Discussing Trauma, Addiction and Spirituality Peter Bray
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Discussing Trauma, Addiction and Spirituality Peter Bray Abstract The following chapter outlines a series of discussions held over a twelve month period with a group of New Zealand mental health professionals. The clinicians are associated with a residential unit and they work with clients who have alcohol and substance addictions. As most of the participants work as counsellors in settings that are influenced by the medical model, they wanted to discover how far their utilisation of, and interest in, spiritual orientations of professional practice might be recognised and developed as an aid to therapy. Naturally they were concerned to explore how they might work in this way in a perceived atmosphere of institutional judgement. As the group freely explored their own spirituality in the context of their professional relationships with clients and the institution, it highlighted the positive benefits of their own non-denominational spirit-led practices. As they discussed addiction as originating in an act of self-medicating survival that supports the individual to overcome behaviours which originate in trauma, they began to consider recovery as a spiritually inspired self-actualising process. Although the initial aim of the group was to explore the significance of spirituality in clients’ presentations and to identify similar principles and beliefs that might underpin their own professional practice, a central theme began to emerge that resonated deeply with the group’s participants. It suggested that the experience of trauma significantly disrupts, or wounds, human beings’ tendencies to actualise, forcing them down less effective pathways to achieving or recovering the capacity to reach higher levels of consciousness. Addiction was therefore conceived not only as a false or unwelcome outcome of the struggle to meaning, a detour in the human journey into actualisation, but also as an adaptive process of recovery. In this context, counsellors saw themselves working with clients in a spiritual quest to reconnect their clients with their lost potential. Key Words: Addiction, counselling, co-existing problems, competence, growth, mental health, recovery, self-actualisation, spirituality, trauma. ***** 1. Introduction There is an undeniable link between trauma and addiction.1 It has been estimated that there is a higher incidence of alcohol and substance addiction in individuals who have been impacted by stressful life events, such as histories of physical and/or sexual trauma, than those in the general population who have not.2 There is also strong evidence to suggest that individuals with co-existing mental health problems (CEP) use drugs and alcohol to avoid and/or to suppress the Peter Bray - 9781848883727 Downloaded from Brill.com09/26/2021 05:10:45AM via free access 138 Discussing Trauma, Addiction and Spirituality __________________________________________________________________ distressing effects of trauma and that a substance abusing lifestyle may predispose them to experience further traumatic events.3 As a result, many clients seeking treatment for substance addiction require trauma treatment services and vice versa. Research also suggests that certain types of trauma can cause existential and spiritual crises and that addressing them can improve psychological and behavioural health.4 Spirituality also has a significant part to play both in the prediction of recovery and in improving addiction treatment outcomes. In cases where individuals have recovered successfully and positively maintained their changes, increases in the levels of spirituality between treatment entry and graduation have been noted.5 It also appears that a significant aspect of recovery from addiction, arguably a parallel to post-traumatic processes, is that over time individuals manage behaviour changes that depend upon successfully addressing struggles with existential meaning and the construction of durable narratives that incorporate new beliefs and goals. Thus, interventions that utilise personal spiritual resources can provide support to manage or resolve addiction, traumatic responses and other CEPs.6 Although interventions that involve spiritual beliefs are difficult to evaluate those that incorporate non-denominational approaches are effective at reducing trauma symptoms.7 The following presents the context and points of view of nine therapists at an addictions centre in New Zealand.8 A series of ten ninety minute conversations was facilitated with the group in which they discussed their experiences of trauma and spirituality work with clients affected by alcohol and substance addictions. This chapter incorporates some of their reflections on spirituality and its relevance to their practice. 2. A Special Interest Discussion Group on Spirituality A. The Group How do we identify spirituality in the medical model? Name it as part of our practice . normalise it amongst our peers? We’ve talked about our own spirituality and the client’s and how that comes together in a collaborative therapeutic partnership. Now we are talking about what we do in addictions and how spirituality fits into that. How our spiritual journey has led us to this moment and how we can become a vehicle for our clients’ spiritualties and raise their awareness.9 Coming from an eclectic practice base the discussion group all agree that ‘addiction is a chronic relapsing brain disease characterized by compulsive behaviour’10 that causes psychological and physical harm to individuals, their families and communities. They also recognise that in the process of recovery, Peter Bray - 9781848883727 Downloaded from Brill.com09/26/2021 05:10:45AM via free access Peter Bray 139 __________________________________________________________________ forms of spiritual rehabilitation are useful in penetrating their clients’ complex psychological defences.11 Almost all of their clients have mental health CEPs, particularly post-traumatic stress, ‘PTSD and Axis II disorders,’12 many derived from traumatic wounding in childhood. Their clients present with active mood, anxiety, personality, and eating disorders, and PTSD characterized by persistent maladaptive symptoms related to the trauma, including blunted emotional responses, hyper-arousal, and flashbacks.13 As our conversations ranged around spirituality, addictions, and trauma it was clear that the group members wanted to examine the impact of their spiritual experiences on professional practice. Their concern to address these issues corresponds to a developing trend in mental health and addictions recovery literature.14 Consequently, discussions involved a good deal of self-reflection that recognised the importance of spirituality in client work.15 The group’s comfort with their own spirituality and enthusiasm for examining spirituality in action was deeply encouraging and contradicted studies where health professionals have been ‘lukewarm’ about spiritual interventions and regarded them as ‘pertaining more to the private than to the public dimension of their own approach to the treatment of “addictions.”’16 Correspondingly, the group was anxious not to be identified or regarded as psychologically similar to their clients in case they might be seen to be contradicting the professional and clinical expectations of their funders. As one group participant put it, ‘How much of ourselves, the person and the clinician, are we to acknowledge and accommodate in our future discussions? I fear disclosing my spiritual side to the institution, to judgement.’ Whilst recognising that using spirituality as an intervention works in their therapeutic practices, ‘It is still an uncomfortable fit with the medical model’ and not an accepted or demonstrable part of their practice with clients.17 B. The Mental Health and Addictions Treatment Centre Over an eight week residential programme the centre works with clients who meet the Diagnostic and Statistical Manual of Mental Disorders definition for substance dependence: ‘a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behaviour.’18 Acknowledging the relationship between substance use and trauma-related mental health problems, clients are those that have committed to being substance-free, and ‘who don’t have healthy environments to grow up in, are unable to make healthy choices, or are afflicted by external traumatic events which have disempowered them.’19 What we are really trying to get to are the behaviours that guide clients’ addictive behaviours. Looking at the cause as well as the effect . We don’t often talk about drugs and alcohol but we do Peter Bray - 9781848883727 Downloaded from Brill.com09/26/2021 05:10:45AM via free access 140 Discussing Trauma, Addiction and Spirituality __________________________________________________________________ talk about behaviour and the things that led to substance use - these are just as much a part of the addictive behaviours as using the substances. C. Pathways to Recovery Looking for a pathway that both respects the intangible nature of clients’ experiential styles and responds to the expectations and constructions of the medical institution is a genuine challenge. ‘Either we are accused of being too cautious or unclear in our assessments or we only tick the boxes that enable us to be accountable.’ In such cases the difficulties entailed in using value-laden vocabulary like ‘faith’ or having a ‘Higher Power’ are clearly challenging when it comes to completing conventional medical assessment documentation.