How Trauma and Crisis may lead to Substance Use Disorder/Addiction. Conversely; How Addiction may lead to Trauma and Crisis.
Trauma can be defined as the psychological distress following exposure to a traumatic or stressful event (Westhuizen, 2019). The way in which people respond to such an event is variable and can present in many different ways. Trauma is an injury to the brain and psyche in that it disrupts our psychological well-being at a neurological level. Trauma is the invisible force that shapes our lives. It shapes the way we live, the way we love and the way we make sense of the world. It is the root of our deepest wounds (Mate’ ,2008). Different people who are exposed to the same event will not necessarily respond in the same way. Each individual has a unique situation and a combination of factors will contribute to how they experience and react to the event. It is not only the event itself that is important, but how the event is perceived by those exposed to it. Mate’ (2008) emphasizes that trauma is not basically what happened to you, it’s what happens inside you as a result of what happened to you. It’s a constriction in your mental capacity to respond in the present moment from your authentic self. In essence, what happens is a shutdown of the self and a disconnection from the body. Nevertheless, it’s the shame about the self. Thus, what happens is a loss of connection to oneself, and a world view that makes it difficult for you to be in the present moment. Ultimately, trauma is disconnection from the self and from the present moment.
Crisis and trauma are two very distinct experiences that challenge an individual to think, react, and behave protectively due to perceptions of stress or danger, real or imagined. Most of the time, crisis precedes trauma. However, if trauma is not effectively resolved, it may act as the springboard for further crises that otherwise would not occur (ACA,2020). Crisis is often an immediate, unpredictable event that occurs in people’s lives, such as receiving a threatening medical diagnosis, experiencing a miscarriage, or undergoing a divorce, that can overwhelm the ways that they naturally cope. People can experience crises individually or as part of a group, community, or other connected system (James & Gilliland, 2013; Myer & Moore, 2006). Crisis experiences often compromise people’s feelings of safety and can induce feelings of fear, sadness, and even a sense of devastation. Crises can also interfere with a person’s ability to function in the world by negatively affecting several life domains, such as work, family, and social connections. Into the bargain, it can aggravate existing emotional injuries, further obstructing a person’s ability to respond to the incident. This aggravation can lead to a person’s sense of hypervigilance following a painful and unexpected violation of trust and safety. This violation can increase the intensity of a person’s feelings, resulting in a deepened experience of anger, anxiety, guilt, and grief. Furthermore, the “intensity, duration, and suddenness” (James & Gilliland, 2013) of an experience may result in a person’s experience of trauma.
Trauma and Crisis have a physiological impact on the nervous system. During a threat, the body’s sympathetic nervous system activates the fight or flight response. It happens quickly so that the body is almost instantly ready to run or defend itself (Mate’,1999). In contrast, the parasympathetic nervous system calms down the fight-or-flight response and use hormones to slow down those frantic responses once the threat is gone (MHS, 2020). This is also called the rest and digest system, which restores the body to equilibrium (homeostasis). Taylor (2022) demonstrates that upon a threat an individual has various options, fight, flight, freeze and Fawn. The fight response is your body’s way of facing any perceived threat aggressively. Flight means your body urges you to run from danger. Freeze is your body’s inability to move or act against a threat. Fawn is your body’s stress response to try to please someone to avoid conflict (Taylor, 2022). A normally regulated nervous system experiences the threat but returns to normal when the threat has passed. This period during which you have the ability to self-regulate is called the window of tolerance, and most people move through several of these cycles daily. One example is rushing to get somewhere and running late but relaxing once you reach your destination on time. However, the system works very differently when the body experiences Trauma. Traumatic events push the nervous system outside its ability to regulate itself. When someone experiences a traumatic event, they may freeze and be unable to respond to the danger (Khiron Clinics,2022). For some, the system gets stuck in the “on” position, and the person is overstimulated and unable to calm.
Anxiety, anger, restlessness, panic, and hyperactivity can all result when you stay in this ready-to-react mode. This physical state of hyperarousal is stressful for every system in the body. In other people, the nervous system is stuck in the “off” position, resulting in depression, disconnection, fatigue, and lethargy. People can alternate between these highs and lows (MHS, 2020). Levine and Kline (2007) affirm that “Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies. Any coping mechanisms we may have had are undermined, and we feel utterly helpless and hopeless.” It has been commonly believed that traumatic symptoms are the result of and equivalent to the type and enormity of an external event. While the magnitude of the stressor is clearly an important factor, it does not define trauma. That is because “trauma is not in the event itself; rather, trauma resides in the nervous system (Levine & Kline, 2007).The impact of trauma does not only reside in the peripheral nervous system but also the central nervous system, the brain precisely (Levine & Kline (2007). According to Ross (2017) and Thatcher (2019) there are three main areas of the brain that are affected by trauma: the amygdala, hippocampus, and prefrontal cortex. This impairs the emotional responses, memory and higher executive functions of the brain respectively.
Trauma can either be physical or emotional. Physical trauma is a serious bodily injury whereas Emotional trauma is the emotional response to a disturbing event or situation (olivine, 2022). According to Westhuizen (2019), trauma can be categorized in various types depending on the nature and the magnitude of the trauma, these includes the following: Simple or single trauma; this is a once-off event. Repeat trauma; this comprises of multiple exposures to the same kind of event. Prolonged trauma; this occurs over an extended period of time. Multiple trauma this constitutes of different events). Continuous trauma; involves multiple exposure over time to the same type of event. Routine trauma; this is the exposure to trauma on a regular basis, for instance first responders. Secondary trauma; the trauma that helpers develop as a result of exposure to other people's trauma; symptoms may be similar to those of the clients. Vicarious trauma; this is the transformation in the counsellor as a result of empathic engagement with the client's trauma material; pervasive changes with alterations in cognitive schemas of identity, memory and belief system. Another common type of trauma is the complex trauma; this includes adverse experiences, typically during early childhood, that disrupt critical development and affects psychological and physical health in complicated ways. Finally, we have the Burnout; this is the prolonged exposure to chronic interpersonally stressors on the job; slow and gradual onset including exhaustion, depersonalization, sense of inefficiency (Westhuizen, 2019).
Key to understanding the correlation between Trauma and addiction is the Adverse Childhood Experiences (Mate’,2008). According to the CDC (2022) Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years) . ACEs are childhood experiences that are unhappy and hurtful. These are sometimes referred to as toxic stress or childhood trauma (Westhuizen, 2019). ACEs change the way the brain develops and as a result affects the entire world of an individual. The effects of ACEs can last a lifetime, but it does not have to. Safe. stable and nurturing relationships heal the effects of ACEs. ACEs are experiences that an individual was exposed to while growing up, and include but not limited to the following: Emotional childhood abuse, Physical childhood abuse, Sexual childhood abuse, Emotional neglect and Physical neglect. Furthermore, growing in a seriously dysfunctional household can induce ACEs. Westhuizen (2019) outlines the characteristics of a dysfunctional household, this includes; Witnessing domestic violence, Alcohol or other substance abuse in the home, Mental illness or suicidal household members, Parental separation of divorce and Crime in the home (imprisonment of the family member). It’s obvious that when the hand that rocks the cradle is also the hand that hurts, the experience becomes traumatic for the child. Mate’ (2008) affirms that , “the more adversity an individual experiences during childhood , exponentially the greater the risk of addiction, which doesn’t mean every person traumatized will become an addict, but every addict was traumatized.”
Dissociation is a mental process that severs connections among a person’s thoughts, memories, feelings, actions, and or sense of identity (SAMHSA,2014). It’s one way the mind copes with too much stress, such as during a traumatic event. It’s the disconnection from the authentic self and the world around you. For example, you may feel detached from your body or feel as though the world around you is unreal. Traumatized individuals learn to dissociate as a way of coping with stressful experiences as a protective element whereby the individual incurs distortion of time, space, or identity. Dissociation helps distance the experience from the individual. People who have experienced severe or developmental trauma may have learned to separate themselves from distress to survive (SAMHSA,2014). Dissociation can affect a child's ability to be fully present in activities of daily life and can significantly fracture a child's sense of time and continuity. As a result, it can have adverse effects on learning, classroom behavior, and social interactions. It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply "spacing out," daydreaming, or not paying attention (Westhuizen, 2019). At times, dissociation can be very pervasive and symptomatic of a mental disorder, such as dissociative identity disorder (DID; formerly known as multiple personality disorder). According to the DSM-5, “dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.”
Trauma impairs the emotional response mechanism and induces emotional dysregulation (Mate’ ,1999). Emotional dysregulation is a term used to describe an emotional response that is poorly regulated and does not fall within the traditionally accepted range of emotional reaction. It may also be referred to as marked fluctuation of mood,mood swings , or labile mood (Sachdev, 2021).Some trauma survivors have difficulty regulating emotions such as anger, anxiety, sadness, and shame; this is more so when the trauma occurred at a young age (van der Kolk, Roth, Pelcovitz, & Mandel, 1993). Traumatic stress tends to evoke two emotional extremes: feeling either too much (overwhelmed) or too little (numb) emotion (SAMHSA 2023). Signs of emotional dysregulation include: Severe depression, Anxiety & Hyperarousal (Hyperarousal (also called hypervigilance) is the body’s way of remaining prepared. It is characterized by sleep disturbances, muscle tension, and a lower threshold for startle responses and can persist years after trauma occurs. It is also one of the primary diagnostic criteria for PTSD. Nevertheless, the symptoms of emotional regulation can manifest in self-harm behaviors and thoughts, Excessive substance use, High-risk sexual behaviors, Extreme perfectionism, Conflict in interpersonal relationships, eating disorder, Suicidal thoughts or attempts and Numbing; a biological process whereby emotions are detached from thoughts, behaviors, and memories. Because numbing symptoms hide what is going on inside emotionally, there can be a tendency for family members, counselors, and other behavioral health staff to assess levels of traumatic stress symptoms and the impact of trauma as less severe than they actually are (Westhuizen, 2019).
Trauma is detrimental to the Physical Health, from the body to the brain and the nervous system in general (body immune system and stress response system). Common physical disorders and symptoms include somatic complaints; sleep disturbances; gastrointestinal, cardiovascular, neurological, musculoskeletal, respiratory, and dermatological disorders; urological problems; and substance use disorders (SAMHSA,2014). Trauma may manifest itself in the form of somatization. This is the manifestation of psychological or emotional distress by the presentation of physical (somatic) symptoms (Robertson, 2023). For example, stress can cause some people to develop headaches, chest pain, back pain, nausea or fatigue. Many individuals who present with somatization are likely unaware of the connection between their emotions and the physical symptoms that they’re experiencing. At times, clients may remain resistant to exploring emotional content and remain focused on bodily complaints as a means of avoidance. Some clients may insist that their primary problems are physical even when medical evaluations and tests fail to confirm ailments. It is important not to assume that clients with physical complaints are using somatization as a means to express emotional pain; they may have specific conditions or disorders that require medical attention. Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or under-respond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result, they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse; they may complain of chronic pain in various body areas for which no physical cause can be found (Westhuizen, 2019).
The aftermath of trauma on the cognitive functioning of the traumatized mind and brain is evident. According to the Beck and colleagues’ cognitive triad model (1979), illustrates that trauma can alter three main cognitive patterns: thoughts about self, the world (others/environment), and the future. To clarify, trauma can lead individuals to see themselves as incompetent or damaged, to see others and the world as unsafe and unpredictable, and to see the future as hopeless; believing that personal suffering will continue, or negative outcomes will preside for the foreseeable future (SAMHSA, 2014). From the outset, trauma challenges the just-world or core life assumptions that help individuals navigate daily life. For example, it would be difficult to leave the house in the morning if you believed that the world was not safe, that all people are dangerous, or that life holds no promise. Belief that one’s efforts and intentions can protect oneself from bad things makes it less likely for an individual to perceive personal vulnerability. However, traumatic events; particularly if they are unexpected can challenge such beliefs (SAMHSA, 2014). Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills (Westhuizen, 2019).
Trauma has significant effects on the victim’s behaviors. Traumatic stress reactions vary widely; often, people engage in behaviors to manage the aftereffects, the intensity of emotions, or the distressing aspects of the traumatic experience. Some people reduce tension or stress through avoidant, self-medicating (for instance, alcohol abuse), compulsive (for instance, overeating), impulsive (for instance, high-risk behaviors), and/or self-injurious behaviors. Others may try to gain control over their experiences by being aggressive or subconsciously reenacting aspects of the trauma (Westhuizen, 2019). Behavioral reactions are also the consequences of, or learned from, traumatic experiences. For example, some people act like they can’t control their current environment, thus failing to take action or make decisions long after the trauma (learned helplessness). Other associate elements of the trauma with current activities, such as by reacting to an intimate moment in a significant relationship as dangerous or unsafe years after a date rape. Key to the behavioral reactions includes re-enactment and self-harm or self-destructive behaviors. Reenactment as a hallmark symptom of trauma is reexperiencing the trauma in various ways (SAMHSA,2014). Reexperiencing can occur through reenactments (literally, to “redo”), by which trauma survivors repetitively relive and recreate a past trauma in their present lives (Sam ,2013). This is very apparent in children, who play by mimicking what occurred during the trauma, such as by pretending to crash a toy airplane into a toy building after seeing televised images of the terrorist attacks on the World Trade Center on September 11, 2001. Whereas self-harm or self-destructive behaviors is any type of intentionally self-inflicted harm, regardless of the severity of injury or whether suicide is intended (SAMHSA,2014).. Often, self-harm is an attempt to cope with emotional or physical distress that seems overwhelming or to cope with a profound sense of dissociation or being trapped, helpless, and “damaged” (Herman, 1997; Santa Mina & Gallop, 1998). Self-harm is associated with past childhood sexual abuse and other forms of trauma as well as substance abuse (SAMHSA,2014).
The correlation between drug addiction and trauma is evident (Mate’, 2008). Trauma victims feel isolated and vulnerable. They try overly hard to fit in and may make poor choices in an attempt to be accepted. That need to be accepted often includes high-risk behaviors. The road between substance abuse and trauma is a two-way path. Trauma increases the risk of developing substance abuse, and substance abuse increases the likelihood of being re-traumatized by engaging in high-risk behavior. It is also true that individuals who are abusing drugs or alcohol are less able to cope with traumatic events (McMahon, 2018). According to the self-medication hypothesis of substance abuse, people develop substance abuse problems in an attempt to manage distress associated with the effects of trauma exposure and traumatic stress symptoms. This theory suggests that youth turn to alcohol and other drugs to manage the intense flood of emotions and traumatic reminders associated with traumatic stress or PTSD, or to numb themselves from the experience of any intense emotion, whether positive or negative (NCTSN, 2008).
In contrast, substance abuse can be a risk factor for trauma. NCTSN (2008) demonstrates that numerous epidemiological studies have found that, for many adolescents (45%–66%), substance use disorders precede the onset of trauma exposure. Not surprisingly, adolescents with substance abuse disorders are also significantly more likely than their nonsubstance abusing peers to experience traumas that result from risky behaviors, including harm to themselves or witnessing harm to others. There is also evidence that youth who are already abusing substances may be less able to cope with a traumatic event as a result of the functional impairments associated with problematic use ( NCTSN, 2008) .
There are a number of different approaches for counselling people who have experienced trauma. The model or approach that the counselor will use with the client depends firstly on the counselor’s training background and level of competency in the specific method. Where counselors are trained in more than one approach, the client’s needs, however, should be the final determinant of the approach the therapist chooses to use to support recovery (Westhuizen, 2019). Among others, common trauma interventions models includes the following.
Brief psychodynamic psychotherapy is an abbreviated form of psychodynamic therapy in which the emotional conflicts caused by the traumatic event are the focus of treatment, particularly as they relate to the client’s early life experiences. The rationale of brief psychodynamic psychotherapy is that a client’s retelling the traumatic event to a calm, empathetic, compassionate, and nonjudgmental therapist will result in greater self-esteem, more effective thinking strategies, and an increased ability to manage intense emotions successfully. In this model of treatment, the therapist emphasizes concepts such as denial, abreaction, and catharsis. By using a psychoanalytic approach, Burton (2004) found that clients were able to reenact their trauma. According to the APA (2023), reenactment is the process of reliving traumatic events and past experiences and relationships while also reexperiencing the original emotions associated with them. As clients re-tell the events they are able to re-enact the trauma. This serves three important goals in the therapeutic process (Dass-Brailsford, 2007): First, re-enacting the trauma is validating for the client since it confirms that the trauma actually happened. Secondly; it helps the client gain mastery over a situation that was previously associated with feelings of helplessness. Thirdly; it presents the possibility of reversing prior outcomes, controlling what was uncontrollable in the past, and dealing with the trauma in different and more hopeful ways. In essence, the goal of the brief psychodynamic psychotherapy is to clarify and resolve focal area of conflict that interferes with the current functioning.
The other common Trauma intervention model is the CBT. Westhuizen (2019) illustrates that Cognitive-Behavioral Therapy (CBT) combines two very effective kinds of psychotherapy: cognitive therapy and behavior therapy. Behavior therapy, based on learning theory, helps clients weaken the connections between troublesome thoughts and situations and their habitual reactions to them. Cognitive therapy focuses on the thoughts and beliefs, it teaches clients how certain thinking patterns may be the cause of their difficulties by giving them a distorted picture and making them distress (feel anxious, depressed, or angry (Beck, 1995). When combined into CBT, behavior therapy and cognitive therapy provide powerful tools for symptom alleviation and help clients resume normal functioning. A cognitive approach has been found to be a suitable framework for trauma therapy because traumatic experiences usually impede the emotional process by conflicting with pre-existing cognitive schemas (Jaycox, Zoellner, & Foa, 2002). This leads to Cognitive dissonance. Cognitive dissonance causes distress, because the individual is unable to match their experience of trauma and the accompanying thoughts, feelings and memories with their existing cognitive structure or view of the world (Westhuizen, 2019). In an attempt to integrate and make sense of the experience, the individual normally "replays" the event that has been stored. Every replay however causes the individual distress and, in an effort, to reduce distress, the individual attempts to avoid stimuli that cause replay of the memory and distress. In this way the individual fluctuates between hyperarousal and inhibition. The counsellor's focus is therefore the client's internal cognitive mechanisms and how the client processes information.
Eye Movement Desensitization and Reprocessing (EMDR) is another common trauma intervention model. EMDR is an integrated, therapeutic approach that considers a person's somatic (physical) and emotional states, with a focus on how the brain perceives events. EMDR was founded in 1987 by Francine Shapiro and is currently one of the most researched methods of contemporary psychotherapy. Whereas desensitization is a process which reduces responsiveness to a certain stimulus by being repeatedly exposed to it. This was developed by Mary Cover Jones, a pioneer in behavior therapy, to help individuals who are suffering from phobia(s) and anxiety. Jones found that it is best to introduce the source of fear while the individual is having a pleasurable experience (AlleyDog, 2023). The goal is to help the client desensitize to traumatic stimuli through saccadic eye movements (Shapiro, 1995). Westhuizen (2019) demonstrates that EMDR makes use of bilateral stimulation (eye movements, sounds or tapping) in order to process and desensitize distressing stimuli. The treatment involves highly structured session in which client arc asked to perform bilateral eye movements while thinking of a disturbing or traumatic image or memory. The counsellor then waves a finger repeatedly across the client's visual field while the client tracks the finger with his or her eyes. After each set of eye-movements the client provides feedback about their experience as well as a rating of the degree of disturbance. EMDR combines elements of exposure and cognitive restructuring in order to help the client process the traumatic experiences by desensitizing the traumatic memory and forming new adaptive associations or beliefs about the experience. EMDR is generally a short-term treatment, but remains a controversial approach. While there is a lot of research to support good treatment outcomes, many remain skeptical about whether short-term therapeutic gains are maintained in the same manner as with CBT (Westhuizen, 2019).
Herman’s stage specific model (Herman, 1997) is an effective trauma intervention model that describes trauma recovery as unfolding in three broad stages, namely: Safety, remembrance and mourning and Reconnection. The relationship between the counsellor and client is that of a partnership in which the client is in charge of his or her own recovery process. The role of the counsellor is to provide support and to be a witness to the recovery process (Dass-Brailsford, 2007). On the first stage of Safety; according to Herman (1997), since trauma causes disempowerment and disconnection and therefore the focus of the first stage of recovery is empowerment and connection. There are a number of shifts that are important during this phase, such as: From unpredictable to reliable safety, from dissociated trauma to acknowledged memory and frosts stigmatized isolation to restored social connection. The role of the counsellor is to help the client have control in the therapeutic setting and refrains from rescuing or patronizing the client, the focus is on empowerment and the client's needs. The process moves at a pace with which the client is comfortable CBT (Westhuizen, 2019). A healing therapeutic relationship restores a survivor’s trust in others by validating the client’s experience. Practitioners of this model are described as; allowing clients to ultimately have control in the therapeutic setting., acting as assistants, allies, and advocates in the role of bearing witness. exercising care in not resorting to dysfunctional rescuing and patronizing, both of which can take control away from client and lastly adopting a neutral stance and not taking sides in the client’s interpersonal conflict (Fredrick, 2023).
During the second stage of remembrance and mourning the client faces the trauma and with the help of the counsellor tells the full story CBT (Westhuizen, 2019). It is important however that the client experiences this as a safe process and that the counsellor only moves at the client's pace. Of particular importance during this re-telling of the trauma is that the memory be recalled with the participation of all the senses. Two techniques in particular may be used for this process, namely flooding and testimony) (Westhuizen, 2019). It is important however that the client feel supported during this process and is taught skills of self-containment such as breathing and relaxation exercises. Mourning is considering to be a natural part of healing and helps clients come to terms with the loss the experienced. Mourning is an inevitable outcome of traumatic loss. Sometimes clients resist mourning in order to “deny victory to the perpetrator” (Herman, 1997). The therapist helps the client accept grief as an act of courage rather than defeat. Mourning can have a restorative power by helping clients come to terms with fantasies of revenge. However, clients never discard the quest for justice and tenaciously hold perpetrators responsible for their immoral acts.
The third stage of reconnection sees clients creating new selves and reconciling with their past (Westhuizen, 2019). Reconnection contains both elements of reconnecting with others while retaining a sense of autonomy and results in an ability to trust both self and others. For some this stage involves confrontation of a perpetrator and for others it may involve becoming an activist as a way to take control as they find new meaning in their lives. However, every individual will find their own way of reconnecting with self and others and the counsellor should never be prescriptive or hold preconceived ideas about this stage (Fredrick, 2023).
Trauma and post-traumatic stress can also be combated by the use of medication, this is called pharmacotherapy or psychopharmacology (Westhuizen, 2019). Colombia (2023) defines psychopharmacology as the use of medication in treating mental health disorders and conditions. Medications can play a role in improving most mental health conditions. Some patients are treated with medication alone, while others are treated in combination with therapy or other treatments (Colombia, 2023). The use of medication to treat trauma and post-traumatic stress is often hotly debated with arguments for and against the use of medication. Medication can reduce the anxiety, depression and insomnia that often accompany post-traumatic stress disorder (Dass-Brailsford, 2007). Medication can reduce the anxiety, depression, and insomnia that often accompany PTSD. In some cases, medication may also relieve the distress and emotional numbness caused by traumatic memories. Several antidepressant drugs have yielded mostly positive results in clinical trials. Antidepressant drugs used to control PTSD symptoms include tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs) (Sutherland & Davidson, 1998).
Westhuizen (2019) emphasizes that counsellors typically see clients more often than a prescribing physician and is therefore in a better position to monitor the client's adjustment. Counsellors can therefore play an important role in communicating with the prescribing physician on the client's behalf (with the client's consent). A multi-disciplinary approach is preferred especially where there are different professionals involved in providing treatment and support to the same client. If appropriate a counsellor can also provide support for clients who do not adhere to medical treatment, although this would depend on the role of the counsellor in the therapeutic alliance. Unless the counsellor is a medical practitioner care should be taken when offering advice to clients regarding medication. There are benefits and risks to taking any medication and only a medical practitioner should advise a client on whether to take medication or not. In cases where there is uncertainly it is advisable for the counsellor to consult with the medical practitioner after consent is obtained from the client so that agreement can be reached on the best treatment for the client. When the medical practitioner is informed about the kind of support that client receives, for example counselling or therapy, they are also in a position to make an informed decision about the medical treatment provided (Westhuizen, 2019).
The correlation between addiction and trauma (crisis) is incontrovertible. Generally, trauma has lasting adverse effects on the individual's mental health, physical health, emotional health, social well-being and the spiritual well-being. In essence, it distorts the normal functioning of the individual since it disconnects the person from their authentic self, others and their general perception of the world around them. The aftermath of trauma doesn’t only impact the traumatized individuals rather it spreads its wings onto the families and society of the victim. Hence addressing trauma and executing effective trauma interventions is not only beneficial to the traumatized induvial but also the society at large. However, imperative to selection of the model of intervention is the client’s needs. Ultimately, trauma and crisis exposure should be a major public health concern worldwide and its prevention and treatment should be prioritized because its burden is too heavy to ignore.
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