1. African American Women Trauma/Addiction and Treatment

2. Objectives 1.Relationship between early trauma and substance use and abuse 2.Recognizing treatment challenges and barriers 3.Treatment strategies

3. Important Development Trauma plays a role and is a risk factor for substance abuse. Studies have found that trauma exposure is one of the pathways to substance use.

4. What is Trauma? What makes something traumatic? Trauma is the persons’ unique experience of an event or condition in which: “The person is unable to integrate their emotional experience and it becomes over whelming.” (Pearlman & Saakvitine, 1995)

5. Data on Childhood Trauma Data from the National Survey of Adolescents and other studies indicate “One in four children and adolescents in the United States experiences at least one traumatic event even before age 16.”

6. When Karen was 7, her parents would go to church at least 2 times a week. She was left in the care an elder brother, John to babysit. John would sexually and physically assault her. The abuse was repeated weekly until age 14. After that happened, I began stealing and using drugs. I became violent and was arrested for domestic violence. My drug use increased as I stopped caring. “I hated the world.”

7. The Impact of Trauma on African American Women Childhood sexual abuse Initiated partner abuse Exposure to community violence Family and social Problems Lower levels of education High rates of unemployment (Boyd, et al., 2003; West, 2002).

8. Why is this an urgent matter for African American Women? There is high rate of untreated trauma among African American women. Untreated trauma can lead to substance use and abuse Addiction is traumatic Addiction can result in death In some studies, African American women have higher rates of trauma compared to similar women from other racial groups.

9. African American Women and Cocaine African American women are at a greater risk than women of any other racial or ethnic group for initiating use and becoming dependent on crack cocaine (SAMHSA,2006b).

10. Data from SAMHSA Using data from SAMHSA, OSA 2008 African American women admitted to public treatment most were: Crack/cocaine 35% Alcohol 24.8% Heroin 18% Marijuana 15%

11. One study suggested that as the level of alcohol consumption increases among African American women the severity of other risk factors such as risky sexual behaviors and use of crack/cocaine increase.

12. What are the Challenges of Treatment ? African American women are less likely to seek treatment for substance abuse. African American women have lower treatment completion rates. African American women are more likely to terminate treatment early.

13. What Barriers are associated with entering treatment Popular Misconception: African American women are thought to be strong. Manage things on their own to include not disclosing trauma events Can endure any pain and keep on going Sacrifice self and care for others Stigma and Discrimination

14. Barriers associated with treatment completion Relapse Lack of motivation I can manage on my own I no longer have a problem

15. Engagement Strategies Motivational Interviewing Asking Permission Affirmation Feedback More likely to open up when there is respect. Can be used to recognize strength. example: you are not responsible for being down but you are responsible for getting up. (Seeking Safety) Provide feedback on the courage to open up and share their experience.

16. Engagement Strategies (cont’d) Readiness for change Change Talk can be difficult Normalizing Can vary for each individual. How to help get past some of the pain. Provide feedback on the courage to open up and share their experience. Helps the client understand there are others who have experienced similar trauma

17. Making the Connection The connection between African American women, trauma, and substance abuse often was never made.

18. Key Points A traumatic experience can be the pathway into substance abuse. African American women ….. Have never made the connection between their trauma and substance use. Use substances as an attempt to manage psychological distress Continue to be underrepresented in treatment Encounter treatment barriers Have lower treatment completion rates.

19. References Najavitis, L. (2001). Seeking Safety. A Treatment Manual for PTSD and Substance Abuse. Guilford Press. Sobell L., Sobell M. (2008). Motivational Interviewing Strategies and Techniques. Rationales and Eamples. Retrieved from www.nova.edu/gsc/forms/mi_rationale_techniques.pdf Substance Abuse and Mental Health Services Administration (2006a). Treatment Episode Data Set (TEDS): 1994-2004. National Admissions to substance treatment services.(DASIS Series S-33, (DHHS Publication No. SMA 06-4180). Rockville, MD: Office of Applied Studies. Substance Abuse and Mental Health Services Administration (2006b). Results from the 2005 National Survey on Drug Use and Health: National Findings. (NSDUH Series H-12, DHHS Publication No. SMA 428. Rockville, MD: Office of Applied Studies.