Trauma-Informed Care in Recovery
Evidence-Based Approaches to Healing
What "Trauma-Informed" Means
Trauma-informed care (TIC) is a way of providing services that assumes trauma may be present, and designs every interaction to be safer, more respectful, and less likely to trigger or re-traumatize someone. SAMHSA defines trauma as an event (or series of events/circumstances) experienced as physically or emotionally harmful or life-threatening, with lasting negative effects on functioning and well-being.
SAMHSA's "4 R's"
- Realize the widespread impact of trauma
- Recognize the signs and symptoms
- Respond by integrating trauma knowledge into policies and practice
- Resist re-traumatization
And it's guided by key principles like safety, trustworthiness, peer support, collaboration, empowerment/choice, and cultural, historical, and gender responsiveness.
Why Trauma-Informed Care Matters for Substance Use Disorder
Trauma and substance use disorder (SUD) commonly overlap. Many people use substances to cope with:
- Hypervigilance, anxiety, intrusive memories
- Emotional pain, shame, numbness, insomnia
- Relationship and attachment injuries
When care is not trauma-informed, the risks go up:
Dropout and disengagement: people who feel judged, controlled, or unsafe often stop showing up.
Escalation and relapse risk: coercion, humiliation, or "gotcha" approaches can trigger panic, anger, shutdown, or avoidance—exactly the states that drive use.
Re-traumatization: practices that remove choice, withhold information, or rely on threat/force can recreate dynamics of prior abuse.
Worse clinical outcomes: bias and stigma reduce trust and reduce the odds someone returns for help.
SAMHSA specifically notes that practices like seclusion and restraint were once perceived as "therapeutic" in treatment of people with mental and/or substance use disorders—trauma-informed care moves systems away from those harmful dynamics and toward safety and recovery.
What Trauma-Informed Care Looks Like (In Real Life)
Trauma-informed care isn't "being soft." It's being effective.
In a trauma-informed setting, you should expect:
- Transparent communication: "Here's what we're doing, here's why, and you can ask questions."
- Choice wherever possible: options in scheduling, pace, goals, and next steps.
- Collaborative planning: "What matters to you?" not "Here's what you must do."
- Strength-based framing: focusing on what's working and what's improving.
- Predictability: clear boundaries, consistent expectations, and no surprises.
- Peer support and lived experience: hope from people who've been there.
Language Matters: Person-Centered, Trauma-Informed Phrasing
Words can either reduce shame or increase it. Stigmatizing language is linked to negative attitudes and can reduce willingness to seek care.
| ❌ Avoid (stigmatizing/shaming) | ✅ Use instead (clinical + person-centered) |
|---|---|
| "He's an addict." | "He's a person with a substance use disorder (SUD)." |
| "Drug abuser / substance abuser" | "Person with SUD" / "person who uses substances" |
| "Dirty" / "failed a drug test" | "Positive drug screen" / "tested positive" |
| "Clean" / "not clean" | "In recovery" / "not currently using" / "in active use" |
| "Relapse means they don't want it." | "Return to use can be part of recovery; let's adjust the plan." |
| "Non-compliant" | "Having difficulty with the plan" / "barriers to engagement" |
| "Manipulative" | "Using survival strategies that worked in the past" |
| "Attention-seeking" | "Support-seeking" / "distress-signaling" |
| "Frequent flyer" | "High-needs patient" / "needs coordinated supports" |
| "They're refusing" | "They're not ready yet" / "they're choosing a different option today" |
| "Treatment resistant" | "Treatment hasn't matched needs yet" |
Rule of thumb: describe what's happening (observable + clinical) without assigning character flaws.
How We Counter Stigma and Build Safety at Red Door
We treat stigma as a barrier to care—not a moral issue.
We counter stigma by:
- Using person-first, medically accurate language (public site + provider outreach)
- Highlighting recovery stories and peer pathways (hope + belonging)
- Making access to basic contact info free so people can reach help without paywalls
- Encouraging providers to make their pages transparent: what to expect, what it costs, what intake feels like, and how privacy is protected
Trauma, ACEs, and Risk Across the Lifespan
Adverse Childhood Experiences (ACEs) are potentially traumatic events in childhood and are linked to long-term negative impacts on health and well-being. CDC data also ties prevention of ACEs to reductions in issues like prescription pain medication misuse and other behavioral health outcomes.
This is why "what happened to you?" often belongs in the room alongside "what substances are involved?"—without forcing disclosure.
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