Understanding the Role of Trauma in the Mental Health and Substance Abuse Fields

Before the focus shifted to trauma caused by war and natural disasters, Judith Herman (1992) identified stages of trauma and healing in the context of understanding responses and recovery from sexual assault and violence against women, childhood physical and sexual abuse and neglect, witnessing violence, unexpected losses, and many other life events. She described the many facets of intensive rehabilitation, beginning with feeling protected and extending through profound feelings of loss and reconnecting with others. Herman's observation that trauma survivors need a certain degree of safety and stability before analyzing the effect of their traumatic experiences in detail is the basis for much of the current work on trauma-informed practice.

Clinical diagnosis of posttraumatic stress disorder (PTSD) has been a common way for professionals in the mental health industry to identify trauma, leading to treatment regimens that may include medication and other psychological or psychiatric therapies. It was assumed that total dedication and a supportive system design were necessary for success in early addiction treatment techniques, hence these methods tended to center on intensive, abstinence-oriented treatments.

Over time, many changes have taken place, such as the incorporation of harm reduction ideas into drug use treatment systems and the greater involvement of consumers in mental health systems. As part of this change, there has been an emphasis on putting the client at the center of all treatment decisions. By highlighting the fact that many people either cannot or choose not to participate in abstinence-oriented treatment, harm reduction-oriented practice has helped the substance use field realize that these individuals still need and deserve health care, albeit of a less intensive and more easily accessible variety.

Over the last three decades, researchers in the area of anti-violence have gradually uncovered the short- and long-term repercussions of violence, sexual assault, and child sexual abuse on both women and men. It was acknowledged by anti-violence agencies that current methods were not meeting the needs of all women to the fullest extent possible, particularly those who were dealing with a number of concerns at once, such as drug abuse and mental health problems.

It has become clear that the idea of trauma is helpful for connecting these many encounters, resources, and infrastructures. Women, Co-occurring Disorders, and Violence: A Study in the United States sought to confront these overlaps head-on and to promote or establish system design changes that could be measured.