Vulnerable Populations and Trauma in AOD Services

10 Questions

What percentage of individuals accessing AOD services have experienced at least one traumatic event?

More than 90%

What is a common consequence of not adequately treating trauma symptoms in AOD clients?

High drop-out rates and poor treatment engagement

Why may AOD services refrain from asking about trauma?

Reluctance amongst AOD service workers to ask about trauma

What is a consequence of detoxification on PTSD symptoms?

Increased risk of exacerbation of PTSD symptoms

According to the self-medication hypothesis, what is a reason why AOD may provide relief from unpleasant trauma-related thoughts?

The pain-relieving effects of substances

Which hypothesis suggests that individual differences in temperament and personality traits may contribute to the co-occurrence of PTSD and substance use disorders?

Common factors hypothesis

What is the primary function of dopamine receptors in the prefrontal cortex in relation to PTSD and substance use disorders?

Processing of fear and reward-related memories

What is the typical response to trauma characterized by?

Fight or flight response (SNS)

What is a characteristic symptom of PTSD?

Recurring, unwanted and uncontrolled memories of the traumatic event

Which of the following is a consequence of heavy drinking in individuals with PTSD?

Worsening of PTSD symptoms and increased risk of suicidality

Study Notes

Vulnerable Populations, Cultural Differences, and Minority Groups

Individuals from cultural groups that have faced disempowerment, poverty, and discrimination are more likely to experience traumatic events.
They are also more likely to have underlying trauma and AOD (Alcohol and Other Drug) problems.

Association between Trauma and AOD

Over 90% of individuals accessing AOD services have experienced at least one traumatic event.
Up to 2/3 of these individuals meet the criteria for PTSD (Posttraumatic Stress Disorder).
Many AOD clients continue to live in environments that expose them to chronic stress.
The interdependent relationship between trauma and AOD leads to more chronic and severe symptoms.
Poor treatment engagement and high dropout rates are common due to the difficulty of addressing both disorders simultaneously.

Barriers to Accurate Identification and Treatment

The majority of AOD services do not systematically screen for trauma or PTSD symptoms.
AOD service workers may be reluctant to ask about trauma due to lack of training or discomfort.
Clients may not disclose trauma due to fear, shame, or stigma.

Theories of Trauma and AOD

Self-Medication Hypothesis: AOD use can provide relief from unpleasant trauma-related thoughts and symptoms.
High-Risk Hypothesis: The lifestyle associated with AOD use increases the risk of experiencing trauma.
Susceptibility Hypothesis: Individuals with higher levels of arousal and anxiety are more susceptible to both PTSD and AOD problems.
Common Factors Hypothesis: There may be common underlying factors driving both PTSD and AOD problems, such as personality traits and adverse environments.

Neurobiological and Endocrine System Interactions

Dopamine receptors in the prefrontal cortex are involved in the processing of both fear and reward-related memories in both PTSD and AOD disorders.
Reactions to trauma and drug cues are intensified and reinforced in individuals with PTSD and AOD disorders.
Similar alterations in reward circuits produced by both PTSD and AOD disorders can lead to anhedonia states.

Responses to Trauma

The typical response to trauma is the "fight, flight, or freeze" response, which is mediated by the Sympathetic Nervous System (SNS).

Posttraumatic Stress Disorder (PTSD)

PTSD may develop following Type 1 trauma, and symptoms must have persisted for more than one month.
Symptoms of PTSD include:
- Intrusion symptoms (recurring, unwanted memories of the traumatic event)
- Persistent avoidance of stimuli associated with the trauma
- And other symptoms