Why a Public Health Approach? There are many reasons to learn about the impact of trauma and untreated trauma on individuals, families, and communities. Trauma and untreated trauma are common in all socioeconomic groups and are often misunderstood. For example, people experiencing opioid addiction, other substance use conditions, mental illness, and homelessness may shy away from treatment because of stigma in communities and treatment settings.
The symptoms of trauma and its under-treatment are evident more and more everyday. Early childhood and adult trauma are implicated in the onset of addictions and the comorbidity of post-traumatic stress disorders and mood-related psychopathology.
Research documents that exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. SUDs are also highly comorbid with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. A study found: "In this highly traumatized population, high rates of lifetime dependence on various substances were found (39% alcohol, 34.1% cocaine, 6.2% heroin/opiates, and 44.8% marijuana). The level of substance use, particularly cocaine, strongly correlated with levels of childhood physical, sexual, and emotional abuse as well as current PTSD symptoms. In particular, there was a significant additive effect of number of types of childhood trauma experienced with history of cocaine dependence in predicting current PTSD symptoms, and this was independent of exposure to adult trauma."
I am a living example of how understanding trauma opened up the possibilities for my recovery and improved my life. Prior to entering trauma-informed treatment, I knew that the medical diagnosis of depression did not describe my experience and did not provide a language that I could use to communicate aspects of my distress not covered by traditional descriptions of trauma. Without knowledge of trauma, I was ill equipped to engage in meaningful recovery. To my dismay, many of my physicians did not believe in PTSD and dissociative disorders. The loneliness and hopelessness of living without a means to understand and describe my experience made getting better impossible. There is a vast research literature and information about trauma and its impact--yet, many physicians, family members, professionals, and lay people would acknowledge that they have little understanding of dissociation, traumatic stress, and dissociative identity disorder.
Some of the benefits to a Public Health approach:
1. Trauma Education Can Reduce Stigma and Self-Stigma: There is an invisible group of people who are not seeking help and live in chaos and turmoil while trying to manage the disarray that comes from untreated trauma. Untreated trauma is an invisible force that can drive behavior and decisions and distort lives. Everyone can benefit from a basic understanding of trauma and the knowledge that there is no shame in experiencing trauma and its adverse outcomes--that help is available and recovery is possible.
2. Trauma Education Can Increase Supports: Family members can learn the facts about the prevalence and role of trauma in hampering recovery by leading to cycles of relapse and other barriers that interfere with family relationships. Too many individuals are left to experience cycles of abandonment and despair that escalate because of a lack of understanding of the power of trauma and the stigma associated with it. Without facts about trauma, people are left to try and find meaning about behaviors they do not understand. This usually ends with the person experiencing trauma and substance use conditions without being able to explain them and then being blamed for the manifestation of their illness. A clear example is the blaming of individuals currently experiencing opioid addiction who are trauma survivors.
3. Trauma Education Promotes Recovery: Individuals and families in local communities can help create new pathways to recovery because stigma and self-stigma can be replaced with facts that promote understanding. New pathways to recovery begin when individuals learn the language of trauma and its impact on their own decisions and how their illness is manifested. As survivors of trauma learn to decipher symptoms related to traumatic stress, they can better manage their symptoms. People with substance use disorders, mental illness, homelessness, and trauma can learn to explain their experiences to themselves and to others. This can result in a new ability to empathize with their “Self” and take self-blame out of their efforts to recover. They can also communicate their experience in a way that can be helpful both to themselves, their families, and their caretakers.