Despite its intuitive appeal, AOD services have been somewhat slow to adopt trauma-informed care at the organisational level, which presents a challenge for AOD workers wishing to adopt this approach fully into their practice. There may be several reasons for this, many of which are organisational, but some relate to AOD workers individually [399]; we highlight a selection of these barriers below.
Firstly, despite the pervasiveness of trauma exposure and PTSD among AOD clients, and the potential impact on treatment, both are largely unrecognised at the service level as few services systematically assess for a history of trauma exposure among their clients, with most preferring to put the onus on the client to raise the issue. However, for a multitude of reasons, including shame and an inability to trust, most clients are unlikely to volunteer information about their past trauma experiences unless specifically asked [400].
The reluctance to assess for trauma is often related to concerns regarding client safety, specifically, fears regarding the ability of clients to manage the emotions that may be elicited [401]. Although well-intentioned, this practice is likely to be doing more harm than good; while some people may become upset when talking about these events, talking about the trauma does not overwhelm or re-traumatise the majority of people, and most people describe the process as a positive experience, when it is conducted in an empathic manner [402]. Further, research has shown that these fears can be allayed with appropriate staff training in trauma inquiry [403].
Second, AOD workers may understandably be concerned about their capacity to respond. Trauma training is not a core feature of most certification courses. In Australia, it has been estimated that less than two-thirds of Australian AOD workers have undergone some form of trauma training [404], and AOD workers themselves have identified this as a priority training need [7].
There are also concerns regarding the potential impact of client trauma on the wellbeing of AOD workers themselves and the potential for secondary traumatic stress, discussed in Chapter B8. An essential component of providing trauma-informed care is the provision of adequate training and supports (e.g., supervision, peer support) to AOD workers, developing an awareness of one’s own vulnerabilities, and maintaining good self-care practices (see Chapter B8) [385].
Finally, until recently, there was very little empirical evidence to guide treatment responses. There is, however, a growing body of evidence that supports the use of integrated trauma-focused treatments for PTSD and AOD use disorders, which is outlined in Chapter B7.