At the drawing board for battling addiction

Drugs are a good escape from pain. A lot of people use drugs and alcohol to help cope with difficult situations, such as being on the brunt end of sexual or physical abuse, or having been part of the horrors of war or murder.

At first people use because it makes them feel better, but then they use drugs because they have to, because they develop a chemical dependency. It's not until that point that rehabilitation centers get involved with these victims with the disease of addiction. And often it's only the symptoms of the addiction that are treated, withdrawl, detoxification and emotional problems. University of Alaska Anchorage Center for Addiction and Alcohol Studies director Dr. Bernard Segal says that's not good enough.

The purpose of the UAA CAAS is to help rehabilitation centers improve their current treatment programs. Segal's expertise is in research of substance abusers who have cases of historical trauma, a condition similar to Post Traumatic Stress Syndrome.

“People who come into treatment bring baggage with them,” Segal said. Segal says, about 90 percent of women who enter centers in Alaska for substance abuse treatment were also sexually or physically abused. Alaska also has the third highest rate of alcoholism in the nation, part of which is attributed to the pipeline and its creation of disposable income. Substance abuse is also more common among Alaska natives. Segal says that many of these statistics may be linked to historical trauma.

This trauma is defined as the cumulative, psychiatric and emotional wounding from across generations of a culture including the current life span of the person suffering. For example, some members of the Alaska Native cultures suffer from a historical trauma, also called historical grief, that is a collage of inherited suffering combined with personal traumatic experiences of individuals.

When European missionaries setup shop within some Yupik communities in the 19th century, they banned people from doing traditional dances and ceremonies. They preached that the Yupik people needed to stop celebrating the devil. Yupik children were placed in mission schools, where they lost the oral traditions and contact with their families.

The result of this cultural stripping is “a breakdown in the ways that held tribal people together,” Segal said. “When these [traditions] went, the values of the culture change. Addiction can then occur rapidly.”

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The problems of abuse, trauma and chemical dependency are often tightly knit. If a woman has a family history of domestic violence and she is in an abusive relationship, her chances for using and becoming addicted increase significantly. She may enter a rehab center or shelter seeking help, but if only her addiction is addressed, then when she is released her old problems are at home waiting and she'll probably begin using again. She has not been given any release from the historical trauma that led her to use in the first place.

The concept of trauma is ancient, as Homer and other Greek scholars wrote about it. According to an article in the New York Times, “The study of trauma graduates at last,” the recognition of trauma as a disorder needing scientific attention is about 100-years-old.

Segal says the research on how historical trauma affects the chemical processes of the brain is about ten-years-old, however, rehab centers are just recently beginning to apply this knowledge to developing improved treatment techniques.

“One is catching-up with the other,” Segal said.

The focus of treatment needs to change. He says that in the past, when a person was asked to talk about their problems and didn't, counselors thought that meant the person wasn't ready for treatment.

It's a common stereotype among treatment facilities. But neurobiological research of the brain shows that people suffering from historical trauma are physically unable to speak about their problems. The brain effectively shuts down because it is overwhelmed by its own stimuli as the person relives an awful experience. Nuerotransmitter activity halts and the person is unable to think cognitively or recall memories of traumatic experiences. Brocher's area of the brain, which controls speech, also shuts down.

In an Alaska treatment center, a woman who had been in a devastating car accident with her partner was asked to speak about the experience while the neurotransmitter activity of her brain was being observed in a PET scan. As soon as the counselor mentioned the accident, the woman's brain activity ceased. She was physically incapable of speaking and her cognitive processes froze.

This example, along with other research, shows that it's not that patients don't want help or are not ready to change their lives – but that treatment needs to be altered to help people overcome the damage that historical trauma causes to the brain and emotional health.

Segal says that new treatment techniques should be devised to work around the obstacles thrown up by neurobiological shut down.

“Don't do it (treatment) by bombarding the individual with stimuli,” Segal said. That makes the treatment just as harsh as the trauma. First, a full understanding of the person's background needs to be established.

“Slam dunking an individual with a whole bunch of things – they're psychiatrically unable to respond to treatment,” Segal said.

When a person can't speak and the brain functions halt, steps need to be taken to get the brain functioning normally, and the person to the point where he or she can process and eventually speak about what has happened. One of the first things that needs to happen is simple physical exercise, forcing the brain to make the body work correctly.

“The body has to function [for treatment to work],” Segal said. “Get them mobilized again. Then help them express emotions they're afraid of.”

Paying this much time and attention to treatment may require revamping treatment program structure.

“Some of this is very hard to do in a 28-day program,” Segal said. He said Alaska does have some different programs that are longer, but current programs are far from being completely developed. It's a growing field of research and success.

UAA CAAS is sponsoring a seminar in the UAA Commons on Nov. 13 with Dr. Maria Yellow Horse Braveheart. For more information, call 786-6575.