DDN_March_2025 DDN March 2025 | Page 20

LETTERS AND COMMENT

GOING UPSTREAM

Helping people link past trauma to current pain can be a catalyst for change says Warren Larkin , as DDN reports

At the recent RCGP / AP conference in Manchester , consultant clinical psychologist Dr Warren Larkin presented on trauma and resilience-informed practice .

Relating to developmental trauma – trauma that happened during childhood – he highlighted the following Adverse Childhood Experiences ( ACEs ): physical , sexual and emotional abuse ; living with someone who was experiencing problematic drug and / or alcohol use , had serious mental illness or who had been incarcerated ; exposure to domestic violence ; parental loss through divorce , death or abandonment ; and neglect .
The more childhood trauma people were exposed to , the worse their health , mental health , and social outcomes were likely to be . ‘ So it ’ s very strange that we still don ’ t ask people about childhood trauma as a routine part of our assessment ,’ he said .
A 1998 study found people with four ACEs – compared to those with none – were five times more likely to use illicit drugs , seven times more likely to self-identify as being addicted to alcohol , and 12 times more likely to attempt suicide . A 2015 study of the English population also found ‘ this association between adversity exposure and health harming behaviours ’ – people with four ACEs were twice as likely to be binge drinkers , three times more likely to be smokers , and 11 times more likely to have used heroin or crack cocaine . A recent study found that those with exposure to one of the ACEs on the list were 4.3 times more likely to develop a substance addiction .
‘ If we can help people link their past trauma to their current pain , and the way they ’ re attempting to cope with that pain , maybe that ’ s a catalyst for change ,’ said Larkin . ‘ We need to ask people what ’ s happened to them , because if you don ’ t ask people , they don ’ t tell you , and if they don ’ t tell you , they ’ re going to get the wrong help .’ He referred to a 1998 study in which 82 per cent of psychiatric inpatients disclosed trauma when they were asked , compared to 8 per cent volunteering their disclosure without being asked . ‘ Eighty-two per cent versus 8 per cent , it ’ s pretty obvious what we need to do – but professionals
‘ If we can help people link their past trauma to their current pain ... maybe that ’ s a catalyst for change .’
WARREN LARKIN
worry about asking these questions because we worry about making it worse ,’ he said .
Larkin stressed the importance of traumainformed care , and said it was important to normalise routine and targeted enquiry – just as with domestic abuse and suicide intent enquiry – to offer the right help sooner , ‘ because treating the symptoms while ignoring the cause isn ’ t working .’ He concluded by quoting Desmond Tutu : ‘ There comes a point where we need to stop just pulling people out of the river . We need to go upstream and find out why they ’ re falling in .’ DDN
‘ Advice on ‘ batch cooking ’ to dilute any nitazenes , while wellintentioned , is unrealistic for most users who are living from one score to the next .’
REALISTIC PRACTICE ?
Thank you for your recent article , ‘ Changing the nitazene narrative ’ ( DDN , Feb , p20 ), and for your continued coverage of this issue and harm reduction initiatives in general .
I fully support Renato Masetti ’ s call for evidence-based , low-threshold harm reduction strategies . However , I worry that the advice on ‘ batch cooking ’ to dilute any nitazenes , while well-intentioned , is unrealistic for most users who are living from one score to the next .
It ’ s a bit like suggesting that people on lower incomes should do a big weekly supermarket shop to save money , when in reality many rely on daily trips to local
shops , even if it costs more . The logic makes sense in theory , but in practice it ’ s just not how most people in that situation live .
This isn ’ t a criticism , as I ’ m sure some will benefit from the advice , but for the majority it ’ s simply not a viable option . Chris Burke , by email
FRAMING THE MESSAGE
In ‘ The friend that won ’ t leave ’ ( DDN , Feb , p8 ), Dr Prudham rightly raises the importance of brief interventions as a key tool to help address the rising toll of alcohol-related deaths and liver disease . Whilst also highlighting important components of effective brief intervention , there are
several statements that may be considered controversial or even problematic .
Firstly , generally speaking , validated screening tools such as the AUDIT or even AUDIT-C are the best approach to identification , and deviating via other more generalised questions can cause a range of problems . Secondly , whilst caveating it as their own opinion , I strongly disagree with Dr Prudham ’ s view that framing addiction as a disease is ‘ sensible ’ in this context .
Irrespective of the contested science around whether addiction is a ‘ disease ’ or not , our and other ’ s research has shown this kind of binary framing is
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