Module 5: Trauma, Violence, and Cultural Safety – Topic A Recognize multiple forms of trauma (e.g., physical, spiritual, emotional, sexual, mental/psychological, environmental, intergenerational, historical).

Learning Objectives

By the end of this topic, the student should be able to:

• Identify and describe contributing factors and the multiple forms that trauma can take.
• Describe how different forms of trauma manifest as opioid use and opioid use disorder.
• Describe how wider distal factors contribute to and inform opioid use.
• Explain the definition of structural violence and how it relates to addiction.
• Describe the different forms structural violence assumes in our society.
• Describe the relationship between societal factors and public policy and its impact upon the individual.

Key Concepts

• There are intuitive causal connections between addiction, substance use, and societal factors such as poverty, lack of opportunity, substandard living, working conditions, colonialism and neocolonialism, assimilation, and social, structural, and other determinants of health.
• These connections are referred to as structural violence, a term that refers to the existence of unequal power, restricted access to resources, and systematic oppression resulting in the denial of basic needs, including health care or treatment of addictions.
• The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people (typically, not those responsible for perpetuating such inequalities).
• This often-subtle form of oppression is multigenerational and normalized by those who experience and exert it, including health and social service providers and educators.
• A result of this kind of oppression is trauma and trauma-like experiences.
• Structural violence and trauma challenges past thinking and the label of addiction as a social disease.
• Trauma- and violence-informed care (TVIC) is a response to both interpersonal and structural violence. Notably, the V in TVIC is important because it points to the ongoing and cumulative effects of violence and the intersection of interpersonal (e.g., physical, emotional, sexual, and spiritual abuse) and structural violence (e.g., racism, homelessness, and political neglect); that is, violence occurs at both individual and systemic/structural levels. This shift in language brings into focus acts of violence and their traumatic impact on victims (and distinguishes violence from other sources of trauma, such as natural disasters); the V emphasizes a person’s experiences of past and ongoing violence as the cause of the trauma and is a reminder that the trauma associated with violence doesn’t just reside in an individual’s psychological state—it is a societal issue (Ponic et al., 2016).
• Trauma is not uniformly experienced in society. It disproportionately affects the poor and Black, Indigenous, and other people of colour.

Trauma

Several proximal and distal factors can contribute to trauma, including that of structural violence.

What is considered trauma?

(Konkolÿ Thege et al. 2017)

Childhood Trauma

Childhood trauma, in the form of physical, sexual, mental, or psychological abuse, is strongly linked to problematic substance use. Recent studies exploring the connection between adverse life experiences during childhood and opioid use found that adults who reported five or more types of abuse were three times as likely to use prescription pain medication and five times as likely to consume substances through injection.

Connection to chronic pain

Childhood abuse and neglect are also connected to chronic pain in adulthood. It is increasingly better understood that adults who have experienced childhood trauma are more likely to report chronic pain symptoms and to receive multiple prescription medications, which enhances the probability of taking opioids for pain relief and developing an addiction.

Connection to stigma and discrimination

High rates of substance use have been documented among Two-Spirit, lesbian, gay, and bisexual youth, which, while not well studied, are thought to be linked to social stigma and homophobic discrimination and violence, which produce poor mental health outcomes.

Indigenous Peoples also experience high rates of childhood trauma arising from adverse experiences such as living with racism, poverty, neglect, abuse, and substance use; structural and institutional racism also contribute to Indigenous childhood trauma through structural violence associated with colonial and neocolonial processes and practices, including child welfare and justice system experiences.

Historical and Intergenerational/Transgenerational Trauma

For Indigenous Peoples in Canada, historic trauma is rooted in imposed social and legal injustices in the form of racist legislation such as the Indian Act, as well as in racist, colonial, neocolonial, and genocidal policies such as the Indian reserve system and the Indian residential school system.

These injustices are documented extensively in the report of the Royal Commission on Aboriginal Peoples (1996) and the report of the Truth and Reconciliation Commission of Canada (2015), among others. These reports document the consequences of these injustices, including geographic isolation and an associated lack of settlement supports, lack of opportunities, poverty, brokenness, and poor health outcomes.

• Although Indigenous people are generally experiencing well-being, many Indigenous people carry significant trauma as a result of violence and abuse experienced historically and intergenerationally, generationally, or transgenerationally. Generational trauma is often passed on by parents who were residential school survivors or experienced other forms of institutional racism and faced interpersonal trauma. Other trauma experienced by Indigenous Peoples results from ongoing colonialism that takes the form of institutional structures, systems, and so on.

Racialized Canadians also often carry the burden of historical trauma related to their historical engagement with slavery, and for others, their engagement with war, torture, and environmental natural and human-made disasters.

The need to cope with traumatic experiences is sometimes addressed through the use of opioids. Later generations of groups who face historic trauma are more susceptible to poorer psychological health and face a higher likelihood of behavioural health challenges.

• It is suggested that historical trauma is inherited through biological and epigenetic mechanisms.
• Intergenerational trauma is further passed through observational learning and child-rearing principles such as attachment patterns.
• New evidence is emerging to support the idea that children are affected by parental trauma exposures occurring before their birth, resulting in a predisposition for anxiety and depression—both which are prodrome conditions for opioid use.

Transgenerational trauma events include colonization, slavery, dispossession, displacement trauma, genocide, war, and rape as a weapon of war and famine.

Interpersonal Trauma, Substance Use, and Addiction

Early Childhood and Adolescent Trauma

Exposure to early childhood and adolescent trauma is strongly associated with adult substance use and may be as a risk factor for addiction later in life.

Questions

Trauma is a broad term that includes which of the following? (Select all that apply.)

a. Abandonment

b. Separation from parents as seen in residential school

c. Physical violence

d. Boredom

e. Lack of leisure time

Check

Please select an answer.

Correct! Trauma is a multi-sourced, complex, and intersecting issue. Boredom can be a contributing factor in the case of Indigenous youth whose land base and relational practices were removed through colonization and resettlement, leaving an emotional and physical void.

Incorrect. The correct answers were a, b, c, and d. Trauma is a multi-sourced, complex, and intersecting issue. Boredom can be a contributing factor in the case of Indigenous youth whose land base and relational practices were removed through colonization and resettlement, leaving an emotional and physical void.

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Why is the term intersectionality important to explaining addiction, substance use, and trauma? (Select all that apply.)

a. It’s a pop culture term.

b. It’s a way of understanding how culture, history, race, identities, gender, and so on, play a role in creating discrimination.

c. It acknowledges how social, cultural, and political systems combine to marginalize certain groups and identities.

d. It’s a simple way of associating addiction and trauma.

Check

Please select an answer.

Correct! Trauma and substance use are not linear terms with a single contributing factor. Constructs such as race, gender, age, and identity, among others, intersect, which intensifies the degree of discrimination and stigma that occurs within marginalized groups of people.

Incorrect. The correct answers were b, and c. Trauma and substance use are not linear terms with a single contributing factor. Constructs such as race, gender, age, and identity, among others, intersect, which intensifies the degree of discrimination and stigma that occurs within marginalized groups of people.

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References