Substance use disorders and trauma- and violence-informed care

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Summary

Research shows that people with substance use disorders are more likely to have a history of trauma and violence than the general population. This can include negative experiences with police and with medical professionals.

On this episode of Addiction Practice Pod, addiction physician Dr. Christy Sutherland and journalist David Ball take a deep dive into trauma and its links to substance use disorder, as well as the concept of trauma- and violence-informed care. As they discuss with their guests, using trauma- and violence-informed approaches with patients is the key to building strong relationships and supporting them to achieve their health goals.

 
Lineup

In this episode, you’ll hear:

• 2:20 – Guy Felicella – Peer Clinical Advisor at the BC Centre on Substance Use and Vancouver Coastal Health
• 11:35 – Christina Chant – Clinical Nurse Specialist, Registered Nurse

 
Pearls

Here’s what listeners can take away from this episode:

1. Self-reflection is an important part of clinical care. Ask yourself, what am I feeling today? How do I feel when I see a certain patient? This reflection time can help you incorporate trauma- and violence-informed care into your work. If you can name your emotions and identify how you feel, this can help you to identify what is important to you, what brings you joy, why you enjoy caring for your patients: that human connection.
2. Providing trauma- and violence- informed care is also about considering the spaces where we offer services and creating welcoming, safe environments and experiences for patients from the moment they walk in the door. This includes all elements of our clinics, from the check-in process, waiting rooms, policies that allow people’s belongings to stay with them, and all staff greeting patients warmly from medical office assistants to health care providers.
3. Negative feelings are normal feelings: they are telling us something. Remember that you are not the sole person responsible for what is going on in a patient’s life.
4. We are in this together for the long haul with our patients. Showing up in a productive way for them also means finding compassion for ourselves and our colleagues.
5. Take note of and use the principles of trauma- and violence-informed care, as outlined in the POATS-P training course listed in the resources below: Avoid re-traumatization; empower patients with choice; work collaboratively and flexibly; establish a relationship of trust.

 
Resources

Online learning

• BC ECHO on Substance Use (Online, interactive sessions delivered via Zoom with didactic and case-based portions; currently offering an Opioid Use Disorder series and Alcohol Use Disorder series)
• BCCSU’s Provincial Opioid Addiction Treatment Support Program (Online, self-paced, free)
• BCCSU’s Addiction Care and Treatment Online Certificate (Online, self-paced, free)

Guidance

• BC Centre on Substance Use. A Guideline for the Clinical Management of Opioid Use Disorder [Internet]. 2017.
• BC Centre on Substance Use. A Guideline for the Clinical Management of Opioid Use Disorder — Youth Supplement [Internet]. 2018.
• BC Centre on Substance Use. A Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder [Internet]. 2020.
• BC Provincial Mental Health and Substance Use Planning Council. Trauma-Informed Practice Guide [Internet]. 2013.

Articles

• Tilson EC. Adverse Childhood Experiences (ACEs): An Important Element of a Comprehensive Approach to the Opioid Crisis. N C Med J. 2018;79(3):166-169. 
• Prangell A, Imtiaz S, Karamouzian M, Hayashi K. Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies. Drug Alcohol Review.  2020;39(1):71-82.
• Grant BF, Goldstein RB, Saha TD, Jung J, Zhang H, Pickering RP et al. Epidemiology of DSM-5 Alcohol Use Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757-766.
• Goldstein RB, Smith SM, Chou SP, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1137-1148.

Additional resources

• The BC Centre on Substance Use (BCCSU)’s ‘Opioid Use Disorder’ page contains links to screening tools, FAQs, forms, and up-to-date bulletins on new treatment approaches
• BC Centre on Substance Use. Opioids: A survivor’s guide [Internet].  Vancouver: BCCSU; 2019.
• Brown C. The pervasiveness of trauma among Canadian women in treatment for alcohol use. Paper presented at Looking Back, Thinking Ahead: Using Research to Improve Policy and Practice in Women’s Health Conference; 2009 Mar 17; Halifax (NS). 
• Canadian Centre on Substance Use and Addiction. Adverse childhood experiences [Internet]. Ottawa (ON): Canadian Centre on Substance Use and Addiction; [date unknown]. 
• Shanahan ME. Adverse Childhood Experiences and Opioid Misuse [Powerpoint slides]. Presentation presented at Work Group on ACEs and Opioid Misuse Prevention Meeting; 2019 Jan 22; Morrisville (NC).
• “We went as a team closer to the truth”: impacts of interprofessional education on trauma- and violence- informed care for staff in primary care settings By Sarah Levine, Dr. Colleen Varcoe & Dr. Annette Browne.