Trauma-Informed Care and Addiction Recovery: An Interview With Nancy J. Smyth, PhD, LCSW

Congratulations to Dean Nancy J. Smyth and colleague Lori Holleran Steiker on the publication of their article, Trauma-Informed Care and Addiction Recovery: An Interview With Nancy J. Smyth, PhD, LCSW, in Journal of Social Work Practice in the Addictions.

Interview Conducted by Lori Holleran Steiker MSW, PhD (2015) Trauma-Informed Care and Addiction Recovery: An Interview With Nancy J. Smyth, PhD, LCSW, Journal of Social Work Practice in the Addictions, 15:1, 134-142.

Read a part of the interview:

Holleran Steiker: It is a privilege to interview the Dean of the School of Social Work at the State University of New York at Buffalo. You wear a number of hats: dean, professor, researcher, and clinician. You are a Board Certified Expert in Traumatic Stress through the American Academy of Experts in Traumatic Stress and have worked in both mental health and addiction-treatment settings for over 35 years as a clinician, manager, educator, researcher, and program developer. To begin with, can you tell us about trauma-informed care and what brought you to study this area?

Smyth: I’ll start with the second part of the question and come back to the first. I got my start in social work working with people who had severe mental illness during the 1980s and then moved into working with people who were struggling with alcohol and other drug problems. In both groups of people I was struck by the high prevalence of significant trauma histories, both in childhood and adulthood. For this reason, I began educating myself about the impact of trauma and its treatment. As I learned more I also recognized the importance of listening to the experiences of trauma survivors themselves, including their negative experiences in our systems of care. Stories like that of Anna—a young woman with a history of sexual abuse and a diagnosis of schizophrenia who had the treatment system fail her, despite good intentions (Jennings, 1994)—made it clear that sometimes our service systems inadvertently harmed clients by re-creating aspects of their traumatic experiences or reinforcing the negative beliefs about themselves that originated in their traumatic experiences. Bloom and Farragher (2011) recently described these negative system effects on both clients and staff in their book, Destroying Sanctuary.

For all of the above reasons, trauma-informed care (TIC) was identified as a priority by the Substance Abuse and Mental Health Services Administration (SAMHSA) and they created the National Center for Trauma-Informed Care (NCTIC) in 2005 through a shared initiative with the National Association of State Mental Health Program Directors (SAMHSA, 2014). Simply stated, TIC is an approach to designing policy, systems of care, and our clinical practice based on what we know from research about the impact of trauma on people, as well the knowledge from our research that most of the clients in our service systems have had significant exposure to traumatic events over the course of their lives (Smyth & Greyber, 2013). Recognizing that traumatic events made people feel unsafe and powerless, TIC seeks to ensure that clients and staff feel safe and empowered, and is organized around the principles of safety/trustworthiness, choice/collaboration/empowerment, and a strengths-based approach (Hopper, Bassuk, & Olivet, 2010).

At the practice level, TIC asks “What happened to you?” versus “What’s wrong with you?” and, therefore incorporates the assessment of trauma and trauma symptoms routinely into all practice approaches. However, this is done by allowing the client to control the pace of disclosure, as well as by ensuring that clients leave the office feeling calm and contained should such disclosures be upsetting. TIC also ensures that clients have access to trauma-focused (sometimes called trauma-specific) interventions; that is, interventions that treat the consequences of traumatic stress.

TIC focuses our attention on the ways in which services are delivered and service systems are organized (Bloom & Farragher, 2011). Trauma-informed organizations ensure that every staff member, from the receptionist to the executive director, understands trauma and trauma reactions. Trauma-informed organizations routinely examine all policies, procedures, and processes to ensure they are not likely to trigger trauma reactions or to be experienced as retraumatizing; that is, putting a client through a process that shares characteristics of the traumas he or she has lived through. An example of such a retraumatizing process would be pushing a client to disclose a rape experience in group therapy before she or he feels ready to do so. Such an experience is reminiscent of the powerless and vulnerability of the rape itself—I’ve seen too many clients drop out of substance abuse treatment after an experience just like this.