Trauma, Addiction, and the Community

Pascal Scoles, DSW, LCSW

For many individuals in recovery self-help groups have evolved to give encouragement, support, and understanding to individuals who face lifelong trauma. Support groups outline a way of living that is not just related to issues of chemical use and abuse but provide a path to a more positive life worth living. A survivor’s sense of emotional and physical safety, autonomy, and the ability to make crucial decisions that impact a person’s future is fundamental to a successful recovery process. Successful recovery from trauma appears to be based upon the empowerment of the survivor to create new connections. Healing from the trauma of addiction is not just related to an individual’s past explanations of their injury. It is also the direct experience of their emotional thoughts and feelings, and the remnants of those emotions that we continue to revisit. Trauma resolution is often related to an individual’s capacity to manage, adapt, and integrate new knowledge. This capacity to integrate new knowledge facilitates a more positive productive view of one’s past and how that past influences one’s recovery in the present and future. To have a responsible life in recovery, a person must engage in new-found resilience to one’s traumatic life. Reemergence or “flooding memories” even after the survivor thought he/she thoroughly addressed the trauma of addiction is a universal life challenge in recovery. The absence of alcohol or other drugs are only the beginning of healing. “Somehow the past must come alive and participate in the present”.

We know that a person’s individual past and future process of recovery is significantly influenced by the social determinants of health in our communities. A person’s “individual pathology” cannot be separated from the “pathology of the community”. To recover from life’s trauma, one must abandon their self-imposed isolation and change their life condition. In addressing this issue, Herman outlines three (3) stages of recovery for trauma survivors; stage one establishment of security requires that the survivor regain power and control over his or her surroundings, emotions, and body. In the second stage of recovery, remembrance and mourning, the survivor works to reconstruct his/her narrative of the traumatic event and integrate it into their life story. In the third stage of recovery, reconnection, the trauma survivor is creating a new life.

Acknowledging that many individuals cope with their trauma in the environment in which they live their daily lives, it is crucial to acknowledge how communities can support or impede the healing process. An injury to one’s psyche does not occur in a vacuum. Individual trauma occurs in a context of society, whether in the city or a person’s geographically defined neighborhood. How a community responds to a person’s stress sets the foundation and the influence of a traumatic event on an individual. Neighborhoods that provide a context of understanding and self-determination may facilitate the healing and recovery process for the individual and/or their family.

Trauma in the Context of Community

The current behavioral health system, with its focus on acute individual disorders, continues to be limited in helping a community and its members develop healthy lifestyles. Thus, the helping professions need to embrace a perspective on healing that views a person’s health intertwined with the health of the community. A lack of attention to the social determinants of health significantly contributes to the overall trauma in one’s community. Healing a neighborhoods “pathology” facilitates an individual’s pathway to recovery. A comprehensive behavioral health management approach must embrace a holistic approach that focuses on (1) the elimination of stress in the overall community; (2) be attentive to negative environmental factors; and (3) support and provide opportunities for better housing, increased employment opportunities, and active family activities. Without attention to these social determinants of health, one will continue to live in a static environment or a neighborhood in decline that becomes a toxic wasteland for individuals, their families, and community. Factors such as high-crime and drug-infested areas, as well as lack of access to parks or playgrounds, transportation, quality education, social services, and mental health care, create a significant negative impact on recovery. By actively working to engage, community organizations, families, schools, and individuals to develop healthy environments one facilitates a process in which all members can thrive.

Communities that avoid, ignore, or misunderstand the impact of the above social determinants can be retraumatized by those individuals whose intent is to be helpful. A second important perspective on trauma is the understanding that neighborhoods can also experience injury resulting from drug dealing, or ongoing exposure to violence in the community. This feeling of hopelessness is often transmitted from one generation to the next in a pattern often referred to as intergenerational trauma. Like individuals, communities can collectively react to injury in ways that are very similar by becoming hyper-vigilant, fearful, and/or retraumatized. The way individuals and families mobilize their resources in support of their neighborhood is very much related to the community’s capacity, knowledge, and skills to understand and respond to the adverse effects of trauma. A community’s resilience to environmental stress has significant implications for the well-being of the people in their community.

Medically managed behavioral health care has often been viewed as something that happened near the end of treatment (if at all) depending on adherence and symptom remission and control. Health care systems struggle to view the community as capable of promoting people’s health. Instead it is often considered a place to which people might be released when they were “healthier.” Many individuals are told to wait until they had achieved abstinence or stability before pursuing any workforce activity or educational studies. In general, the treatment community viewed the neighborhood in which clients live as a contributing factor to the problem not a part of the solution. Therefore, the person receiving services along with his or her supporters had very little input into public health decisions. The individual’s immediate eco-community (e.g., family, key allies, spiritual resources) were rarely invited into assessment, planning, or service-delivery processes. Community connections were considered the purview of social workers, peer specialists, etc. and even then, were viewed as referrals rather than intentional clinical connections to these resources. To validate this perception, one only needs to look at the funding and staffing patterns of many treatment agencies and realize that there is very little data, assessment or planning activity that values the voices of community health organizers, or recovery peer specialists.