Addiction and substance use disorders (SUD) are frequently driven and exacerbated by unresolved trauma—especially childhood trauma.
“Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse,” wrote Canadian physician Gabor Maté in his influential addiction study In the Realm of Hungry Ghosts. “For each adverse childhood experience, or ACE, the risk for the early initiation of substance abuse increased two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than did those with none.”
NUWAY treats clients who frequently endorse multiple items on the ACE screening questionnaire—individuals who begin experiencing multiple severe traumatic events early in life. While people with addiction may have experienced childhood trauma, living with active addiction can also expose people to trauma and negative experiences. Acquiring and using illicit drugs like cocaine, methamphetamine, and heroin on the streets often means being in dangerous situations or engaging in activities that conflict with societal norms and the individual’s moral code. This process of satisfying the need for substances can add yet more trauma to an already traumatized person and enhance their sense of shame and stigma.
Unresolved trauma and its impact on self-esteem often enhance a perceived need to self-medicate, fueling the cycle of addiction. People living with trauma are often less able to trust others, creating barriers between patients and caregivers. Since trauma—often in the form of posttraumatic stress disorder (PTSD)—is prevalent among people with substance use disorder, addressing trauma in addiction treatment is paramount. But how can this be done effectively in an addiction treatment setting?
Since 2018, NUWAY has been using a revolutionary new approach known as “Accelerated Resolution Therapy,” also referred to as ART. It is a form of psychotherapy with roots in existing evidence-based therapies but shown to achieve benefits much more rapidly—usually within only one to five sessions.
ART has been a game-changer for NUWAY clients. “They see results right away, whether we’re helping them with PTSD or anxiety or just showing up for their therapy group and participating,” says Lindsay Battuello, Executive Director of Outpatient Development at NUWAY. “Unprocessed trauma can easily derail early recovery from addiction if it isn’t addressed quickly,” says Ken Roberts, NUWAY’s Chief Clinical Officer. “ART is just the right tool for that.”
Licensed Marriage and Family Therapist (LMFT) Laney Rosenzweig developed accelerated resolution therapy. As a mental health clinician, Rosenzweig was proficient in multiple treatment modalities, including Eye Movement Desensitization and Reprocessing or EMDR. She appreciated the therapeutic value of eye movements but also felt the need to modify how they are used and integrated with other techniques. The genesis of ART involved integrating elements from different therapies more uniquely and effectively.
In ART, clients are in control of the session, and therapists guide the process. Visualizing traumatic events like rape, combat, or the loss of a loved one can be painful. ART, differently than other forms of trauma therapy, helps clients move quickly past these experiences. The process is very straightforward, using relaxing eye movements and a technique called “voluntary memory/image replacement” to change how the negative images are stored in the brain.
“The eye movements allow for dual brain processing, giving the brain a unique space to process,” explains Roberts. “This is very different from the normal process. While doing the eye movements, we’re simulating REM sleep in the awake state. With eye movements, clients can’t retain multiple memories, so they cannot focus on how much pain they retain from the traumatic event, which allows it to be uncoupled.”
ART also helps to make the work of therapists more efficient and less stressful. Therapists are less exposed to the details of traumatic events patients might share with them, a common cause of compassion-fatigue in therapists. Because they are spending less time on the content of traumatic experiences therapists remain resilient and can both treat more patients, and achieve positive outcomes in fewer therapy sessions. The innovative ART approach helps systematically increase treatment efficiency and efficacy.
An additional benefit to integrating ART as the preferred therapy for NUWAY clinicians was the opportunity to utilize a specific sub-component of the ART protocol called “Sensation Awareness Focus Technique” (SĀF-T) for non-licensed staff as well. Rosenzweig developed SĀF-T to harness the power of eye movements as a stand-alone technique for decreasing anxiety and resolving negative body sensations. Clinicians use this method during ART therapy sessions, but anyone who receives training can also use it. Clients learn to use SĀF-T when they are triggered to use substances or experience episodes of high anxiety. “If that happens, they can sit down with someone who doesn’t require any certification and do the eye movements,” says Battuello.
The eye movements used in SĀF-T and ART trigger a relaxation response similar to the rapid eye movement (REM) stage of sleep, during which the body is very relaxed. Most people find the eye movements very relaxing and can rid themselves of the negative sensations they are feeling.
Tackling trauma early in the treatment process is very important because traumatized patients have a hard time working on their recovery from addiction. People who have PTSD often experience high rates of anxiety and depression, hyper-vigilance, the inability to form close relationships, and intrusive thinking.
What does that mean for patients undergoing addiction treatment? “It may mean, they cannot tolerate being around other people,” says Roberts. “We serve many clients each day. If you have trouble in that setting, we need to address that. We want to build a trusting relationship bond, and if clients can’t trust anyone, they won’t get very far. The very practical result of ART allows people to trust and engage more.”
NUWAY is one of the first addiction treatment programs to use Accelerated Resolution Therapy on a large scale. Adopting ART is part of an ongoing growth strategy at NUWAY that has significantly increased access to high-quality treatment for the people of Minnesota in recent years. Using ART means that NUWAY clinicians can help more people resolve underlying trauma more quickly and progress to other areas of therapy. Making the benefits of ART available to its large patient population allows NUWAY to develop insights and best practices for the effective use of advanced resolution therapy that can benefit patients and behavioral healthcare practitioners around the country.
“ART helps clients develop a new perspective, new lens, particularly with trauma, that has been with them their whole life,” says Battuello. “Accelerated resolution therapy helps shift their perspective, so they can see their world in a different way.”