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Trauma-Informed Care in Substance Abuse Treatment

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Substance use disorder (SUD) can have a severely negative impact on an individual’s relationships, career, reputation, and future. Recovery is a difficult road, but with the proper support from compassionate, trained professionals who understand the role of trauma and other co-occurring disorders, it is possible to heal from substance misuse.

As a substance abuse social worker, you could have the opportunity to play a pivotal role in the lives of thousands of people throughout your career. Supporting an individual’s recovery from substance abuse requires commitment and patience in addition to training and education. Below, learn more about substance abuse social work and the role of trauma-informed care in treating SUD.

What is Substance Abuse Social Work?

Substance abuse social workers provide counseling and other services to individuals fighting SUD. These can include individual and group therapy, crisis intervention, client advocacy, community education services, and more. Many substance abuse social workers are licensed clinical social workers (LCSW) with the clinical expertise needed to provide their clients with the best care possible.

Job Outlook

The U.S. is currently experiencing a high rate of substance use disorder among people ages 12 and older. In 2022, 48.7 million people reported experiencing SUD.1 This number includes people struggling with both alcoholism and illicit drug abuse and accounts for about 17.3% of the total U.S. population.1

The prevalence of substance use disorder has led to increased demand for professionals who are trained and certified to provide treatment, including substance abuse social workers. Job openings for mental health and substance abuse social workers are expected to grow 11% overall between 2022 and 2032, much faster than the average for all occupations.2 In Montana specifically, job growth for these specialists is expected to slightly outpace the national statistic, with a 12% projected increase in openings.2

Work Environment

Substance abuse social workers serve in a variety of environments, including hospitals, private practices, and community centers. However, their most common employers include outpatient care centers, individual and family service centers, offices of other health practitioners, local governments, and residential substance abuse facilities.3

Required Education

Social work is a complex profession that requires a high level of training and certification. While you may be able to begin your career with a bachelor’s degree, you’ll need specific addiction training for social workers to treat people experiencing SUD. This includes earning a Master of Social Work degree and, in some states, becoming a licensed clinical social worker. Check the Social Work License Map for information about requirements in your state.

Fortunately, some master’s programs do their best to support students who are working and earning a degree at the same time, so you don’t have to put your career on hold. At the University of Montana, you can earn your MSW online and take classes part-time while you work. Plus, the program’s focus on social justice and trauma-informed practice is especially well-suited to social workers who are interested in specializing in substance abuse. After completing a 900-hour practicum experience for hands-on learning and prepare to graduate in three years with the educational requirements needed to pursue a clinical social worker license.*

Experts working in the field of substance abuse treatment have identified a strong link between trauma and substance abuse. Trauma is an emotional response to a circumstance, event, or series of events that are extremely harmful to an individual, either physically or emotionally. While childhood trauma is often discussed as a trigger for SUD and other mental health disorders, it’s important to note that events occurring at any age can cause trauma. Examples of trauma-inducing events include4:

  • Being the victim of a crime
  • Childhood neglect
  • Death of a loved one
  • Experiencing or witnessing violence
  • Natural disasters
  • Physical or emotional abuse
  • Vehicle crashes accidents
  • War or military deployment

Many patients undergoing treatment for substance use disorder may exhibit symptoms of trauma, which can include numbness, flashbacks, insomnia, unpredictable emotions, difficulty in relationships, severe headaches, and more. Experts estimate that individuals with post-traumatic stress disorder (PTSD) are five times more likely to seek SUD treatment.5 This has led clinicians to classify the two as co-occurring disorders, meaning that an individual experiencing trauma or substance use disorder is at an increased risk of developing the other.

Other Co-Occurring Disorders

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorder often co-occurs with several other mental health disorders in addition to PTSD. While studies haven’t defined the specific rates of co-occurrence for SUD with most other disorders, SAMHSA reports the most common mental disorders among Americans as6:

  • Anxiety and mood disorders
  • Attention deficit hyperactivity disorder
  • Bipolar disorder
  • Conduct disorders
  • Major depressive disorder
  • Post-traumatic stress disorder
  • Schizophrenia

In 2022, SAMHSA’s National Survey on Drug Use and Health found that 43.9% of adults who experienced any mental illness also reported being users of illicit drugs. Prevalence of illicit substance use was even higher among adults who were experiencing serious mental illness (SMI), defined as conditions causing severe functional impairment that substantially interferes with or limits major life activities. Adults with an SMI used illicit drugs at an estimated rate of 52.9%, more than twice the rate of adults who reported having no mental illness.1

This data reinforces the observations of mental health experts who classify SUD as a co-occurring disorder with various other mental health conditions. In particular, the co-occurrence of substance use disorder and trauma has a significant influence on modern treatment approaches. As a substance abuse social worker, you’ll play a critical role in ensuring your clients receive treatment that responds to their trauma as well as their substance use disorder.

Trauma-Informed Care in Substance Abuse Treatment

Today, it’s common for substance abuse social workers and other professionals who treat people experiencing SUD to implement an approach called trauma-informed care. Importantly, trauma-informed care is different from treatment that directly involves trauma healing or processing. In trauma-informed care, the goal is to treat the co-occurring disorder, such as SUD, through care that accounts for and attempts to mitigate the symptoms of a client’s experiences of trauma. While some clients may require further counseling and direct treatment for their trauma, that should take place separately and will require a much more trauma-specific approach.5

What is trauma-informed care in substance abuse treatment? SAMHSA specifies “Four Rs” that each person in an organization must be capable of to provide this type of care7:

  • Realize the basic concept of trauma and understand how trauma impacts individuals, families, organizations, and communities.
  • Recognize the signs of trauma; individuals may also utilize trauma screening and assessment tools to clinically identify trauma.
  • Respond appropriately to symptoms of trauma through a trauma-informed approach.
  • Resist re-traumatization of clients and staff members by avoiding the use of practices that may create stress or interfere with recovery.

SAMHSA further explains that the specific strategies and best practices implemented during trauma-informed care will differ based on the needs of individual clients and the setting in which they’re receiving treatment. However, six key principles are involved in any trauma-informed approach to care7:

  1. Safety: Throughout the organization, staff and the people they serve feel physically and psychologically safe.
  2. Trustworthiness and Transparency: Organizational operations and decisions are conducted with transparency in order to build and maintain trust between staff, clients, family members, and all other individuals in the organization.
  3. Peer Support: Support and mutual self-help from other people with lived experiences of trauma are incorporated into treatment to promote recovery and healing.
  4. Collaboration and Mutuality: The organization recognizes that everyone has a role to play in trauma-informed care, and importance is placed on the leveling of power differences between staff and clients and among organizational staff.
  5. Empowerment, Voice, and Choice: The organization emphasizes each individual’s strengths and ability to contribute. Clients are encouraged and supported in shared decision-making, choice, and goal-setting.
  6. Cultural, Historical, and Gender Issues: The organization actively moves past cultural stereotypes and biases, offers access to gender-responsive services, incorporates policies, protocols, and processes that are responsive to the racial, ethnic, and cultural needs of individual clients, and addresses historical trauma.

When it comes to specific treatments and therapies, there are many options for implementing trauma-informed care for substance abuse. The American Addiction Centers lists the following strategies as the most common8:

If you’re interested in learning more about the role of trauma-informed care in substance abuse treatment, take a look at the resources below.

Earn an MSW that Emphasizes Integrated Practice

Providing trauma-informed care as a substance abuse social worker requires a high level of education and training. In the University of Montana’s online MSW program, you’ll study a curriculum focused on preparing you with the clinical skills and social justice focus to honor the dignity and worth of each client you serve. Complete a 900-hour practicum experience for hands-on learning and graduate in three years with the educational requirements to pursue a clinical social worker license.*

UM’s program is CSWE-accredited and has been recognized by U.S. News & World Report as a Best School for Social Work.9 Request more information about this 100% online MSW today.

Sources and Disclaimer

*Licensed clinical social worker (LCSW) requirements vary by state. Check the Social Work License Map to learn more about requirements in your state.

  1. Substance Abuse and Mental Health Services Administration. “Highlights for the 2022 National Survey on Drug Use and Health.” Retrieved July 2, 2024 from https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-main-highlights.pdf.
  2. O*NET OnLine. “Montana Employment Trends: Mental Health and Substance Abuse Social Workers.” Retrieved July 5, 2024 from https://www.onetonline.org/link/localtrends/21-1023.00?st=MT.
  3. Bureau of Labor Statistics, U.S. Department of Labor. “21-1023 Mental Health and Substance Abuse Social Workers.” Occupational Employment and Wage Statistics. April 3, 2024. Retrieved July 5, 2024 from https://www.bls.gov/oes/current/oes211023.htm.
  4. American Psychological Association. “Trauma.” Retrieved July 3, 2024 from https://www.apa.org/topics/trauma.
  5. Tkach, Michael J. “Trauma Informed Care for Substance Abuse Counseling.” Butler Center for Research. January 2018. Retrieved July 3, 2024 from https://www.hazeldenbettyford.org/research-studies/addiction-research/trauma-informed-care.
  6. Substance Abuse and Mental Health Services Administration. “Co-Occurring Disorders and Other Health Conditions.” Retrieved July 2, 2024 from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/co-occurring-disorders.
  7. SAMHSA’s Trauma and Justice Strategic Initiative. “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.” Substance Abuse and Mental Health Services Administration. Retrieved July 2, 2024 from https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf.
  8. Linney, Susan. “What Is Trauma-Informed Addiction Treatment?” American Addiction Centers. May 16, 2024. Retrieved July 5, 2024 from https://americanaddictioncenters.org/blog/trauma-informed-addiction-treatment.
  9. U.S. News and World Report. “Best Schools for Social Work.” Retrieved July 2, 2024 from https://www.usnews.com/best-graduate-schools/top-health-schools/social-work-rankings.

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