Conceptualization of a Trauma-Informed Practice Environment for Addictions Service Delivery Organizations: A Qualitative Analysis

Background: The strong connection between addiction and trauma has been discussed and examined thoroughly in the literature, offering confident substantiation of the triggering potential of histories of trauma on the prevalence of substance abuse later in life. However, the emphasis on trauma as a causal force to addiction all but translates from literature into practice. Within a trauma-informed practice lens are core values’ listed as ‘safety’, ‘trustworthiness’, ‘choice’, ‘collaboration’, and ‘empowerment’ (Harris & Fallot, 2001). Each value addresses different aspects of trauma, and in its entirety allows a program to be ‘trauma-informed’ (Harris & Fallot). However, it is unclear how these values become manifested within the programmatic structures, processes and procedures of human service organizations that provide supports to individuals engaged in substance abuse. To further develop this line of inquiry, this research highlights the practical application of a trauma-informed practice lens in community-based residential addictions treatment organizations.

Methods: This research follows from a qualitative study design. One to one interviews were conducted with 71 program participants (n=41) and program staff (n=30) at a large addictions treatment service delivery organization in Toronto, Ontario. Respondents were engaged in long term (i.e. 6 month and 11 month) and short term (i.e. 6 weeks) addictions treatment programs. The interview guide was structured following Harris and Fallot’s (2001) core values associated with a trauma-informed practice framework. Respondents were asked questions related to how they experienced (or supported in the case of program staff) safety, trustworthiness, choice, collaboration, and empowerment. Data were transcribed verbatim and analysed utilizing analytic induction and constant comparison strategies.

Results: Respondents provided direct insight into how they experienced each core value associated with a trauma-informed lens. For safety, respondents associated this with their physical safety, confidentiality, reassurances from program staff, rule enforcement, and positive peer relationships. With regard to trust, this was manifested in being comfortable in sharing, staff availability, nonjudgmental experiences, positive relationship dynamics, and the perception that program staff cared. Choice was identified through programming that recognized individual needs, having clear expectations, participation in programmatic activities, being exposed to a range of opportunities to support recovery, and a focus on the individual. Collaboration was indicative of receiving feedback, involvement in planning, goal setting activities, specificity in program structure, and ongoing support. Finally, empowerment was characterized through supports that manage triggers, a demonstrated understanding of client situations by staff, validating client experiences, and ability to share at one’s own pace. 

Conclusions and Implications: This analysis provides a conceptual framework of the various ways that each trauma-informed value is embedded within the organization’s processes and procedures of engagement with service users. The analysis supports the development of hypotheses, which highlight the association of each core trauma-informed value and the program structure and organizational processes of this one organization; essentially contributing to a holistic model of trauma-informed practice in addictions treatment, and supporting the item generation for an Addictions Treatment Trauma-informed Practice Scale. Authors are currently conducting research to assess the scale for construct validity and reliability.