DDN December 2022 DDN Dec_2022 | Page 11

Research into the impact of childhood abuse has demonstrated a correlation with impacts such as on establishing safety in relationships , hypervigilance , deteriorated self-esteem and increased possibility of developing a range of mental health issues ...
ACEs ( adverse childhood experiences ) research and training has increased awareness of the impact of early trauma on health outcomes . Research into the impact of childhood abuse has demonstrated a correlation with impacts such as on establishing safety in relationships , hypervigilance , deteriorated selfesteem and increased possibility of developing a range of mental health issues , including anxiety , depression and psychosis .
NEGATIVE CONSEQUENCES The 2010 drug strategy with its focus on recovery and abstinence , a period of reduced funding and an outcome-based focus – such as payment by results – had many negative consequences , including record levels of drug-related deaths . The value of therapeutic support diminished with a perception that engaging clients in dialogue to discuss difficult experiences was slowing down the process toward ‘ successful discharges ’, on which services were measured for effectiveness .
Unfortunately , a focus on abstinence without the opportunity to provide a means to address the issues to which substance use had developed as a coping response is likely to lead to increased risks – either of relapse , development of alternative maladaptive coping responses such as self-harm , or ultimately , of course , of an increase in drugrelated deaths .
In England , no area has been affected more by drug-related deaths than Blackpool . Thankfully there is a well-informed and dedicated leadership within Delphi , as the lead substance misuse service provider , as well as local commissioners with passion to drive forward harmreduction initiatives and the compassion of staff with a wealth of knowledge and determination . This has provided the foundation for an effective , innovative and meaningful way of addressing the issues that can result from experiences of early trauma .
At Acorn , the residential rehabilitation programme is based around attachment theory and working with ACEs . The former refers to the type of emotional bond formed between an infant and a caregiver – those who are at increased risk of substance misuse as such insecure attachments can influence psychological , physical , and behavioural wellbeing later in life .
Substance use may be seen as a dysfunctional way of compensating for feelings of insecurity . These feelings make it difficult to form meaningful and healthy relationships , with the substance a replacement for secure relationships . The substance is predictable , unlike the caregivers of the past . In this sense , the relationship with substances can be an attempt to replace the lack of safety and security as an infant . The substance user is looking for a solution ‘ out there ’ to make up for the lack ‘ in there ’.
Many in recovery will attest to this theory , having had a history of trauma or abuse , neglect and inconsistent care-giving when they were children . However , a common view in society is that people who suffer from substance dependency have made a choice to become dependent or have some kind of moral failing .
To be effective , treatment focuses on the inner deficit , the lack of a sense of security and the
DELPHI AND ACORN offer substance misuse services within prisons in Manchester and Lancashire , detox , residential rehab and community-based services in Blackpool and Blackburn with Darwen , including ADDER .
According to Clark ( 2022 ), there are just under 80,000 prisoners in the UK . A study of Welsh prisoners by Ford et al ( 2020 ) found more than 80 per cent of male prisoners have suffered at least one ACE , while approximately 45 per cent have suffered four or more ACEs . This demonstrates how many of our clients in prison services might have experienced ACEs , so our understanding of them is vital to adopting a holistic , person-centred approach when supporting them through psychosocial interventions and OST treatments . Staff need to be mindful of the possibility of re-traumatisation and develop close working relationships with the prison mental health services to ensure the clients ’ mental health and wellbeing is supported .
feelings of inner pain . Compassion and understanding are required to fully assist the person to heal from their inner pain , and treatment may require longer-term therapeutic support with a focus on repairing the pain from the past . The emphasis is to develop a ‘ secure base ’ using a traumainformed model of : no blame , no shame , empathic curiosity and that the behaviour is not the problem but the answer to the problem .
TRAUMA-INFORMED In each of our services , a traumainformed approach ( TIA ) is applied to the way services are delivered , how professionals relate to the people who use services and how staff are supported . TIA is becoming evident in every aspect of our work , from the ways in which prescriptions are managed to how we consider our policies and how we create our environments to promote safety , choice and trust .
Assessments are designed , and trusting relationships are formed , to appreciate the possibility of adverse experiences and improve awareness of early trauma . We are developing our services to be psychologically informed , reducing the possibility of triggers of vulnerability ( re-traumatisation ) and use a ‘ trauma lens ’ to understand clients ’ behaviour , including considering why a person may have disengaged from services or responded with aggression – fight / flight responses to vulnerability often associated with early childhood experiences .
We are also mindful of the possibility of ‘ vicarious trauma ’, experienced by staff when working with those who have experienced early trauma , on a regular basis . Safe spaces , in the form of weekly talking circles , are available to ensure wellbeing and develop supportive relationships as well as opportunities for discussion . All of this is already having a positive effect on the ways that we engage with service users and support our staff .
However , further work is needed and we realise that our work is situated in a wider context . Hopefully , as other services also address their approach to appreciate the prevalence and impacts of early trauma , this will lead to provision of suitable and safe housing , opportunities to develop safe and trusted relationship within the community , and timely provision of trauma-specific interventions , to support the undoubted progress that is being made .
With acknowledgement to all of the wonderful and determined staff and clients .
Dr Andrew Tye is clinical psychologist and Kimberley Ward is recovery nurse at Delphi Medical