Good afternoon, everyone. Welcome to today’s webinar hosted by Patagonia Health. Today’s topic is Trauma, Drugs, and the Nervous System.
We are excited to hear from:
- Dr. Catava Burton, for more than two decades Dr. Catava Burton has been a steady voice for the wellbeing of educators, students, and the community at large. With a Doctorate of Education in community counseling and a focus on traumatology, she brings both academic expertise and hands-on leadership to the complex realities of stress, secondary traumatic stress, vicarious trauma, compassion fatigue, and burnout.
Good afternoon, everyone. Thank you for being here. Again, I am Dr. Catava Burton. I go by Catava. My first name is very complicated, but again, thank you for being here.
I am going to move right in. I know I only have roughly 45 minutes, and I know there may be some questions. Hopefully I can answer them at the end.
Setting the Stage
I want you to imagine being asked to do a webinar on this topic and only having 45 minutes, so bear with me. I tried to include the slides that I felt were most important. I am always open to answering questions outside of the webinar. I listed my email on the very last slide, and I do believe the slides will be sent out to participants.
Also, just as a disclaimer, I use a lot of humor. Although this topic is not funny, I use humor to cope and to make something heavy not feel heavy all the time. So if I throw in a joke or something sarcastic, that is just how I operate.
Trigger Exercise
I have a trigger warning. I like to trigger people, not on purpose, but to get us in the mindset of trauma.
If we were face-to-face, this would go a little differently. I want you to pretend I have given you some paper. On one piece of paper, write down the name of someone you love. It could be a sister, brother, aunt, uncle, mother, child. It does not matter. Just one person.
On the next piece of paper, write down one of your favorite places to go. You can just think of it if you prefer.
On the third piece of paper, write down something you like to do. Maybe it is going to the gym, something you do after work that is calming or soothing.
For the last one, if we were face-to-face, I would ask you to write down a symbol that represents something personal. But for today, instead of a symbol, I want you to think of a drug or alcohol. Just one. It does not matter which one.
Now we are going to go back to the person you love. Trigger warning. That person is dead. That person was killed at the place you like to go. And the activity you enjoy, you no longer like to do it because of the death of that person.
So what do you have left? That secret. That drug you would not want anyone to know you use or abuse.
To get us to understand and feel trauma, that is why I did that. Then we add substance use on top of it. Oftentimes, in my experience with friends, coworkers, or clients, when people experience trauma, they cope through drugs or alcohol.
Today, hopefully you will understand:
- How traumatic stress alters the neurochemistry in your brain
- How substance use can become an adaptive strategy or coping skill
- How to apply trauma-informed approaches to assessment and treatment
What Is Addiction?
Here are some definitions:
- One says it is a brain disease
- Psychologist Gene Heyman says it is a choice
- Neuroscientist Marc Lewis says it is almost normal
Which one do you think it is?
Personally, I do not like the word addiction. You can be addicted to pornography, gambling, shopping, social media. So I do not look at substance use strictly as addiction.
If I had to pick one, I would say almost normal. Think about high-stress jobs, especially clinicians or those in helping roles. After work, what do people say? “We are going to have a glass of wine.” That is socially acceptable. But we put labels on other substances.
You can drink a bottle of wine and that is okay. But you cannot eat a THC gummy. Society labels substances differently, but they can all have negative effects.
Iron Man as a Case Example
I have a co-host today: Iron Man.
I do not really watch these movies, but I once saw one and thought, I think he has PTSD. After some research, I said yes, he does.
Tony Stark shows:
- Intrusion and re-experiencing
- Insomnia
- Panic attacks
- Hypervigilance
He is wealthy, functional, and cherished. Most individuals in my experience are functional. They go to work. They are CEOs, teachers, principals, supervisors. They look put together. But behind closed doors, they may struggle.
His central nervous system is dysregulated. His suit is his shield. Many of us wear a shield every day. Then when we get home, substance use may come into play.
Trauma and the Nervous System
PTEs are potentially traumatic events. Just because you experience something does not mean you will develop PTSD. It is potentially traumatic.
Types of trauma include:
- Acute trauma, such as a car accident or natural disaster
- Chronic trauma or toxic stress, including ACEs like abuse, neglect, domestic violence
- Complex trauma, such as prolonged sexual abuse over many years
There are others: medical trauma, refugee trauma, military trauma, bullying.
Regardless of type, trauma impacts the nervous system.
Psychiatric and Physical Impact
Psychiatric conditions can include:
- PTSD
- Depression
- Anxiety
- Substance use disorders
Physical conditions can include:
- Diabetes
- Hypertension
- Obesity
- Chronic fatigue syndrome
Trauma involves:
- A threat
- Feeling helpless
- Insufficient healing
You can survive an event, but your body may not realize you survived. The body remains in fight or flight.
Biological and Psychological Layers
There are two substrates:
Biological layer:
- Genetics
- Nervous system
- Autonomic nervous system
- Sympathetic
- Parasympathetic
Psychological layer:
- Ego
- Emotions
- Perceptions
- Cognitions
These combine to shape how someone responds to trauma.
Gender, race, and ethnicity also play roles in trauma response and substance use patterns.
Key Brain Structures
Amygdala
Emotional processing, fear, anxiety. I call it the smoke alarm.
Hippocampus
Memory, especially episodic memory. Trauma can impair memory and learning.
Thalamus
Air traffic control for sensory information.
Hypothalamus
The thermostat. Regulates homeostasis and activates the HPA axis: hypothalamic pituitary adrenal axis. Chronic activation leads to inflammation.
Prefrontal cortex
Decision-making, logic, reasoning. Trauma and substance use can override it. I call it firing the CEO.
Dopamine and Substance Use
Dopamine is the reward system. Natural dopamine comes from sunlight, creativity, certain foods.
Substances create artificial dopamine.
Key areas involved:
- Ventral tegmental area
- Dorsal striatum
- Nucleus accumbens
These areas are also activated with behaviors like scrolling social media.
With repeated use, the brain is rewired to want more. People increase quantity. That escalation can lead to overdose.
Hyperarousal and Hypoarousal
Hyperarousal:
- Irritability
- Panic
- Hypervigilance
Hypoarousal:
- Numbness
- Dissociation
- Time distortion
Clients may present differently depending on their trauma and substance use patterns.
Craving Versus Trauma Activation
Craving can predict treatment outcomes. It is central in addiction studies.
But we must differentiate:
- Is the person craving the substance itself?
- Or is trauma being activated, such as an anniversary of a death?
For example, is someone drinking because they crave alcohol? Or because February reminds them of their mother’s death?
There is a difference between craving and trauma activation that drives behavior.
Assessment Considerations
Clients may underreport due to:
- Fear of losing benefits
- Housing instability
- Employment consequences
- Legal issues
- Pain management concerns
Use discernment and trauma-informed approaches to minimize re-traumatization.
Assessment tools may include:
- PTSD Checklist
- Trauma Symptom Checklist
- Stressful Life Experiences Screening
- Clinician-Administered PTSD Scale
- Trauma History Questionnaire
- Drug Abuse Screening Test
- Structured Clinical Interview
- Addiction Severity Index
- Timeline Follow-Back
- ACEs
For children and adolescents, family input is essential.
Assess:
- Consequences of substance use
- Readiness for change
- Ambivalence
Treatment Considerations
Before encouraging abstinence, ensure regulation. Removing the “suit” without tools for coping can lead to relapse.
Important components:
- Safety and trust
- Stabilization
- Social support
- Motivational interviewing
- Grounding techniques
- Breathing exercises
- Sleep hygiene
- Seeking Safety treatment model
Be cautious of misdiagnosis, including borderline or antisocial personality disorders when trauma may be primary.
Avoid assessing clients while intoxicated.
Polyvagal theory emphasizes social engagement. When people feel connected and supported, they may be less likely to rely on substances.
Takeaways
- Trauma alters neurobiology.
- Substance use can be an adaptive coping mechanism.
- Craving and trauma activation must be differentiated.
- Assessment must be trauma-informed.
- Regulation and safety come before abstinence.
- Self-care for clinicians is imperative.
We must take care of ourselves because our clients need us.
Q & A
Question: if you could elaborate on craving versus trauma activation.
Dr. Burton:
Is the person craving the drug itself, or is it something like an anniversary of a death activating trauma? For example, my mom died in February. Am I drinking because I crave alcohol, or because I am trying to drown out thoughts tied to that loss?
There is a difference between craving and trauma activation that induces substance use.
If that does not fully answer it, we can talk outside of the webinar because I know time is limited.
Closing
This was a great webinar, Dr. Burton. We appreciate you being here today. Dr. Burton’s email is in the slides, so please reach out if you have questions.
If this is your first time hearing about Patagonia Health, we are an integrated EHR, practice management, and billing solution designed specifically for behavioral health and public health. To learn more, please visit our website.
Thank you, everyone, for joining today, and have a great day.
