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Trauma and Substance Abuse

As we work to prevent drug and alcohol use in youth, it is important for us to consider the relationship between trauma and substance abuse. Trauma occurs at a high rate in the United States and is considered a public health concern in the United States (http://www.nlm.nih.gov/). According to the National Child Traumatic Stress Network, 1 in 4 youth experience a potentially traumatic event before they turn 16, and 1 in 8 youth experience Post Traumatic Stress Disorder (PTSD) before they turn 18. Of those diagnosed with PTSD, 59% will develop a substance use disorder.  This can be especially problematic as those with substance abuse have a higher risk of experiencing a traumatic event, which can lead to a cycle of problem behaviors that are difficult to recover from.

Recognizing the signs

It is not always easy to recognize the signs of trauma or substance abuse in youth, because often these signs can simply be indicators of youth going through the typical stages of adolescence. It important that you watch for sudden or dramatic changes in the youth as these may indicate trauma, substance abuse or other unhealthy behaviors.


Signs of trauma:

  • Loss of trust
  • Fear of event occurring again
  • Flashbacks
  • Avoidance of things that might trigger reminders of the event
  • Disruptive behaviors
  • Withdrawal
  • Depression

Signs of substance use:

  • Failing to fulfill obligations at school, work or home
  • Change in peer group, or not introducing peers to parents
  • Dropping out of activities
  • Disruptive behavior
  • Depression
  • Change in physical appearance.

What can we do?

Early identification is important when working with youth who are at risk for substance use or trauma. When a problem is identified early, it allows parents and caregivers the ability to identify the youth’s emotional and behavioral challenges, and helps them get the services and support needed to attempt to stop the problem before it becomes a lifelong issue.  The ACE’s Study and the BRRIMM Model discussed below are two methods that are currently being used to address early identification of trauma and substance abuse.

ACE’s Study

The Adverse Childhood Experience (ACE) Study began in 1995 and is centered around the key concept that traumatic events lead to an increased risk of unhealthy behavior. According to research, ACE’s are common. In a study of more than 17,000 mostly middle class Kaiser patients, 28% reported physical abuse, and 21% reported sexual abuse. Because research has shown a strong correlation between ACE’s and substance abuse, we can use this information in our prevention efforts. We are able to do this by:

  • Increasing overall awareness of ACE’s.
  • Collecting state- and county-level ACE data to drive local decision making.
  • Using ACE research to identify individuals who might be at a higher risk of substance abuse.



Brief Risk Reduction Interview and Intervention Model (BRRIIM)

The BRRIIM Model is a prevention process designed to screen and educate individuals at high risk for alcohol and other drug use. Trained prevention specialist conduct a 90 minute interview with individuals who are referred to them by law enforcement, schools, courts, social services etc.

During the interview the prevention specialist focuses on engaging the interviewee with respect and positive regard. The objective of the interview is to give the interviewee a chance to share their story; the focus is not meant to be on gathering information. The interview is conducted with a parent, or trusted adult present and participating, and the questions are about the interests of the interviewee, and are not necessarily related to the behaviors of concern. During the interview all participants sign a prevention service agreement, which includes the steps that the individual, family and staff are ready to take following the interview. Preliminary findings show that three months after participating in a BRRIIMM interview, 77% of participants said their alcohol use decreased, and 88% said their drug use decreased.  Participants have also stated that they have a better outlook on life, and feel they have the support needed to make healthy choices in life.



If you are interested in learning more about the connection between trauma and substance abuse click on the links below.






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