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Trauma Addiction &

Criminal Justice

Diagnosis & Treatment

Introduction

!   Winford Amos, LPC, LAC, CCS

!  Owner: Kingdom Source Counseling & Training

!   15th JDC Adult Drug Court Provider

!   15th JDC Zone Area Intervention Provider

!   15th JDC Track 1 Provider

Overview of Presentation

!   This presentation will explore the link between trauma and substance use as well as the link between trauma and antisocial behavior.

!   The goal is to increase competency of counselors in the area of trauma informed care.

!   Strategies for Diagnosis and available evidenced based treatment will be discussed.

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Adverse Childhood Experiences

Study What are Adverse Childhood Experiences?

!   Adverse childhood experiences (ACEs) are stressful or traumatic experiences, including abuse, neglect and a range of household dysfunction such as witnessing domestic violence, or growing up with substance abuse, mental illness, parental discord, or crime in the home. ACEs are strongly related to development and prevalence of a wide range of health problems, including substance abuse, throughout the lifespan.

The Relationship of ACEs to Substance Use

& Related Behavioral Health Problems

!   Early initiation of alcohol use. For states, tribes, and jurisdictions focusing on underage drinking, these results suggest the importance of addressing ACEs as one component of preventing underage drinking, as responses to underage drinking may not be effective unless they help youth recognize and cope with stressors of abuse, domestic violence and other adverse experiences (Dube et al, 2006)

!   Problem drinking behavior into adulthood (Dube et al, 2002)

The Relationship of ACEs to Substance Use

& Related Behavioral Health Problems

!   Increased likelihood of early smoking initiation (Anda et al, 1999))

!   • Continued smoking, heavy smoking during adulthood (Ford et al, 2011)

!   • Prescription drug use (Anda et al, 2008)

!   • Lifetime illicit drug use, ever having a drug problem, and self-reported addiction (Dube et al, 2003)

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The Relationship of ACEs to Substance Use

& Related Behavioral Health Problems

!   Increased risk of suicide attempts, including attempts by men and women, as well as attempts during adolescence and adulthood (Dube et al, 2004).

!   Lifetime depressive episodes (Chapman et al, 2004).

!   Sleep disturbances in adults (Chapman et al, 2011)

!   Sexual risk behaviors (Hillis et al, 2001)

Antecedents to Antisocial Behavior

and Substance Misuse

!   Myriad factors and events have been linked to developmental psychopathology and its antiso- cial consequences or sequelae. These include abuse and neglect, exposure to interpersonal/ interparental violence, intergenerational substance abuse, maladaptive attachments in early life, maltreatment such as abandonment, and neuro- development.

Trauma & Substance Use

!   Discussion of Substance use a a coping mechanism for trauma

!   Discussion of how Substance use increases the risk of exposure to trauma

!   Discussion of how Substance use leads to involvement in the criminal justice system

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Trauma & Criminality

!   Discussion of peer reviewed research on the link between trauma and antisocial behavior.

!   Discussion of how antisocial behavior increases the risk of exposure to trauma.

!   Discussion of how antisocial behavior with a history of trauma is viewed in the criminal justice system.

Trauma Addiction & Criminality

!   Cultural implications of the link between Trauma, Addiction and Criminality

!  Socioeconomic status

!  Minorities

!   Impoverished neighborhoods

!   Lack of parental supervision

!   Family of origin

Diagnosis

!   Review diagnostic criteria for Acute Stress Disorder and Post Traumatic Stress Disorder

!   Review diagnostic criteria for Antisocial Personality Disorder and Borderline Personality Disorder

!   Review diagnotic criteria for Substance Use Disorder

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Diagnosis

!   Discussion of how clients presenting with Substance Use Disorders display antisocial traits and have a trauma history.

!   Discussion of how PTSD clients present with antisocial traits and substance use issues.

!   Discussion of how clients presenting Antisocial Personality Disorder present with trauma history and comorbid substance use disorder.

Treatment

!   Discussion of evidence based practices available for clients with co-occurring PTSD and Substance Use Disorders.

!   Discussion of evidence based practices available for clients with co-occurring Substance Use Disorders and Borderline Personality Disorder.

Case Conceptualization

!   Discussion of how this information impacts case conceptualization.

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Advocacy

!   Discussion of how to better advocate for criminal justice involved clients with trauma histories.

!   Jail sanctions introduce trauma

!  Safety is proximal

!  Avoidance and other trauma related criteria are to be expected in the early stages of treatment.

Closing

!   Review of presentation key points

!   Questions from participants.

Thank You