Trauma-Informed Care

TraumaIndividuals with substance use disorders often have a history of trauma, with research data indicating that 60 percent to 90 percent of treatment participants have experienced one or more traumatic events. Failure to understand and address trauma may lead to lack of engagement in services, increase in symptoms, re-traumatization, increase in relapse, withdrawal from the service relationship, and poor treatment outcomes. Growing up in a home with a parent with a substance use disorder is also associated with trauma. Families affected by substance use disorders who are involved in the child welfare system need a system of care that recognizes the impact of trauma on their functioning and recovery. Evidence-based trauma services should be provided within the context of an organizational culture that avoids triggering or unintentional re-traumatization for both parents and children. In a trauma-informed organization, every part of the organization—from management to service delivery—has an understanding of how trauma affects the life of an individual seeking services.

Contact us at ncsacw@cffutures.org or 1(866) 493-2758 to learn more about implementing trauma-informed care and trauma-specific services for families affected by substance use disorders.

Policy and Practice Resources

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  • Trauma-Informed Care Walkthrough Project Report—Data and Findings (PDF 4.83 MB)
    National Center on Substance Abuse and Child Welfare, 2015

    This report describes findings from the Trauma-Informed Care Assessment Project, through which the National Center on Substance Abuse and Child Welfare conducted trauma-informed care walkthrough assessments with five partnerships across the country with family drug courts that serve families affected by substance abuse and child maltreatment. These walkthrough assessments enabled the sites to better understand services through the eyes of their clients, uncovered inadvertent trauma triggers and generated concrete changes to become a more trauma-informed system. This report provides information on key strategies that systems can implement to minimize trauma triggers for clients.
  • TIP 57: Trauma-Informed Care in Behavioral Health Services
    Substance Abuse and Mental Health Services Administration, 2014

    This manual helps behavioral health professionals understand the impact of trauma and discusses assessment and treatment planning strategies that support recovery and building a trauma-informed care workforce.
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  • SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (PDF 789 KB)
    Substance Abuse and Mental Health Services Administration, 2014

    This manual introduces a concept of trauma and offers a framework for becoming a trauma-informed organization, system, or service sector. The manual provides a definition of trauma and a trauma-informed approach, and offers six key principles and 10 implementation domains.

Additional Resources

  • Resource Guide to Trauma-Informed Human Services
    Administration for Children and Families, 2017

    This guide provides human services leaders with information and resources on recent advances in the understanding of trauma, toxic stress, and executive functioning and highlights what these advances mean for program design and service delivery. The guide helps professionals learn about trauma-informed care and helps those currently engaged in trauma-informed work to improve their practice.
  • The Child Welfare Trauma Training Toolkit, 2nd Edition
    National Child Traumatic Stress Network, 2013

    This toolkit is designed to teach basic knowledge, skills, and values about working with children who are in the child welfare system and who have experienced traumatic events.
  • National Center for Trauma-Informed Care
    Substance Abuse and Mental Health Services Administration, 2017

    This webpage offers an overview of a trauma-informed approach and trauma-specific interventions to facilitate healing.
  • National Child Traumatic Stress Network (NCTSN)
    NCTSN was established to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events. The NCTSN website provides a host of resources and publications on child trauma.

Amaro, H., Chernoff, M., Brown, V., Arevalo, S., & Gatz, M. (2007). Does integrated trauma-informed substance abuse treatment increase treatment retention? Journal of Community Psychology, 35(7), 845-862 From http://onlinelibrary.wiley.com/doi/10.1002/jcop.20185/abstract;jsessionid=FF18675234128B3A90D2D19342E21426.f04t02 (accessed August 17, 2017).

Brown, V. B., Harris, M., & Fallot, R. (2014). Moving toward trauma-informed practice in addiction treatment: A collaborative model of agency assessment. Journal of Psychoactive Drugs, 45(5), 386-393. doi:10.1080/02791072.2013.844381

Caringi, J. C., & Lawson, H. A. (2014). Conceptualizing a trauma informed child welfare system for Indian country. Journal of Family Strengths, 14(1), 10.

Clark, C. B., Reiland, S., Thorne, C., & Cropsey, K. L. (2014). Relationship of trauma exposure and substance abuse to self-reported violence among men and women in substance abuse treatment. Journal of Interpersonal Violence, 29(1), 1514.

Cohen, L. R., Field. C., Campbell, A. N. C., & Hien, D. A. (2013). Intimate partner violence outcomes in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials Network “Women and Trauma” Multi-site Study. Addictive Behaviors, 38(7), 2325-2332.

Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2016). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research, 1-11.

Collins, K. S., Clarkson Freeman, P. A., Strieder, F. H., Reinicker, P., & Baldwin, C. (2016). A pilot study examining the reduction of trauma symptomology in families to prevent abuse and neglect: Trauma adapted family connections. Journal of Public Child Welfare, 9(5), 506-527. doi:10.1080/15548732.2015.1098582

Cross, D., Crow, T., Powers, A., & Bradley, B. (2015). Childhood trauma, PTSD, and problematic alcohol and substance use in low-income, African-American men and women. Child Abuse & Neglect, 44(1), 26-35.

Devries, K. M., Child, J. C., Bacchus, L. J., Mak, J., Falder, G., Graham, K., Watts, C., & Heise, L. (2014). Intimate partner violence victimization and alcohol consumption in women: a systematic review and meta-analysis. Addictions, 109, 379-391.

Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2002). Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experience Study. Pediatrics, 111(3), 564-572.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,…& Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14, 245-258.

Fraser, J. G., Griffin, J. L., Barto, B. L., Lo, C., Wenz-Gross, M., Spinazzola, J.,… Bartlett, J. D. (2014). Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts Child Trauma Project. Children and Youth Services Review, 44, 233-242.

Greeson, J. K. P., Briggs, E. C., Kisiel, C., Layne, C. M., Ake, G. S., Ko, S. J.,…& Fairbank J. A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic stress Network. Child Welfare, 90(6), 91-108.

Keyser-Marcus, L., Alvanzo, A., Rieckmann, T., Thacker, L., Sepulveda, A., Forcehimes, A.,… & Svikis, D. S. (2015). Trauma, gender, and mental health symptoms in individuals with substance use disorders. Journal of Interpersonal Violence, 30(1), 3-24. doi:10.1177/0886260514532523

Kisiel, C. L., Fehrenbach, T., Torgensen, E., Stolbach, B., McClelland, G., Griffin, G.,… & Burkman, K. (2014). Constellations of interpersonal trauma and symptoms in child welfare: Implications for a developmental trauma framework. Journal of Family Violence, 29, 1-14.

Kisiel, C., Summersett-Ringgold, F., Weil, L. E., & McClelland, G. (2016). Understanding strengths in relation to complex trauma and mental health symptoms within child welfare. Journal of Child and Family Studies, 1-15.

Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016). Building capacity for trauma-informed care in the child welfare system initial results of a statewide Implementation. Child Maltreatment, 21(2), 1077559516635273.

Linden, I., Torchalla, I., & Krausz, M. (2013). Addiction in maternity: Prevalence of mental illness, substance use, and trauma. Journal of Aggression, Maltreatment & Trauma, (22)1, 1070-1084.

Mandavia, A., Robinson, G. G., Bradley, B., Ressler, K. J., & Powers, A. (2016). Exposure to childhood abuse and later substance use: Indirect effects of emotion dysregulation and exposure to trauma. Journal of Traumatic Stress, 29(5), 422-429.

Ruglass, L. M., Hien, D. A., Hu, M., & Campbell, A. N. C. (2014). Associations between post‐traumatic stress symptoms, stimulant use, and treatment outcomes: a secondary analysis of NIDA’s women and trauma study. The American Journal on Addictions, 23(1), 90-95.

Salter, M., & Breckenridge, J. (2014). Women, trauma and substance abuse: Understanding the experiences of female survivors of childhood abuse in alcohol and drug treatment. International Journal of Social Welfare, 23(2), 165-173. doi:10.1111/ijsw.12045

Staiger, P. K., Melville, F., Hides, L., Kambouropoulos, N., & Lubman, D. I. (2009). Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults? Journal of Substance Abuse Treatment, 36, 220-226. doi:10.1016/j.jsat.2008.05.008


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