Drug Use's Effects on Etiology Reversal
Social Drug Use

Introduction

While applying TRT, parallel social drug use like the periodic and controlled drinking of alcoholic beverage, or the parallel use of pharmacological treatment methods like tranquilizers and some antidepressants, can cause problems. If these problems are not addressed during the application of Phase One, the affected patients will not continue to the second and other TRT phases; the trauma's etiology will not be reversed. These problems and their prospective remedies are the subject of this addendum.

Importantly, we distinguish social drug use from pathological use, chemical dependency, and do not emphasize the latter here. Chemical dependency's relationship to psychological trauma is covered in its own chapter.

History

During the trauma resolution process, a perpetrator's (of the traumatic event) chemical use was an important variable that directly related to the trauma victim's (spouse's or child's) ability to recall trauma-causing episodes. For example, spouses of chemically dependent people routinely omitted descriptions of the chemical use behaviors: slurred and incoherent speech patterns, walking and driving into things, smell and so forth.

Presumably, the omissions occurred because the recollections evoked memories of trauma-causing behaviors. These behaviors were the source of considerable emotional pain.

Early on in these trauma resolution efforts, our alcoholism family intervention training (see About/ Development/ Individuals) taught us to remove these variables, the omissions of the toxic behaviors, by assisting the family members to focus upon that identification. We made sure that they did not leave out the information.

Importantly, this identification was difficult enough to make if that family member was not a drug user, but the identification was even more difficult if the family member drank along (or used other drugs) with the alcoholic, albeit not to include pathological drinking. Our training instructed us to stop that parallel family drug use. When successful, that is, when the family members agreed to not use drugs, the chemically dependent person's drug use, the toxic condition, and the obvious pathological drug use behaviors were easier for the non chemically dependent and abstaining family member to identify.

We also recommended that non chemically dependent people who were participating in family intervention training not use drugs during the period and process leading up to the intervention because such chemical use activities usually made family member confrontation of the addict's use more difficult. For example, the non chemically dependent family member questioned his or her own intake, that is, the family member felt guilty about the social drug use, and subsequently became hesitant to help the alcoholic to address his or her pathological use.

Moreover, the alcoholic frequently supported this guilt by reminding the social drinkers or other drug users who were participating in the intervention that they too were drinkers or drug users; "Who were they to judge, moralize, another's use?"

Prescription medications also influenced the intervention. In that regard, it was not an infrequent experience for spouses of alcoholics to take prescription medications provided by other practitioners; the medications apparently mitigated the stress experienced during the non alcoholic spouse's (family member's) exposure to the behaviors resulting from the chemically dependent person's pathological drug use activities. During either the process of facilitating the intervention method or during the parallel supporting group processes (see About/ Development/ Individuals and Families for a description of all of these clinical activities), clinical efforts to elicit feelings from a spouse on a tranquilizer, say valium, was not an easy task. Thus, a family member's toxic condition during either the intervention or developing TRT (TRT was just being developed while we were facilitating intervention counseling;) process was deemed to be incompatible with the administration of those therapies.

As indicated earlier, through the influence of our training, we employed standard rules to address the myriad drug uses' influences on non alcoholic/drug addicted patients; we did not allow, as a condition of therapy, family member alcohol (or for that matter other non pharmacologically applied substances like marijuana) use while family members were participating in the intervention process (including the periods between sessions). Eventually, we applied the same rule to the application of TRT because the same problems, omission of perpetrator drug use behaviors, which omissions resulted in the inability to identify the trauma-causing event, occurred in that clinical process (TRT) too. At the time that these rules were initiated, however, we did not realize the ramifications they held for the clinical progression of trauma victims participating in the trauma resolution process; those ramifications are described in the rest of this section.

The Effects of Chemical Use on
Non Chemically Dependent Trauma Victims

Social drug using family members (of chemically dependent people) and other trauma victims (from now on both groups are referred to as "trauma victims") reflected similar progressions (or non progressions) when they attempted to use TRT; during the clinical process, social drug using trauma victims (including those that only used sporadically -- once every week or two) could not make progress in the trauma resolution program, even with the assistance of TRT's structured format, as did those who did not use drugs. Differences between the progressing and non-progressing groups included:

1. users had difficulty proceeding, while non users moved more easily, through TRT's first phase.
2. non users' progressions did not reverse, but users' progressions in a particular session were often reversed by the following one. On a continuum, this progression reversal was manifested at the extreme end of the continuum by (the following show the most pronounced implications of drug use's interference with the therapeutic process):
• the trauma victim's prolonged experience of, and repeated return to, the shock - denial stage of grief related to the particular trauma-causing episode being addressed.
• a reiteration of fear of, and profound anxiety about, the prospects of addressing the emotional pain associated with the trauma.
• a return of focus upon, and continued obsession with, the perpetrator of the traumatic episode or the episode itself, to the detriment of the trauma victim's ability to address the internal psychodynamic aspects of the trauma's damage.
• the prolific use of abstractions, to include rationalizations, intellectualizations, and slogans, and the obsessive use of self-evaluation, self-criticism, and behavioral change techniques; this use of abstractions appeared to be motivated by attempts to divert attention from the therapeutic address of the emotional elements of the trauma.
• a resurgence of energy required to manage, keep in place, the divisions to personality resulting from the trauma.
• a return to denial that the trauma even occurred.

At the other end of the continuum, patients who used drugs while engaged in the therapy just failed to learn readily from the previous clinical experience; the therapy did not stick.

When the use was discontinued, progression through the trauma resolution cycles was immediately forthcoming and identical to the progressions of non-users. Progression was manifested by:

• ready passage through the shock-denial stage of grief related to the particular trauma-causing episode being addressed.
• a replacement of the fear of addressing the emotional pain associated with the trauma with a determination and resignation to address the trauma directly, including an interest in understanding its effects upon the person.
• a reduction in, and eventual ending of, the focus upon, and obsession with, the perpetrator of the traumatic episode or obsessive focus on the episode itself; the focus no longer served as a detriment to the interests of the trauma victim.
• an ending of the use (for defensive purposes) of abstractions, for example, there was an ending of the use of rationalizations, intellectualizations, and slogans; obsessive use of self-evaluation, self-criticism, and behavioral change techniques was also ended.
• a diminishment of the energy previously directed to the management (maintenance) of the divisions to personality resulting from the trauma.
• an unwavering recognition that the trauma did occur and that it affected the person profoundly.
• consistent and predictable progressions through the various grief cycles attending the trauma resolution process.

The Influence of Chemical Use on Chemically
Dependent People Attempting to Resolve
Psychological Trauma

Clearly, there was no trauma resolution effort made, or possibility of its being made, while chemically dependent people were using. Clinical activities, programs, and energies were directed toward achieving abstinence first; trauma resolution for these people came second.

Conclusions -- Chemical Use by TRT
Participating Trauma Victims

Psychoactive chemical use by trauma victims is an interfering therapeutic variable that will, unequivocally, affect, alter, or in other ways retard the therapeutic activities of the remedial process. When the trauma resolution process is completed by the trauma victim, the client may reinitiate the chemical use activities without concern for the effect such use will have on the work completed; obviously, chemically dependent trauma victims may not return to drug use: ever.

Guidelines for the Implementation of TRT
Policy on Chemical Use by TRT Participating Trauma Victims

1. TRT participants should not use drugs, including the social use of alcoholic beverage, from the time the participant has entered TRT Phase One and until TRT Phase Five has been completed.
2. Non chemically dependent people who refuse to participate in the non chemical use component of the TRT program should be accorded other therapeutic opportunities outside of TRT -- opportunities that are conducive to their particular interests and needs; for example non chemically dependent trauma victims who do not want to discontinue the drug use as a condition of therapy (TRT) are candidates for individual or group psychotherapy.
3. Education that emphasizes the therapeutic aspects ("therapeutic" means -- as opposed to moral or life-style aspects) of the non chemical use component of the TRT program should precede or accompany explanations of the program's requirements of the participant. In other words, participants should have explained to them the concept of chemical use's being a paralleling and prospectively countervailing therapeutic variable.

Chemical Use by Clinicians and the Subsequent
Influence on the Clinicians' Capacities and Abilities
to Facilitate the Trauma Resolution Process

TRT's structure facilitates both trauma victims and facilitators through the trauma resolution process. Like the trauma victim, if the facilitator used drugs socially between sessions, that person's parallel facilitation progressions were apparently interrupted similarly, although not to the degree or extent, to which using trauma victims' progressions were interrupted. Examples of such prospective interruptions included:

• The facilitator's shifting, through the use of abstractions, to include interrogatories, rhetoric and admonitions, the TRT process to an analytical-cognitive and behavioral-oriented program (TRT readings are reduced and group time is dedicated to the application of various forms of psychotherapy) with the specific effect being the avoidance of the direct address of the damage to the psych caused by the traumatic episode; the damage is often caused by drug use behavior.
• The facilitator's avoidance of the direct address, by the trauma victim, of the influence of chemical use by the perpetrator of the trauma (the facilitator will tend to forget to facilitate the family member's identification of drug use by the chemically dependent person); the relationship of the drug use to the bizarre behavior will go unidentified.
• Clearly, the degree to which the facilitators' progressions were influenced by chemical use determined the degree to which the trauma victims' progressions were influenced.

Similar to the effects upon the resolution process of chemical use by trauma victims, psychoactive chemical use by TRT facilitating clinicians is an interfering therapeutic variable that will, unequivocally, affect, alter, or in other ways, retard the therapeutic activities of the trauma resolution process.

Guidelines for chemical use
by TRT Facilitating Clinicians

The experiential component of the ETM Professional Training School provides clinicians with the necessary understanding of the principles and importance of non chemical use by TRT participating trauma victims and clinicians; when professionals, who do not as a rule believe in the prospective effects of social drug use on the resolution effort, complete the School, they report understanding and accepting the relationship: statistically, 1000 out of 1000 graduates have reflected this affirmative response.

Thereafter, compliance with non-chemical use aspects (by clinicians) of the program is a private matter for the clinician. And we do not, as a rule, intend to become involved with professionals' drug using attitudes and activities. However, chemical use by TRT participants is not a private matter existing outside of our responsibilities -- TRT will not attain the results described in the this book and shown in the ETM School if the client uses psychoactive drugs while engaged in TRT. Our responsibilities to the end user of TRT and participating clinicians end with these notifications of social drug use's influence on the TRT process.

With regard to drug addicted therapists and mental health managers, actively using (drug) chemically dependent professionals should not attempt to facilitate TRT or attempt to provide management to the Integrated Trauma Management System; professionals so affected, will, in our experience, interrupt, both the clinical and trauma/mental health management processes. For those who are aware of their condition, they should excuse themselves from both the clinical and management processes.

Regrettably, many such people are unaware of the addiction condition. Consequently, we have no guideline for such people, except to say good luck and that we hope that you discover your condition and get sober before according injury, or further injury, to yourself or others, including your clients.

Medication (Psychoactive/Antidepressant)

Generally, people who were obviously suffering mental illnesses such as manic-depression, schizophrenia, or emotional disorder, were not referred to us. However, we did encounter a number of such conditions in our patient population of trauma victims -- people affected by chemical dependency, including family members of chemically dependent people. All of these special people (those suffering mental illnesses) were provided with care by properly trained professionals either who worked in association with us or such patients were assisted through proper referral. In those circumstances where there was an overlap between chemical dependency related problems and other illnesses, medication was a natural and usual component of the overall therapeutic process. These people, as a rule (some people suffering manic-depression were applied TRT) did not participate in TRT as it was usually impossible to apply the structured grieving approach to them. That is, either the illnesses or the need for use of the medication prevented such participation.

In our populations of trauma victims, there also were a number of clients who were using medications prescribed by internists, general practitioners, and psychiatrists, all professionals unaffiliated with our efforts, as treatment for what those professionals considered to be anxiety or depression conditions; usually, the pharmacological treatments were begun some time before we saw these people. Moreover, the medications were reported to have been extradordinarily helpful and meaningful to this group.

Appropriate attempts were made to coordinate the two treatment processes, TRT and the medications, with the prescribing physicians. Eventually, we realized that such efforts would not work. As a rule, people who were using prescription medications for sedative, tranquilizing, or for treatment of depression while they were participating in TRT could not progress through the resolution experience (described in Clinical/ Reversing Long-term Trauma Etiology/ TRT Phases One - Five) and thus did not and could not acquire the same intellectual understandings about the effects of the trauma's damage on the existential and operational elements of identity as did non medicated patients.

Observations, with the understanding that pharmacological therapies are different today than they might have been 10 - 15 years ago, included that, generally

• The medicated client was emotionally and subsequently intellectually removed, when compared to non medicated patients, from much of the therapeutic process.
• Attempts to progress through all of the grief cycles (see About/ Theory/ Psychological Etiology Reversal), that is, to go beyond a generalized grief process and reverse the etiology, were not successful. In fact, the medicated patient rarely surpassed even the preliminary stages of the traditional grieving process.
• Withdrawal from the use of the medication was not a consideration for the patient; life without the medication often seemed inconceivable.
• Medicated patients withdrew from the therapeutic process early on.
• Where there was a desire on the part of both the patient and prescribing physician to end the drug therapy and transfer to a chemically free approach (rare occurrences), such efforts were not successful; such transition was too fearful for the client and he or she returned to reliance upon the medication as the principal therapeutic approach.

Our conclusion was that, generally, the use of medication as a paralleling therapy was incompatible with the use of TRT. Nothing in the literature (see About/ Comparison - Contrast) or our experience since has altered this opinion. Although we have not had direct experience with TRT's application to people who are using the new classes of drugs, which new and improved varieties appear periodically, we believe (because of our reviews of the literature, About/ Comparison - Contrast and Development) at the time of this writing (1993) that the theory of the problems with pharmalogical applications (the theoretical problems are described in the neurobiology chapters and related appendices) still holds even with the newer pharmacological treatment theories and applications. But importantly, hopefully this view will change as the pharmacological therapies change to become more compatible with trauma's resolution with TRT.

For now (1993), a guideline for providing TRT to clients is that TRT should not be offered in conjunction with parallel pharmacological-based approaches, least the client unnecessarily deplete his or her therapeutic energies and efforts on a project that has little means of success. Trauma victims who have previously been treated via the pharmacological approach before referral to TRT should be referred back to that care giver or referred into a parallel and compatible process (non TRT). Psychotherapy is the principal interactional method used to support the pharmacological methodology. Considerable help can be provided by combining the two.

Moreover, we should add that we believe that pharmacological methods are very helpful to many people. We worked, in conjunction with physicians, to assist patients for whom the pharmacological methods were appropriate to initiate and continue the use of such treatment.

Our responsibility in this book, however, is not to those methods. Nor is it to the political (clinical) processes that support them. Our responsibility is to explain the etiology reversal methods that we have discovered and present the truth of the formula for, and to establish correlate guidelines that lend themselves to, the effective implementation of TRT.