The interplay between trauma defense systems and dissociation and freeze responses significantly contributes to the perpetuation of substance abuse and increases the risk of relapse. Neuroimaging research has revealed valuable insights into the impact of these defense mechanisms on successful psychotherapy or psychoeducation interventions. Without a proper trauma assessment, a thorough understanding of the differences between top trauma modalities and knowledge of what not to do with clients caught in a trauma defense response, we inadvertently fail to practice trauma-focused care. 

Trauma treatment should be tailored to individual needs, preferences, and learning styles. After assessing a client’s complete narrative, a skilled therapist and mental-health practitioner will be able to determine the appropriate treatment modality. With respect to working with clients experiencing trauma-related freeze and dissociation, several evidence-based modalities will be explored, including Eye Movement Desensitization and Reprocessing (EMDR), Sensorimotor Psychotherapy, Internal Family Systems, Somatic Experiencing, and others. 

The five areas we will focus on are: slowing down treatment to observe for trauma defense mechanisms; learning to do a proper trauma-focused assessment utilizing case studies of collecting a narrative without triggering a client; understanding the do’s and don’ts of working with clients who are currently activated by freeze or dissociation; avoiding hasty misdiagnosis of both axis I and axis II; and building a referral resource of competent trauma-focused practitioners.

Scientific Basis or Research

In this presentation, attendees will be presented with research and resources that support the perspective emphasizing the importance of treating trauma and addiction concurrently. The following experts’ work, among others, will be highlighted: Bessel van der Kolk, MD, Judith Herman, MD, Lisa M. Najavits, PhD, Peter Levine, Richard Schwartz, PhD, Stephen Porges, PhD, and Pat Ogden, PhD. 

A specific focus will be given to empirical evidence on trauma defense mechanisms, including dissociation, freeze response, feigning, and attachment cry for help. Dissociation, for example, disconnects individuals from their emotions, leading to an increased reliance on substances for temporary relief. Experts such as Colin A. Ross, MD, Onno van der Hart, PhD, Ellert R.S. Nijenhuis, PhD, Janina Fisher, PhD, and Christine A. Courtois, PhD, have written extensively on trauma-related disorders, including dissociative disorders, and their connection to substance abuse.