NCAD: Leader in trauma-informed care guides look at risk and protective factors

While admitting to struggle with the “big T, little T” language that some health professionals use to evaluate patient trauma, renowned trainer and author Claudia Black, PhD, on Sunday discussed key factors that can make patients more vulnerable or more resilient to the most harmful effects of traumatic experiences.

Speaking at the opening plenary session of the National Conference on Alcohol & Addiction Disorders (NCAD), Black said that for a child living in a family affected by addiction, resilience to trauma could be enhanced by factors such as outside support offered when a stressor is experienced (such as from a grandparent), or a low incidence of prior stressors in the child's life. Conversely, trauma can lead to more adverse impacts if it is repeated, unpredictable, and perpetrated by someone who is supposed to be a caregiver.

Black's talk at the Anaheim, Calif., conference reflected the much broader view of trauma that the helping professions have taken in recent years. “Not long ago we thought of trauma as situational trauma,” she said. “Most will experience a trauma more subtle, more chronic,” and usually stemming from their own family system.

A senior fellow at The Meadows and a pioneering influence in trauma-informed care for the addiction and mental health fields, Black offered some powerful but surprising observations about how trauma manifests in families. She discussed the concept of the “witness factor,” observed initially in research on returning combat veterans that demonstrated a greater tendency to experience post-traumatic stress among non-injured veterans than among those who suffered physical wounds from service.

She described from her own case experiences the phenomenon of a brother who experienced behavioral crisis much earlier than the room-sharing sibling who had been the direct target of their father's physical outbursts.

Professionals' task

Black admitted that the work of professionals in helping families to heal is demanding but ultimately highly rewarding. “We get to be witness to the miracles of recovery,” she said.

She described the main tasks of professionals' work in this area as:

• Identifying the primary disorder.

• Assessing the potential for co-occurring disorders and multiple addictions, as few individuals present to treatment with one discrete problem.

• Prioritizing the treatment of intergenerational family dynamics.

She pointed out her satisfaction with the addition of alcohol to the title and focus of this year's NCAD meeting, adding that she recently has seen in younger-adult patients clearer manifestations of alcohol misuse, including cirrhosis.