Trauma-informed approach to care in substance use and addictive behaviour

Past trauma is any experience that is physically or emotionally harmful or life threatening (eg violence, physical or sexual abuse, neglect from childhood, natural disasters). Trauma is common; 90% of people who access specialist services for management of disorders of substance use have experienced at least one traumatic eventPhipps, 2019. Enduring effects of trauma on a person’s physical, mental, social and emotional functions alter their experience of care and limit treatment access, engagement and outcomes.

Note: Past trauma contributes to substance use and addictive behaviours and affects a person’s experience of and ability to participate in health care.

A trauma-informed approach to care involves an understanding of the impact trauma may have on a person’s behaviour and complexity of need. This approach can improve the patient experience but organisational change and staff training is required to support trauma-informed careConnell M, 2019.

A trauma-informed approach is based on:

  • creating a safe environment—elements include a welcoming waiting area, appropriate lighting, good signage, culturally sensitive décor and appropriate staff responses to challenging behaviours in the waiting room
  • building trust—ensure patients are given clear information about their rights and responsibilities, what treatment services can offer and the limits of confidentiality. Ensure informed consent and articulate and maintain clear professional boundaries
  • patient choice—provide patient-centred treatment that offers options and supports the person to make informed decisions. Ask the person what matters to them rather than what is the matter with them
  • empowerment—improve the power imbalance between health staff and patients by supporting the patient to take an active role in treatment decisions, building on their strengths, promoting their sense of self-efficacy and giving messages of hope for positive health outcomes
  • collaboration—work with the patient to achieve mutually agreed goals. Seek feedback on patients’ experience of the service.

A trauma-informed approach does not mean condoning unsafe behaviours or contributing to this with reckless prescribing. It is being clear about professional boundaries and allowing the person to choose whether they concur and are happy to work with the treatment team.