TRAUMA, DRUGS FORM VICIOUS CIRCLE

A growing body of research that indicates many alcoholics and drug
addicts also suffer from the after-effects of trauma is leading some
Quebec treatment centres to alter their approach.

One goal of the change is to prevent clients from dropping
out.

If trauma syndromes go undetected, "an awful lot of these people will
not last more than a few weeks in treatment," said David Ross,
co-ordinator of professional services at the Foster Pavilion, an
English-language addiction-treatment agency that treats about 1,200
Quebecers annually.

Researchers in the United States have found that between 21 and 44 per
cent of clients in substance-abuse treatment programs are suffering
from concurrent post-traumatic stress disorder (PTSD), Ross said. (The
figures vary according to type of treatment program.)

For some, PTSD is caused by an adulthood trauma; in other cases, it is
the result of childhood abuse.

Standard interventions for alcoholics and drug addicts can severely
increase anxiety symptoms for people suffering from post-traumatic
stress, because most use an emotion-focused group approach in which
clients are encouraged to talk about their life experiences, Ross said.

For PTSD sufferers, talking about the trauma can bring on their
symptoms, creating a vicious circle, he explained.

"When you elicit PTSD symptoms, it evokes a craving for
anxiety-reducing drugs," Ross said.

One step to increasing the chances of treatment success is to ensure
counsellors know which clients are suffering from PTSD so they can
tread carefully on sensitive themes, Ross said. Another step is to
urge clients to ask their physician to prescribe anti-anxiety drugs.

Another issue that often comes up with trauma survivors is trust, said
Louise Nadeau, a psychologist and addiction specialist at the
Universite de Montreal.

"If you've been betrayed by a significant adult, it's really hard to
trust humanity," Nadeau said.

Distrust can impede development of a positive working relationship
with a therapist, said Nadeau, a member of a research team at the
Centre Dollard Cormier, a Montreal treatment centre.

Nadeau's team has applied for a federal research grant to assess
Dollard Cormier's clients for concurrent PTSD.

Ross said his centre began three years ago to train staff to better
address PTSD.

Now, Foster Pavilion clients are assessed for PTSD and other
concurrent mental disorders with the help of a special
questionnaire.

Ross and a colleague are looking for funding to have the questionnaire
translated into French so other treatment centres in Quebec can use
it. The questionnaire also has been useful for identifying clients
with depression, Ross said. Foster Pavilion workers have been adapting
their methods of working with those clients, too.