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Scott Webb: The US Department of Veterans Affairs reports that six out of every 10 men and five out of every 10 women experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. And men are more likely to experience accidents, physical assault, combat, disaster or to witness death or injury.

And joining me today to discuss the importance of trauma-informed care for those seeking or providing treatment is Camille Drachman. She's the Director of Clinical Education and Specialty Programming at Sierra Tucson.

This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one Best Addiction Treatment Centers 2020 in Arizona by Newsweek. I'm Scott Webb.

So Camille, it's so great to speak with you again today. We're talking about trauma-informed care. So let's start here, maybe the most obvious one, how did the concept of trauma-informed care come about?

Camille Drachman: Trauma-informed care really has evolved over time. And over the last 30 years, we have expanded our understanding into trauma vastly, really having a better understanding of the physiology of trauma. And in 1995, there was this study called the Adverse Childhood Experiences study, which was a joint venture with Kaiser Permanente Health Maintenance Organization and the Centers for Disease Control.

And they queried over 17,000 individuals that were with the Kaiser Permanente Health Benefit Organization. So they had access to these individuals that were getting benefits with their health insurance. And there were 10 categories of questions that they asked these individuals. And the resulting information was pretty astounding. The study was both retrospective and prospective.

So they were trying to find out about how an individual's childhood experiences impacted their health and well-being including mental health as an adult. And they really found some pretty, like I said, astounding results from this. And this really was a turning point in our understanding about the importance of trauma-informed care, and really helped illuminate how often trauma does show up in childhood and how it can impact long-term care for individuals for the rest of their lives, basically.

So not only did that ACES study, and that's the acronym for Adverse childhood Experiences, impact our understanding and help shape how we provide care in a behavioral health and mental health setting, but also our expanded understanding of what trauma actually is and how individuals can have trauma show up ongoing in their lives.

Scott Webb: Yeah. I think that's so true. And some of the things I've learned in hosting these podcasts for Sierra Tucson is really the traumas that we suffer as kids and how they can sort of permeate and be with us and stay with us for the rest of our lives and how, you know, we may not even realize how those traumas affected us until later in life.

So when we talk about treatment, why is this type of treatment important for treating substance use disorder or eating disorders or just other pain and other challenges that we face?

Camille Drachman: Often what we see is substance use disorders, eating disorders, chronic pain. Those are the symptoms that show up. Those are the presenting issues that we see, especially with individuals coming in for treatment. That's what they think the issue is. And in fact, what's underlying is that trauma history of the difficult or life's stressful events that an individual may not actually characterize as trauma. But when we're talking about how it shows up in the physiology, it can show up, you know, in the very same way as a trauma response and then has these symptoms, these outwardly exhibited symptoms that we do understand as substance abuse or eating disorders or the chronic pain conditions. So trauma is under it all.

Scott Webb: Yeah, definitely. And trauma really is a wound, right? And it affects many parts of who we are. So just like any other wound, a physical wound, how do we heal the wounds that are caused by trauma?

Camille Drachman: You're right. You're absolutely right. This trauma is a wound and it's a wound to the spirit, the body, our belief system, the whole part of who we are. And so when we're talking about healing it, we also have to address it from that whole part of who we are. So we do work with them. You know, we work with the psychology, the psyche, and work from helping them understand their belief systems. We work at healing the physiology from a lot of different modalities that work with the body itself. We work from that spiritual perspective and we really have to understand the importance of that overall healing in order to assist in an individual's healing and long-term recovery.

Scott Webb: Yeah. And I know that's a big part of the Sierra Tucson model, working to heal and address the mind, body, spirit, a comprehensive approach to trying to help people and heal people. And along those lines, I'm wondering if you can share a success story with us.

Camille Drachman: There's a lot of success stories. And I guess what I would want to say is when someone starts to feel better, when those presenting issues that they seek treatment for are less pronounced, when they realize that, "Oh my gosh. It's been three weeks since I've actually felt so anxious that I've had to go hide in my room," when they start realizing that those symptoms are less pronounced, less intrusive, when it hasn't been as evident, you know, as it used to be a daily thing and now they're noticing that they haven't had to fall into some of their old coping mechanisms or survival strategies in a week, those are some pretty good indicators that they are starting to get better, that the treatment they've been receiving and working so hard to embody and incorporate into their lives is actually starting to work. So it's more of a general response to your question, but that's how it shows up. That's when people know they're starting to be successful in their healing journey.

Scott Webb: If you can talk more about the work you do with the shame reduction and that perspective and why the words we use are just so important.

Camille Drachman: Shame is such a huge part of trauma. Shame is born out of trauma. And we also categorize shame in a couple of different ways. We understand that shame can be useful as a tool for learning and growing, but we also understand about toxic shame. And the toxic shame is what can really change and influence how we see ourselves in the world, what we believe about ourselves in the world and it can be so damaging to our perspective of, you know, how we can heal and be accomplished adults in our lives.

So language is huge. And so from a trauma-informed perspective, we want to be very careful and we guide our staff in being careful on how they language their approach to dealing with individuals. We, of course, don't want to use any labels when we're working with individuals. We also want to come from a really strengths-based, respectful perspective in our individual interactions. We want to have an understanding and perspective that we see those individuals, and we have our own perspective that is grounded in hope and honoring of each person's resiliency and capacity to heal. We want to normalize an individual's response to trauma because, you know, if we're working with somebody and they're struggling and they're acting out, that is their response to trauma and an attempt to maybe have their needs met when they never learned how to.

And so it's very important to be careful how we language our approaches with interactions with individuals. We want to offer choices if someone's struggling and we're working to deescalate their current way of interacting. We want to say, you know, "Here's this opportunity or here's this opportunity," and that allows them a little sense of control in a situation when they feel like they don't have much, if any. And of course, you know, respecting boundaries is always incredibly important for individuals who are in treatment.

Scott Webb: Yeah, for sure. And I'm wondering when we’re talking about, you know, from the staff's point of view, why it's so important for staff in a trauma-informed care program to have awareness of their own self-regulation?

Camille Drachman: If we have staff that are struggling with their own inability to regulate, they're going to have a hard time meeting someone who is really having a big acting out. So we do want to educate and support our staff so that they can understand their responsiveness over a reaction on their part. We want to help them expand their own awareness into their own stress or trauma responses. And we want to help them understand and have awareness into questions like, you know, what are they seeing when an individual might be acting out in front of them? How does that behavior show up? How do they feel as a result of the behavior they're experiencing in front of them in the resident or the patient? What are their thoughts as a result of this? How might they be responding or reacting? You know, what do they want to say? What do they want to do in that moment?

And so that kind of helps them pay attention to their own response so that they can better respond to the needs of the individual. And, you know, there's always that option that if they feel like they can't respond and their reaction may not be appropriate, the best next step is for them to seek assistance. So they find another staff person who might be better to respond in that moment while they get to go take care of themselves.

Scott Webb: That's great to know that the staff members have the freedom, if you will, you know, and are encouraged to self-regulate and obviously to be mindful and cognizant of their language. And if they need help, there's help and assistance there for them as well as you say, as the residents or patients. So good to know that everybody's just sort of helping each other and looking out for each other. That's really great. And Camille, again, it's so great to have you on great to speak with you and hear your voice again. As we wrap up here, anything else you want to tell people or share with listeners?

Camille Drachman: I'd love to say that, you know, whether you are somebody who's working in the helping profession or somebody who's working on your own journey of healing, self-care is huge. It's very important. And self-care is way more than a bubble bath or a pedicure. It's about seeking out resources in your area to help you learn and grow in the areas that you need to and keep an eye on when you might be feeling burnout, when you might be noticing that your stress levels are higher than what you're used to and you might need to find ways to manage those.

Scott Webb: Yeah. And as you say, you know, bubble baths and things like that are certainly helpful in the moment, of course. But if we're all being mindful and sort of being honest with ourselves and we're dealing with trauma or we haven't. You know, we know that we have trauma in our past, but we haven't dealt with it yet, as you say, people need to be responsible for their own mental and physical health. There's plenty of help out there. People just need to reach out for assistance, get the help that they need. And I just love the Sierra Tucson approach. And thank you so much. You stay well.

Camille Drachman: Thank you so much for having me. I always enjoy these conversations and sharing what I'm passionate about.

Scott Webb: Call (800) 842-4487 or go to SierraTucson.com for more information, Sierra Tucson, where change begins.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.