The Link Between Trauma and Substance Misuse: Strategies to Address This in Medical Practice

Monday, February 7, 2022, 8:00 AM - Thursday, February 6, 2025, 8:00 AM

AMA PRA Category 1 Credits™ (0.50 hours), CME-Designated Participation Credit (0.50 hours)

This is a 30 min talk about ACEs, the impact of trauma physically and the connection with substance misuse. The presenters use a case presentation to walk you through how to reduce bias in patient interactions. And there is a discussion of strategies that practices have tried to become more trauma informed.

Presenters
Holly Gaspar, MEd, MPH; Project Co-Director Upper Valley Project Launch; Dartmouth Hitchcock Community and Population Health

Becky Parton, MSW, LICSW; Project Co-Director Upper Valley Project Launch; Dartmouth Trauma Interventions Research Center

Learning Outcome(s)
At the conclusion of this learning activity, participants will be able to describe how ACEs and substance misuse are connected.

Disclosure
The activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for this activity have reported NO financial relationship(s)* with ineligible companies**. 

* A “financial relationship" includes employee, researcher (named as the PI), consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and/or an ownership interest (not including stocks owned in a managed portfolio).

** An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Bibliographic Material
• American Academy of Pediatrics. Trauma Toolbox for Primary Care. Retrieved from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx

• Bethell, C.D., Davis, M.B., Gombojav, N, Stumbo, S, Powers, K.  Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive. Johns Hopkins Bloomberg School of Public Health, October 2017. Retrieved from: https://www.cahmi.org/projects/Adverse-childhood-experiences-aces

• Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatrics, 173 (11), e193007.

• CDC. (2019). Data Visualizations: Adverse Childhood Experiences (ACEs).

• CDC. (2020). Adverse Childhood Experiences: Looking at how ACEs affect our lives & society.

• Cook, A., Spinazzola,  J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., & van der Kolk, B. (2005). Complex Trauma in Children and Adolescents. Psychiatric Annals, 35(5), 390-398.

• Corvini, M., Cox, K., O’Neil, M., Ryer, J., & Tutko, H. Addressing Childhood Adversity and Social Determinants in Pediatric Primary Care: Recommendations for New Hampshire. July 2018. Retrieved from: https://www.nhpip.org/sites/default/files/user-uploads/NH%20ACEs%20Report%20FINAL%20July%202018.pdf

• Felitti, V.J., & Anda, R.F. (2014). The Lifelong Effects of Adverse Childhood Experiences. In Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment, (Vol. 2, pp. 203-216). St. Louis, MO: STM Learning, Inc.

• Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.

• McClafferty, H., & Brown, O.W. (2014). Clinical report: Physician health and wellness. Pediatrics, 134(4), 830-835.

• Merrick, M.T., Ford, D.C., Ports, K.A., & Guinn, A.S. (2018). Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatrics, 172, E1-E7. doi:10.1001/jamapediatrics.2018.2537

• Merrick, M.T., Ford, D.C., Ports, K.A., … Mercy, J.A. (2019). Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep, 68, 999-1005.

• National Child Traumatic Stress Network. Child Welfare Trauma Training Toolkit [PowerPoint presentation]. Retrieved from NCTSN Learning Center: http://learn.nctsn.org/course/view.php?id=25

• NIDA. (2020, May 25). What are risk factors and protective factors?. Retrieved from https://www.drugabuse.gov/publications/preventing-drug-use-among-children-adolescents/chapter-1-risk-factors-protective-factors/what-are-risk-factors

• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.

• Substance Abuse and Mental Health Services Administration. (2019). The Role of Adverse Childhood Experiences in Substance Misuse and Related Behavioral Health Problems.

• Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

• van der Kolk, B. (2014). The body keeps score: Brain, mind and body in the healing of trauma. New York, NY: Penguin Group. 
 
Websites
• The Adverse Childhood Experiences CDC website 
 
• The Center on the Developing Child at Harvard 
 
• Robert Wood Johnson Foundation 
  
• SAMHSA National Center for Trauma Informed Care and Alternatives to Seclusion and Restraint 
  
• NH Child Well Being Data Hub 
  
• AAP COVID19 resources
 
• https://physiciansguidetodoctoring.libsyn.com/physicians-guide-to-trauma-informed-care-with-dr-megan-gerber
 
• https://www.acesconnection.com/  
 
• http://marc.healthfederation.org/ 
 
• www.positiveexperience.org

Recommended Videos:
• Center on the Developing Child at Harvard – Three Core Concepts videos 
 
• Resilience: The Biology of Stress and the Science of Hope (2016). KPJR films. 
 
• Cracked Up: The Darrell Hammond Story (2018)  
 
• Downstream: The Effects of Parental Incarceration (2019), Bear Notch Productions.  
 
Recommended Books:
• Burke Harris, N. (2018). The deepest well: Healing the long term effects of childhood adversity. Houghton Mifflin Harcourt. 
  
• Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. St. Martin's Press.
 
• Van der Kolk, B. (2014). The body keeps score: Brain, mind, and body in the healing of trauma. Viking. 
 
• Perry, B. (2017). The boy who was raised as a dog. Basic Books. 

Further resource and infographics:
• National Child Traumatic Stress Network
 
• Creating TI Systems
 
• Resources for working with families
 
• Child Welfare Trauma Training Toolkit
 
• Echo Training
 
“Physical impact of trauma”
“The impact of trauma”
“How to support someone who has experienced trauma”
“Trauma-informed support for children”
“Do’s and Don’ts of a trauma-informed classroom”
“Trauma-informed arrow”

Data websites mentioned:
• NH DHHS Drug Monitoring data
 
• Healthcare Cost and Utilization Project
 
• 2020 NH DCYF Databook
 
• NH DCYF Data Dashboard

Dartmouth Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Dartmouth Health designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Provider Contact Information
For questions of the activity or regarding accreditation:

Center for Learning and Professional Development
Dartmouth Health
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