For many young people, trauma and substance use are closely linked. Experiencing trauma can put a person at increased risk for substance use problems, and using substances can also diminish their capacity to cope with a traumatic experience.

Incidence of traumatic experiences amongst young people
Research indicates that by the age of 16 years, more than two-thirds of people will have experienced at least one traumatic event in their lives (Copeland, Keeler, Angold, & Costello, 2007). Therefore, it is likely that there is a high rate of trauma exposure amongst those young people currently accessing your service - regardless of whether or not this trauma exposure has led to the development of lasting problems like mental health conditions. Importantly, research indicates that young people with a substance use disorder are at a greater risk of experiencing future traumatic events (Blumenthal et al., 2008).

Prevalence of comorbid substance use and posttraumatic health problems amongst your clients
It is likely that amongst the young people you support, there will be quite a number of individuals with both substance use and posttraumatic stress symptoms. Young people who have experienced trauma often use substances to manage or “self-medicate” distressing and unpleasant reactions to trauma (Dixon, Leen-Feldner, Ham, Feldner, & Lewis, 2009). Some of these reactions include posttraumatic stress symptoms, like intrusive memories of the trauma and distressing emotional reactions. Research suggests that up to one half of young people with substance use disorder meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) (Ouimette & Brown, 2003). In young men with PTSD, rates of substance abuse or dependence are as high as 30% (Kilpatrick et al., 2003). 

Implications for your practice
Statistics such as those above suggest that many practitioners and organisations are already working with young people with a history of significant trauma and posttraumatic mental health symptoms and conditions.  However, in many services, support and treatment services are provided by practitioners without them being fully aware of or addressing the impact of trauma. This can have serious impacts on how effectively we are supporting the young person, not least because a trauma exposure can set up dynamics that are counterproductive to young people accessing and remaining engaged with supports and treatments. An example of this would be having difficulty trusting people who have control over important aspects of their life. Promisingly, there is some evidence that providing trauma-informed treatment and support leads to better retention rates for clients with substance use problems (Amaro, Chernoff, Brown, Arévalo, & Gatz, 2007).

This highlights the need for increasing the use of trauma-informed care in services working with young people, especially young people with substance use problems. Research supports this notion, for example, indicating that interventions have limited success with helping people modify their substance use when underlying trauma-related problems are not addressed (Grella, Hser, Joshi, & Rounds-Bryant, 2001).

Aims of this module
This module serves as a foundation guide to trauma-informed care for AOD practitioners working with youth. Specifically, we hope that by the end of this module you will:

• have an increased awareness of the incidence of trauma, and its effects, amongst your clients
• better understand the possible relationships between substance use and trauma
• have an overview of the key principles of trauma-informed care be able to apply many of your existing skills (e.g. relaxation and engagement strategies) to the practice of trauma-informed care
• have a range of options for supporting your client after trauma e.g., screening for trauma history, assist by skills strengthening and stabilisation, or refer to a specialist evidence-based treatment for posttraumatic mental health problems.