Trauma-Informed Care

There was a time when trauma was seen as something experienced by relatively few people, and events and circumstances that are now understood as harmful and traumatic were even seen as preventive. Incest is an example. According to Bessel van der Kolk, in his book The Body Keeps the Score (2014), incest between a father and daughter was (1) legal, (2) considered rare, and (3) considered a protective factor against the trauma of later sexual intercourse.

Fortunately, we know better now.

According to SAMHSA trauma is caused by an “event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening...”

We also understand that trauma can disrupt a person’s ability to function in many areas of their lives, and that trauma is common among people who struggle with substance use disorders.

Connecting the dots between trauma and substance use and understanding the high rate of comorbidity between PTSD and substance use disorders led to improving treatment.  Trauma-informed care grew out of the ever-growing piles of research on the prevalence of trauma in the general population and in those with high levels of substance abuse.

The trauma-informed approach to care has 3 key elements:

• The realization of the prevalence of trauma,


• The recognition of how trauma affects all individuals in the organization (not just patients), and


• The response of putting that knowledge into practice and actively resisting retraumatization.

Trauma-informed care has also shifted the focus of treatment from “What’s wrong with you?” to “What happened to you?” 

In the past, people looking for help with addiction were seen as a cluster of problems.  Treatment focused on fixing those problems. Behavioral, cognitive, and emotional symptoms were fixed with behavior modification, talk therapy, and often, medication.

Symptoms are still important in treatment, but there’s more to every person than the troubling symptoms that they present with. Practitioners of trauma-informed care strive to see the whole person and to approach each patient as a unique individual with a history that has contributed to their current life circumstances and symptoms. Trauma-informed practitioners are sensitive to the life circumstances that impact their patients, and ultimately, the movement toward trauma-informed care is a movement toward greater sensitivity to the needs of unique individuals. Trauma-informed practitioners practice greater awareness of and focus on the strengths and resiliency that allowed them to survive and can help them thrive.