After almost 15 years as a model client in a Medication Assisted Treatment (MAT) program, I performed a medically supervised withdrawal from methadone maintenance therapy nine months ago. Although the “acute” phase of detoxifying from the drug was relatively easy and took a couple of weeks to accomplish, I was completely unprepared for what came next and has lasted through today. I was tormented by numerous challenges after completing MAT: Post-Acute Withdrawal Syndrome (PAWS), resurgence of long dormant Bipolar 2 symptoms, and a new and profound psychological and physical response to repetitive traumatic events that I had experienced.
Although the PAWS and bipolar symptoms were difficult to endure for myself and those around me, they were quickly and efficiently treated with minimal medication. Comparatively speaking, my current medication is now more a finger tap than the hammer’s blow of methadone.
But the trauma and the slow realization of how severely it impacted me created a new awareness. As a direct result of the trauma and the resultant brain changes that inevitably occur, I have reacted to various triggers that have been both frightening and enlightening. While this new awareness has promoted personal growth, I’m more interested in how my experience can be broadly applied by direct service providers conducting outreach, assessment, and engagement.
For almost 10 years now, I’ve certainly “talked the talk” of Trauma-Informed Care (TIC). I’ve studied the literature, attended trainings, sat through webinars, trained others, and used the principles of TIC in direct service to others on the street. I’ve even known that I too have experienced trauma given my history of homelessness, addiction, criminal justice involvement and mental health challenges. However, like so many of us working in behavioral health fields, we seem to have a tendency to minimize our own experiences when compared to the experiences of so many others we hear and support. To me, my own trauma was…barely worth mentioning.
That changed rather dramatically this summer when, after detoxing from methadone and working to “normalize” my daily life again, an event brought my own traumatic recollections flooding back with a clarity and impact unlike anything I’ve experienced before. Part of the problem was that I’d been looking for that big “single incident” trauma event ever since I learned about TIC, but the search always proved futile. Then, sitting through a recent basic TIC training refresher, the light bulb finally came on. I realized that my trauma was sustained throughout my childhood and continued over a very long period, and then was exacerbated by poverty, into adulthood. Those earliest events blurred together as I aged so that the physiological “protective” response firing off from my amygdala every time I was triggered was buried under literally tons of traumatic garbage.
As soon as I really understood this, the dots connected and I began sorting through much of that garbage. I suddenly recognized what was happening when my arms started buzzing, my breath became shallow, my anxiety exploded over my head and tingled the tips of my fingers, and I lost my ability to critically think. I realized I was being triggered, and the response I was having was one that I’d been conditioned to have since I was a young child; it was as natural as breathing. Finally, after many years of talking about trauma’s impacts, I began “walking the walk” of being truly trauma-informed. While I continue working through this new growth around my own trauma, it has also given me a very different lens through which to view people, especially those considered “challenging,” “non-compliant,” “shelter-resistant,” or “difficult.”
Generally, trauma is pervasive in our lives. For those living on the streets, the threat to health and safety is almost constant. If mental health challenges and substance use accompany the experience of homelessness, the perceived threat rises exponentially. Those who work with persons who are homeless or newly housed would do well to understand the true impact of trauma on an individual, particularly the physiological response the brain and body has when it is triggered or retraumatized.
Coping with trauma gives an individual three options: fight, flight, or freeze. If we are dealing with individuals exhibiting these classic responses, that should be our “trigger” that we’re doing something wrong in our approach and engagement or that we need to do more. We should be capable of rational, critical thought, whereas the triggered trauma survivor may find this challenging; it is up to us to provide the necessary approaches that work to deescalate the situation and engage the individual, helping him/her feel safe again. If you’ve not been trained in Trauma-Informed Care, I recommend you do so immediately. If you have been trained, please take a moment to refresh your training. The information can be life-changing for everyone involved.
Image by Jeff Olivet.