are painful and inevitable: accidents, illness, violence, abuse, natural disasters, death, and broken relationships are all too common in the human experience. As clinicians, our work is to help clients move through these painful aspects of life in ways that support them to develop or reconnect with resources that help them heal.
In this previous post, I discussed the two bimodal categories of trauma symptoms: hyper-arousal symptoms and hypo-arousal symptoms. These two broad types of trauma symptoms form the basis for the next two stages of the Vortex Model: Overwhelmed and Shutdown.
The hyper-arousal symptoms include fear, anger, intrusive experiences, and the high activation in the nervous system that remains following stressful and traumatic experiences. This ongoing activation of the fight or flight response can remain long after the threat or trauma has ended – this is what contributes to the experience of a state of chronic “overwhelmed”.
But clients often present with a different set of symptoms – those belonging to the hypo-arousal cluster. Rather than a state of high activation experienced through hyper-arousal, hypo-arousal shows up as a state of “shutdown” that results when trauma and traumatic stress become overwhelming, and the nervous system moves into dissociative responses.
Patterns of harmful substance use as well as mood-altering behaviours begin to take root in these two stages, often because they serve specific purposes in helping clients manage the symptoms of trauma. This leads to the next stage …
It isn’t difficult to see the result of attempts to disconnect from the overwhelming and painful symptoms of unresolved trauma with mood-altering substances or compulsive behaviours. It creates a fast-track into addiction and the host of adverse outcomes that result from addiction: loss of control, self-destruction, suicidality, substance-induced psychosis, and all the profound impacts on health, relationships, and overall functioning. Although “Oblivion” isn’t a clinical term, it is an apt description of the state of disconnection from themselves, others, and even reality.
Summing It Up
There you have it: a quick summary of the Vortex of Trauma & Addiction. It is a model that provides a framework for understanding the nervous system responses to traumatic and stressful experiences as well as the process of addiction. It also speaks to the process of recovery and the journey of healing as well as applying to a broader range of challenges, coping, and responses to being overwhelmed.
You read the next posts in this series: Overwhelmed, Shutdown, and Oblivion stages in much greater detail. I invite you to sign up if you wish to receive updates as well as information about training opportunities where I present this model in greater depth.
Carrie DeJong is a therapist, consultant, and writer with over 20 years of clinical experience working with trauma and addiction. Her goal is to bring more science and more compassion to the field of addiction recovery. She has worked in residential addiction treatment as well as in trauma treatment programs for children, youth, and adults. Carrie focuses on bringing greater awareness of the impact that trauma, stress, and mental health challenges have on the use of mood-altering substances and behaviours as a way of coping. Her therapeutic approach, as well as the Vortex Model of Addiction she has developed, is rooted in somatic and neurobiological approaches that provide a foundation for understanding the complex behavioural and emotional patterns of addiction. Carrie utilizes the Vortex Model as a framework in providing training on the connection between trauma, substance misuse, and addiction disorders to professionals in a wide variety of clinical settings.