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1. Addiction is a complex, socially constructed, political concept with many attendant emotions. What, if anything, has “escape”, “risk” and “impulsiveness” got to do with it?

2. Social workers need to be able to critique the concept of addictions because….

3. Low-income parents with chronic substance abuse problems are not necessarily bad parents. Agree or disagree and explain why.

4. In relation to trauma, critically analyse the concepts of addiction: surrender, self-regulation, recovery and relapse.

5. Critically analyse one kind of ‘addiction’ (e.g. one that is related to either drugs, gambling, gaming, eating or hoarding etc) as it affects on a specified Indigenous population of your choosing (eg, young, older, urban, rural, parents or single Indigenous people, and so on)

What is Trauma and Addiction?

Trauma refers to an injury, either physical or psychological, that can affect the wellbeing of an individual (Nasirian et al. 2018; Afari et al. 2014). From a psychological perspective, trauma can be the effect of a distressing or disturbing experience (such as a life threatening event, abuse, neglect, suffering, natural disasters, death, social isolation, chronic health conditions, rape or incarceration) that adversely affects the psychological or mental wellbeing of an individual (McCann and Pearlman 2015; Afari et al. 2014). Different individuals can react to traumatic episodes in different ways, and signs can psychological trauma can be diverse (from psychological symptoms such as irritability, anxiety, mood swings, anger, depression and addiction to physiological symptoms such as headaches, loss of appetite or insomnia) (Herman 2015; Mikulincer and Shaver 2015).

Addiction on the other hand is referred to a compulsive behaviour to engage in a rewarding stimulus even though it can have negative consequences (Foo et al. 2017). This creates a dependency towards certain substances such as drugs or alcohol or even certain behaviours such as gambling, hoarding, eating or gaming. These substances or behaviour produces a rewarding stimulus that helps in the maintenance of the behaviour, regardless of its adverse effects.

Addiction can have both short term as well as long term health effects. The health effects can also be both physical and mental, and affect the overall wellbeing of the addicted person as well as those close to them or dependant on them. The short term effects include impaired judgement, mood swings, memory problems, speech and coordination problem, accidents, concentration problems and stupor. The long term effects includes hallucinations, perception dysfunction and psychosis. Long term health conditions can also be cay=used due to addiction such as cardiac problems, neurological problems, liver dysfunction and seizures. Moreover a person with severe addiction can also face legal problems, family problems, financial crisis and social isolation. This adequately shows how addiction can adversely affect health and well being of individuals (Wise and Koob, 2014)

Addiction or addictive behaviour can be caused due to exposure to trauma. According to authors, trauma can be a single event, a series of events, or certain circumstances that can be psychologically harmful or even life threatening, experienced by individuals which affects the normal functioning of the individual as well as their social, physical, mental and spiritual wellbeing. The adverse psychological effects of these traumatic experiences include a range of negative emotions, anxiety disorders (such as Post Traumatic Stress Disorder) and depression. Individuals who experience traumatic events are shown to be more prone towards addiction to alcohol or drugs. Studies by Mills et al. (2005) studied 615 people with heroin dependencies, and their study showed that 92% of the participants have been exposed to trauma at some point in their lives and 41% have been diagnosed of PTSD. This showed that exposure to trauma or the diagnosis of PTSD can increase the risks of addiction. Similarly studies by Forbes et al. (2015) show that among the Australian citizens, PTSD and alcohol use disorder occur along with smoking and tobacco use disorder, showing that individuals with PTSD can develop dependencies towards alcohol and tobacco. Usage of recreational drugs such as cannabis was also found to be linked to the exposure of trauma and early use of tobacco (Werner et al. 2015).  According to Wiechelt and Straussner. (2015) the link between trauma related disorders and substance abuse or addiction disorders have been empirically analysed showing the addiction can happen due to exposure to trauma (Wiechelt 2007). It has been proposed that individuals who have addictive behaviour often engage in such behaviour because of the positive stimuli that elicits from the behaviour, and helps them to deal with the psychological stress caused by the trauma. This highlights that addiction can start as a mechanism of coping among individuals who have experienced trauma during their lives (either childhood or later life).

Link between Trauma and Addiction

According to Barret et al. (2015), exposure to childhood trauma can cause mental health issues and increase the risks of substance abuse in later life. Experiencing events such as child abuse, violence, bullying, neglect, crime, accidents, sexual assault, war, natural disaster, extreme deprivation and domestic violence can leave traumatizing memories, and individuals often develop a dependency towards drugs or alcohol to cope up with the negative emotions caused by these memories (Graves and Shapiro 2016; Levenson and Grady 2016)). According to studies, children experiencing such events are often affected by them at a neurological level because of the rapid development the brain undergoes during childhood. These experiences can affect the normal development of the brain, and increase the risks of addictive behaviour (Bergen-Cico et al. 2016). This is supported by studies that show that children who have been exposed to such stressors are more likely to develop addictions in later life (Wolf et al. 2015). Children experiencing such events can also develop learning disabilities, which can additionally increase the risks of addiction. This is because of how these experiences can influence the connections between neurons in the brain that can impede normal learning process, due to which individuals are unable to completely understand how the addictive behaviour can cause harm to them. Studies by Garami et al. (2018) show that both childhood trauma as well as lifetime trauma can lead to opioid addiction through interviews with 36 opiod dependant individuals and using the Childhood Maltreatment Questionnaire, Lifetime Trauma Survey, and Perceived Levels of Stress Scale. These studies clearly indicates that exposure to trauma can cause trauma related disorders (like PTSD), lead to neurological changes in the brain and can increase the risks of addiction to tobacco, smoking, alcohol, opioids and other drugs (such as heroin or cocaine) (Litt and West 2017; Tull et al. 2016; Mills et al. 2005). This is also supported through the studies by Schäfer et al.(2010) that studied patients with drug and alcohol dependencies, showing that experiences of childhood trauma was a common theme among most patient, as well as dissociative disorders. The link between exposure to trauma and mental health conditions also proves that the exposure can cause changes in the brain that leads to mental health problems. According to Wolf et al. (2015), traumatic events such as sexual abuse during childhood was found to be the cause of addiction in 18 of 229 participants studies by them who are suffering from drug addiction.

Addiction is a treatable condition and individuals suffering from addiction can completely recover from it. However, the treatment can often be long term, and can involve several efforts. Relapse of addiction is a common factor and is considered in any treatment plan which primarily focuses on the prevention and management of repeated drug use (Shields et al. 2015). In the treatment, success does not happen in one step, and therefore the treatment aims towards attaining success through several small steps or small improvements. Since addiction can affect lives of individuals in various ways, the treatment also needs to incorporate different aspects such as mental health, physical health, role of family and friends and motivations (Barber and Crisp 1995). Treatment can therefore include several components which can be used in a combination and monitor the progress of the individual. These components includes: detoxification, medications, motivational interviews, Cognitive Behaviour Therapy (CBT), Group Therapy, Family Therapy, Life skills training (Brown et al. 2013; Barber 1994; Barber and Crisp 1995; Shields et al. 2015)

Importance of Surrender, Self Regulation, Recovery, and Relapse Prevention in Addiction Treatment

The therapies for addiction aim to help the individuals to give up the addiction, helping them to identify the factors that act as triggers for the use of drugs. Through Motivational Interviews, individuals can he helped to understand the benefits of stopping addiction and motivate them to achieve it. In CBT the patient are helped to overcome their triggers for substance use. In group therapy, peer support is utilized to overcome drug dependency and involving the members sharing their own experiences with addiction. Family therapy utilizes the family support to help patients overcome addiction. In all of these therapies, aspects such as Surrender, Self Regulation, Recovery and Relapse have very important implications. The treatment or therapy focuses on this aspect as important stages that the individuals go through (Mills et al. 2005).

Surrender: This is considered as the first step towards giving up an addiction. Surrender essentially means letting go, which in the context of addiction treatment can imply letting go of their powers of self control, and seek help, and hand over the power to someone conducting the treatment. At this stage, the individual has the realization that they are unable to control their addiction anymore by themselves, and they need help from another person to get rid of the addiction. Giving up the self control is vital, as addiction often is maintained due to a false sense of control over the addiction (Shields et al. 2015).

Self Regulation: This is the ability to control one’s own actions and behaviour without any external help. Effective self regulation can help to overcome impulsive behaviour of addiction and substance use. Treatments aim to develop self regulation among the patients in order for them to overcome the urge of substance use. Self regulation can also be helpful as a coping mechanism for emotional stress that often triggers addictive behaviour. Such coping strategies can further help to improve the mental and emotional wellbeing of the patients in the long run, and thus Self Regulation is an important component of addiction treatment (Tull et al. 2016).

Recovery: This essentially is the main aim of the treatment of addiction. Recovery is the phase where an individual recovers from the addiction. In other words, the recovery is the discontinuance of the addictive behaviour or substance use. However, recovery might not always be complete, and it might be followed by a relapse of the addiction. In such cases, even a partial recovery can be considered as a step towards progress towards total recovery. Recovery therefore is one of the most important steps in treatment for addiction. Once a complete recovery occurs, it is understood that the addictive problems has been successfully overcome (Fisher 2000).

Relapse: This is the stage that can come after recovery or partial recovery, where the patient gets back to the addictive behaviour or resumes substance use. Studies show that more than 50% of individuals who go thorough treatment can go through a relapse within the first year of the treatment. Relapse is therefore a common consideration within any treatment, and patients are expected to go through a relapse. Relapse shows that the treatment cannot be completed at one go, and that patients can be overcome by their triggers at times, which can cause them to start using drugs again. According to Barber (1994), prevention of relapse is an important consideration in the treatment of alcohol use. Thus even though relapse might be considered as a common stage in the treatment, strategies are needed to prevent them in the first place, in order for the treatment program to be effective (Barber and Crisp 1995).

Conclusion:

From the discussion above it can be understood that experiences of traumatic incidents can increase the risks of addiction and substance abuse. Studies have shown that traumatic events such as a life threatening event, abuse, neglect, suffering, natural disasters, death, social isolation, chronic health conditions, rape or incarceration can cause mental health problems which can lead to the risks of addictions or addictive behaviours (Barrett et al. 2015). Traumatic events experienced during childhood or later in life can also cause problems in the brain, causing neuronal changes, which can manifest as addictive behaviours and substance dependencies. Treatment for addiction is a long term process, and a complete recovery is possible, however patients often experience relapse of the addiction. However, in order to recover, patients who are unable to quit addiction on their own must identify that they need help and surrender their sense of self control. Treatment also aims to improve self regulation, as it can help the patients to overcome their addictive behaviours on their own.

References:

Afari, N., Ahumada, S.M., Wright, L.J., Mostoufi, S., Golnari, G., Reis, V. and Cuneo, J.G., 2014. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic medicine, 76(1), p.2.

Barber, J. G. 1994. Social work with addictions.New York University Press.

Barber, J.G. and Crisp, B.R., 1995. Social support and prevention of relapse following treatment for alcohol abuse. Research on Social Work Practice, 5(3), pp.283-296.

Barrett, E. L., Teesson, M., Chapman, C., Slade, T., Carragher, N., and Mills, K. (2015). Substance use and mental health consequences of childhood trauma: An epidemiological investigation. Drug & Alcohol Dependence, 146, e217-e218.

Bergen-Cico, D., Wolf-Stanton, S., Filipovic, R. and Weisberg, J., 2016. Trauma and Neurological Risks of Addiction. In Neuropathology of Drug Addictions and Substance Misuse (pp. 61-70).

Brown, V.B., Harris, M. and Fallot, R., 2013. Moving toward trauma-informed practice in addiction treatment: A collaborative model of agency assessment. Journal of Psychoactive Drugs, 45(5), pp.386-393.

Fisher, J., 2000. Addictions and trauma recovery. International Society for the Study of Dissociation, November, 13.

Foo, J.C., Noori, H.R., Yamaguchi, I., Vengeliene, V., Cosa-Linan, A., Nakamura, T., Morita, K., Spanagel, R. and Yamamoto, Y., 2017. Dynamical state transitions into addictive behaviour and their early-warning signals. Proc. R. Soc. B, 284(1860), p.20170882.

Forbes, M.K., Flanagan, J.C., Barrett, E.L., Crome, E., Baillie, A.J., Mills, K.L. and Teesson, M., 2015. Smoking, posttraumatic stress disorder, and alcohol use disorders in a nationally representative sample of Australian men and women. Drug and alcohol dependence, 156, pp.176-183.

Garami, J., Valikhani, A., Parkes, D., Haber, P., Mahlberg, J., Misiak, B., Frydecka, D. and Moustafa, A.A., 2018. Examining perceived stress, childhood trauma and interpersonal trauma in individuals with drug addiction. Psychological reports, p.0033294118764918.

Graves, J. and Shapiro, J., 2016. Trauma Informed Clinical Social Work Practice: Case Composite with Court-Involved Adolescent. Smith College Studies in Social Work, 86(3), pp.204-224.

Herman, J.L., 2015. Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. Hachette UK.

Levenson, J. and Grady, M., 2016. Childhood adversity, substance abuse, and violence: implications for trauma-informed social work practice. Journal of social work practice in the addictions, 16(1-2), pp.24-45.

Litt, J. and West, C., 2017. Understanding addictions: tackling smoking and hazardous drinking. In Lifestyle Medicine (Third Edition) (pp. 355-370).

McCann, L. and Pearlman, L.A., 2015. Psychological trauma and adult survivor theory: Therapy and transformation. Routledge.

Mikulincer, M. and Shaver, P.R., 2015. The psychological effects of the contextual activation of security-enhancing mental representations in adulthood. Current Opinion in Psychology, 1, pp.18-21.

Mills, K.L., Lynskey, M., Teesson, M., Ross, J. and Darke, S., 2005. Post-traumatic stress disorder among people with heroin dependence in the Australian treatment outcome study (ATOS): prevalence and correlates. Drug and alcohol dependence, 77(3), pp.243-249.

Nasirian, S., Olsén, M.F. and Engström, M., 2018. Patients' Experiences of Their Recovery Process After Minor Physical Trauma. Journal of Trauma Nursing, 25(4), pp.233-241.

Schäfer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M.D., Chodzinski, C., Kemper, U., Keiper, P., Wedekind, D., Havemann-Reinecke, U. and Teunissen, S., 2010. Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both—a multi-center study. Drug and alcohol dependence, 109(1-3), pp.84-89.

Shields, J.J., Delany, P.J. and Smith, K.E., 2015. Factors related to the delivery of trauma services in outpatient treatment programs. Journal of Social Work Practice in the Addictions, 15(1), pp.114-129.

Tull, M.T., Gratz, K.L., McDermott, M.J., Bordieri, M.J., Daughters, S.B. and Lejuez, C.W., 2016. The role of emotion regulation difficulties in the relation between PTSD symptoms and the learned association between trauma-related and cocaine cues. Substance use & misuse, 51(10), pp.1318-1329.

Werner, K.B., McCutcheon, V.V., Sartor, C.E., Nelson, E.C., Heath, A.C. and Bucholz, K.K., 2015. Black–white disparities in risk for cannabis use and problems in women: The role of early tobacco use, trauma type and psychiatric pathology. Drug & Alcohol Dependence, 156, p.e237.

Wiechelt, S.A. and Straussner, S.L.A., 2015. Introduction to the special issue: Examining the relationship between trauma and addiction. Journal of Social Work Practice in the Addictions, 15(1), pp.1-5.

Wiechelt, S.A., 2007. Trauma and substance misuse: Critical considerations in understanding the maelstrom. Substance use & misuse, 42(2-3), pp.527-533.

Wise, R.A. and Koob, G.F., 2014. The development and maintenance of drug addiction. Neuropsychopharmacology, 39(2), p.254.

Wolf, M.R., Nochajski, T.H. and Farrell, H.M.G., 2015. The effects of childhood sexual abuse and other trauma on drug court participants. Journal of Social Work Practice in the Addictions, 15(1), pp.44-65.

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