Relapse Prevention Group: Reducing Stress
Co-occurring Substance Use and Trauma
Due to confidentiality in a therapy group, the names and situations identified in this story are fictitious. They are typical of situations that might be shared in a similar therapy group. Any resemblance to an actual situation is coincidental, yet not surprising.
In a treatment group for substance use disorders, 60% of women and 40% of men are likely to have co-occurring trauma symptoms. Sometimes the traumatic event precedes the substance use and sometimes it is a result of the substance use. In order to maintain sobriety from substance use, it is necessary to also seek treatment for trauma symptoms. In order to recover from trauma symptoms, it is necessary to maintain sobriety.
I am leaving the premises of my day job at a Fortune 500 corporate office location in an affluent suburb north of the city. Home is a scenic six mile drive east into a more rural area that was booming with suburban sprawl a few years ago. I am driving into the sunset en route to an urban, blue collar town that is further north and west of the city; a thirty five minute drive that I have been making two to three times a week for the past three years. The steel mill closed several years ago, and most of the men in town are unemployed. Many of the women with children are on assistance.
It’s cold. I’m tired. I have to stop for gas. It’s drizzling and has been overcast all day. It is getting dark especially early tonight because of the dense clouds. Traffic is not too heavy, but my car is making a funny noise. I arrive at the counseling center and stop to fix a pot of coffee for the group and pick up my attendance book. It’s a court ordered relapse prevention group for indigent and habitual substance offenders.
Jenna is early. Last week she was depressed and irritable. Tonight she is more hopeful. She shares her good news about the progress she is making toward reunifying with her children. She celebrates seven months clean from crack. Group members trickle into the group room one at a time. The sign in sheet is passed around. The opening go-around begins. Social chatter stops and the group rules are in effect; one person talks at a time, what’s said in group stays in group, show respect to self, others and property, etc.
Usually there is a theme or issue identified during the opening go-around that the group works on. Sometimes there is not. On those occasions, we work more from the book. The topic tonight is, “Reducing Stress.” The objective is to identify stressors and work at reducing them in order to prevent relapse. I am concerned that if no one wants to work tonight, we will speed through the topic without really getting the full therapeutic benefit of the topic. My concerns are unfounded.
Item two of ten on the worksheet relates to staying in the present by avoiding excessive guilt about the past and anxiety about the future. Todd shares about the traumatic loss of his father, and the difficulty he has with intrusive thoughts and dreams about their motorcycle trip turned fatal. Justin shares about his mother’s suicide four months ago; that this time was an apparent accidental overdose after several failed attempts at suicide in the past.
Steven is able to talk about his trauma for the first time without crying, and seems surprised to learn that other people have experienced traumatic events as well. Even though he wasn’t drinking on this particular occasion, he was involved in a motor vehicle accident ten years ago in which he was driving a semi truck and an elderly woman failed to stop at an intersection. He still has visions of seeing her face as her body hit his windshield and was thrown quite a distance. He began to drink heavily to quiet the visions. Even though he wasn’t drinking and didn’t cause his trucking accident, he had felt guilty about it and responsible for it. He believes he should have seen it coming; if only he had been more alert. He never drove a truck again. Last year he was involved in a drunken driving crash. He was injured and has problems with chronic pain. The alcohol that stilled his earlier crash memories helped him manage chronic pain. He started group two months ago, has two months sober, and has a great deal of pain.
Megan is quiet and appears upset. She shares that she too has experienced a traumatic loss, but is not able or willing to share about it at this time. Jenna had shared in a previous group about her childhood trauma, and was able to identify and share with the group that the memories and nightmares are symptoms of PTSD, and even though their trauma is different from hers, their symptoms are the same. Harry’s trauma events occurred in Iraq. He can’t afford medications, and doesn’t want to go to VA. He just wants to complete his court and legal requirements. He does seem comforted to know that others experience similar symptoms, and does acknowledge having trauma symptoms. Once again, Shawn was not able to relate to the topic. With the exception of his arresting event, his life is “normal” and he doesn’t have any “drama” like everyone else. He is a college student and his situation is different. He got a second DUI and accepts that attending group is part of the consequences he needs to pay for breaking the law.
I share my reflection that current stressors were not identified in the opening go-around, yet past stressors were easily identified when asked what interferes with being able to stay in the here and now. Group members share what they “got from group tonight” in the closing go-around, and recite the Serenity Prayer before leaving. I finish my paperwork, lock up and set the alarm on my way out.
It is raining harder and the temperature is colder. The wipers and defroster work. The streets are slippery. I am driving slower as I leave the parking lot and head home. The moon is nearly full but barely visible. I am warm and calm.