Module 5: Trauma, Violence, and Cultural Safety – Topic H Provide opportunities to persons using opioids and with opioid use disorders to develop coping skills, promote resilience, and foster healing.

Learning Objectives

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

• Describe how opportunities can be created to promote positive mental health.
• Describe ways that wellness and self-care can foster healing.
• Recognize how to promote resilience to improve health outcomes.

Key Concepts

• Wellness is an active process through which people become aware of, and make choices towards, a healthier lifestyle and greater overall well-being or existence.
• Wellness is a holistic concept and framework that is focused on achieving and maintaining balance in all aspects of life (e.g., mental, emotional, physical, spiritual, environmental, occupational, economic).
• Different cultures use different frameworks of wellness, which emphasizes the importance of listening to and respecting the values, beliefs, practices, and preferences of the client.
• Promoting change within systems of care and practices is needed to create space for diverse wellness frameworks and approaches, thereby reducing the health inequities of marginalized groups.
• Opioid misuse and addiction might be an attempt to cope with a past traumatic event.
• Creating resilience in communities helps to ensure people with substance use disorders have the resources and supports needed to equalize their opportunities for success.

What Does Wellness Mean?

Wellness means being mindful of different dimensions of life, which includes emotional, occupational, physical, social, intellectual, and spiritual aspects.

• Working toward all dimensions builds resiliency and positive coping skills.

Six Dimensions of Wellness

1. Physical: A healthy body through exercise, nutrition, sleep, etc.
2. Mental: Engagement with the world through learning, problem-solving, creativity, etc.
3. Emotional: Being in touch with, aware of, accepting of, and able to express one’s feelings (and those of others).
4. Spiritual: Our search for meaning and purpose in human existence.
5. Social: Connecting with, interacting with, and contributing to other people and our communities.
6. Environmental: A healthy physical environment free of hazards; awareness of the role we play in bettering rather than denigrating the natural environment.

(Global Wellness Institute, n.d.)

When working with someone who is healing from trauma or violence, it is important to support them in all aspects of their life, as reflected by the holistic model and examples listed below.

What opportunities for wellness can look like

Wellness and Culture

It is important to be aware that different cultures have different understandings of wellness and not to impose one’s viewpoint or cultural perspective onto another person. For example, the concept of individual self-care is not necessarily viewed as a natural element in cultures that are collectivist as opposed to individualist.

Mindfulness as a Coping Response

Mindfulness involves meditative practices that foster “awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally” (Kabat-Zinn, as cited in Purser, 2015). It is gaining legitimacy as a holistic approach to cope with anxiety, depression, and chronic pain—conditions that can lead to substance use.

• Research on the impacts of mindfulness practice on opioid use found that cravings and pain associated with opioid use can be reduced through the use of mindfulness techniques complimented by medication (i.e., methadone maintenance therapy).
• Mindfulness-based interventions also have been successfully used in conjunction with psychotherapy counselling approaches such as cognitive behavioural therapy to reduce cravings, anxiety, and stress, within people experiencing substance use disorders.

Mindfulness can be an effective tool to promote improved self-care and prevent and reduce compassion fatigue and burnout among health care and social service providers.

The image below outlines techniques used by the mindfulness approach and the relationship with biological and behavioural mechanisms, leading to resulting clinical outcomes.

Mindfulness techniques such as mindful breathing, body scan, mindfulness of craving, and informal mindfulness are used in mindfulness based interventions. They are used in conjunction with biological mechanisms such as amplifying prefrontal activation, increasing frontostriatal connectivity, decreasing limbic reactivity, and improving autonomic reactivity, and behavioural mechanisms such as restructuring reward processing, boosting executive function, strengthening dispositional mindfulness, reducing stress reactivity, decreasing drug cue-reactivity, minimizing thought suppression. Resulting clinical outcomes include decreased craving, reduced substance use, decreased distress, enhanced well-being, meaningful recovery.

(Garland & Howard, 2018)

Opioid Use and Building Resilience

Problematic opioid use and addiction might be an attempt to cope with a past traumatic event. As confirmed by multiple research studies, opioid use and addiction are common responses to trauma. Health and social service providers should focus on strengths rather than deficits and provide opportunities for people to build skills (coping skills, self-regulation skills such as mindfulness, and recognition of triggers):

• Acknowledge the resilience of individuals who experienced trauma.
• Promote increasing social, emotional, and resiliency skills.
• Encourage grounding skills and coping skills for managing trauma (recognizing triggers, self de-escalating, centring, staying present-minded).
• Facilitate the development of pain management skills (through relaxation techniques, mindfulness, yoga, physical exercise, breathing techniques).
• Promote attachment and relational skills.
• Create safety plans and facilitate goal setting.

Creating resilience in communities also helps to ensure people with substance use disorders have equal opportunities to succeed:

• Social determinants of health (education, employment, housing, and income) are highly correlated with an individual’s sense of competence and control. These influence a person’s ability to cope and thrive within their environment.
• Housing with supports, including health services, income support, social support, and securing employment can immensely help individuals with substance use issues gain stability in their lives.
• Investing in community resources such as by enhancing community-based services and peer support services, and improving engagement with the primary care sector, can improve access to services and facilitate greater engagement with resources and supports, thereby reducing health inequalities and creating more resilient communities.

Support policies and regulations that promote health, affordable housing, accessible employment resources, and income support are essential.

Health and social service providers must work to change policies and practices that do not respond to diversity or that re-colonize, such as regulations (including funding structures, systems, or processes) that limit or prevent Indigenous communities from designing and governing health and social services that recognize and support prevention, access, and use of traditional medicines and land-based healing practices.

• A move to require agencies to have people with lived experience and family members as voting members on health and social service organization boards to develop inclusive community tools and resources is important.
• Health and social service providers should support the implementation of a shared and laddered care model.

Questions

Which of the following are part of the definition of wellness? (Select all that apply.)

a. Self-directed

b. A newly discovered term

c. Spiritual well-being

d. Positive and affirming

e. Something that can be marketed

Check

Please select an answer.

Correct! While wellness is now used more and is marketed as a commodity, true wellness is a much deeper and spiritual experience, guided and experienced individually, although groups and communities can practise wellness.

Incorrect. The correct answers were a, c, and d. While wellness is now used more and is marketed as a commodity, true wellness is a much deeper and spiritual experience, guided and experienced individually, although groups and communities can practise wellness.

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Wellness has a cultural component.

a. Not at all

b. Depends upon the culture

c. Only in marginalized groups

d. Yes, it is culturally informed

Correct! Different cultures may define and practise wellness differently, making it important for the health and social service provider not to make assumptions but rather to inquire about it in a nonjudgmental and respectful manner.

Incorrect. The correct answer is d. Different cultures may define and practise wellness differently, making it important for the health and social service provider not to make assumptions but rather to inquire about it in a nonjudgmental and respectful manner.

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Mindfulness is not an acceptable treatment for substance use or abuse.

a. Yes, that is true.

b. No, this is changing, with more studies showing efficacy of mindfulness interventions for substance use or abuse.

c. Not sure—there are differing accounts.

Correct! More programs are using mindfulness to be present with the emotions associated with substance use. Individuals in treatment can also practise mindfulness.

Incorrect. The correct answer is b. More programs are using mindfulness to be present with the emotions associated with substance use. Individuals in treatment can also practise mindfulness.

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It can be traumatizing for some individuals to become aware of their body during therapy or treatment.

a. Yes

b. No

c. Depends upon the therapist

d. Depends upon the trauma

e. Only if a health condition is present

Correct! Reliving or talking about past traumatic experiences during therapy can cause stress and anxiety or even disassociation if the trauma was severe. Person-centered care is effective with the individual to determine how to proceed should this occur.

Incorrect. The correct answer is a. Reliving or talking about past traumatic experiences during therapy can cause stress and anxiety or even disassociation if the trauma was severe. Person-centered care is effective with the individual to determine how to proceed should this occur.

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References