Many people who suffer post-traumatic stress disorder (PTSD) or operational stress injuries (OSI) also suffer concurrently from addiction. OSI’s are a form of psychological injury that is more likely to occur in individuals with highly stressful occupations, such people who serve in the military or people who work as a first responder. For individuals affected by PTSD or OSI who attempt to manage their trauma symptoms—such as hyperarousal, difficulty sleeping, flashbacks, hypervigilance, and isolation—by using substances, their substance use can often develop into addiction.
Our nine-week concurrent trauma and addiction program (CTAP) is designed to specifically treat post-traumatic stress disorder (PTSD) and operational stress injuries (OSI) at the same time as addiction, and is designated for military, police, firefighters, EMS, and other first responders. Each patient is matched with a primary counsellor who has extensive trauma therapy training, as well as with a medical doctor. The multidisciplinary CTAP team also includes a clinical psychologist, occupational therapists, and social workers. Patients also have access to a psychiatrist, as needed.
Research suggests that therapy for post-traumatic stress disorder (PTSD) and operational stress injuries (OSI) is more effective in smaller, more intimate groups. Therefore, the concurrent trauma and addiction program (CTAP) is conducted independently from Bellwood’s core programs. All clinical sessions are conducted in small groups containing only CTAP patients of the same cohort, which allows for more safety and trust. However, CTAP patients do attend addiction-related peer support groups (e.g. 12-step meetings, SMART recovery) to develop their understanding of recovery and support.
The concurrent trauma and addiction program (CTAP) has three stages, as follow.
1. Safety, Stabilization, and Psychoeducation
Our counsellors and doctors educate patients on the nature of PTSD: how it develops, what the symptoms are, and how it affects the body. A thorough understanding of the disorder and why it occurs is essential for learning how to manage it. In addition, addiction education is provided to understand the effects of substances on the brain and body, the multiple causes of addiction, other mental health disorders, risk factors for relapse, and other relevant topics. Staff work with patients to help them increase their engagement in activities from which they have withdrawn to provide enjoyment and a sense of accomplishment, and to decrease isolation.
2. Symptom Management, Trauma Processing, and Relapse Prevention
We help patients develop strategies to manage their symptoms. We use Dialectical Behavioural Therapy (DBT) and Stress Inoculation Therapy (SIT) to help patients develop skills to regulate emotions, develop distress tolerance, and increase interpersonal effectiveness. This reduces the symptoms of PTSD and also gives the patient tools to regulate intense emotions—thus reducing their need to seek drugs or alcohol.
Patients begin to work on in-vivo exposure with our occupational therapist. This involves the gradual, guided, and systematic approach to situations and activities that have been avoided due to distress. Patients set their weekly exposure goals with their groups and therapist, and gradually progress through a hierarchy of triggers as progress is made. Patients have opportunities to leave the property either alone or in groups to support their in-vivo exposure work. In this stage, patients also attend a Cognitive Processing Therapy (CPT) group that focuses on thoughts and feelings related to their trauma. In these groups, patients identify how their traumas have affected the way they see themselves and the world, and they learn skills to address counterproductive thoughts and feelings. Having the support of others who are struggling with similar difficulties is an important benefit of these groups.
Simultaneously, patients continue to learn about the effects of their addiction, and how they are related to post-traumatic stress disorder (PTSD) or operational stress injuries (OSI). Patients also attend an intense addiction-relapse prevention program to identify their own signs of behavioural, mental, and emotional deterioration that may precede a relapse; patients then design strategies to address these warning signs of relapse, when they occur.
Towards the end of the program, the focus shifts to planning for next steps and discharge. Patients attend sessions to help them identify strategies to maintain their gains when they return home. The team works with patients on developing a solid discharge plan and connects them with ongoing support upon leaving Bellwood.
The program also includes three anger management workshops, totalling nine hours. This popular component of the program informs patients about the purpose of anger, its triggers, and its warning signs. Centred around the concept of balance, these sessions teach patients how to live a more centred existence and develop healthier, more constructive responses to anger.
Lead Psychologist: Dr. Hester Dunlap
Dr. Dunlap is the Lead Psychologist of the Concurrent Trauma and Addiction Program (CTAP) and the Trauma and Psychological Injury Program (TPIP) at Bellwood Health Services; she provides treatment for operational stress injuries (OSI).
She is the former Clinic Head of the Work, Stress, and Health Program at the Centre for Addiction and Mental Health, where she also held a cross appointment as Assistant Professor in the Department of Psychiatry at the University of Toronto. She has been providing assessment and treatment of occupational trauma for over 10 years and has extensive experience working with stress-related disorders including PTSD, depression, anxiety, substance use, and chronic pain.