Chronic Pain and The Trauma Egg

Chronic Pain and Opioid Addiction in America

This presentation is on chronic pain and the trauma egg. Thank you to our presenting partner Eric McLaughlin with Intervention 911 and Kemah Palms very own Dr. James Flowers.

I’m just going to introduce Dr. James Flowers. Oh, thank you, guys, and I’m so happy to be able to. Yeah. He said, Oh yeah, I’m not going to go there. I won’t tell our whole story. Dr. Flowers and I have been business partners for over 20 years now, and I’m so happy to have he and Eric both present today. There are two of my most respected people that I respect and learn from in the industry. So I’m just I’m honored to have you, you guys here today. Like I said, Dr. Flowers that I’ve been in business together for 20 years. We’ve been been doing treating people with pain for 20 years and then combined with the substance use issues for the past seven years. So really excited to hear him today and to have this combination. We know that people deal with trauma and they deal with. If they deal with addiction, they deal with trauma and many, many people deal with pain. So I am just honored.

Dr. Flowers received his PhD from Sam Houston University. He holds an LPCS. And without further ado, I’m going to let him take this over. He’s got a lot to say, and if I don’t turn it over, he’s probably going to mute my mic because I may tell stories. But here we go. Welcome, James. Thank you, Tonda. There’s there’s there’s a lot of history there. Yes, Tonda and Michael and I have been working together for 20 years, which is just, I think, twenty one years actually now. But it’s just crazy. And and you know, what I would say is, is this is a great time, and Michael and I don’t get to be in the same room very often at all. And we’re not today either. But we don’t get to be on the same Zoom calls very often. So what I would like to say is, Tonda, thank you for everything you’re doing leading right now. It Kemah Palms and I’m so proud to be founder and CEO of Kemah Palms Recovery. It’s an amazing program. As most of you know, I’ve built most of the pain programs around the country. This is my 29th or 30th year in business and practice. Really, I guess I should say and really being an entrepreneur in this space that we’re in. But I would absolutely say that I would not be where I am today if it was not for Michael Beard and Tonda Chapman.

And we make an amazing team and love working side by side with them every single day. So I’m just real excited and so excited that Eric and I could get our calendars together. And so thanks for being here, and now I’m going to see if I can share my screen because usually I’m an assistant doing this for me and she because we had ice storms and her house flooded. She’s not here today. And by the way, I had five pipes in my own home burst, and it’s just a crazy time in Houston. So let me see if I can share my screen. I think I’m supposed to double click. Is that it? Tonda, do you see that? You got it, all right. Yay. Ok. So Krystle, at any time, if you need to interrupt me or if I’m running way too short or I’m running early, just just say something or Lauren or anybody out there is welcome to do that. Today, what we’re going to talk about is my passion, and that’s chronic pain, addiction and really the healing process of chronic pain. And it really is a great precursor to what Eric is going to be talking about because with chronic pain, there is indefinitely trauma. There is always trauma related to chronic pain, no matter what type of chronic pain it is, whether it’s a three mm tiny herniated disc or someone was shot six times and had multiple gunshot wounds and lots of neurological damage and are in the healing process.

So I’m really excited that we get to talk about chronic pain and then go right into Eric and talk about the trauma or the trauma. So the first thing that I’m going to do, though, is Michael and I were in Los Angeles last year with Shron at MusiCares and got to visit and see Macklemore perform, and this is a song that he wrote and performed. And I just want to start with this song because it touched every time I hear it, I cry because for 30 years now, I have been intimately involved in physician practices around the United States that prescribe opiate prescriptions to chronic pain patients and not just a little bit of opiates, but a lot of opiates to chronic pain patients around the United States. And I’ve worked in academic and university settings where physicians prescribe opiates, and I’ve worked in private practice settings where physicians prescribe opiates and and it has been amazing to watch this 30 year curve of opiates go from this opophelia type feeling of we have to prescribe opiates to an opiate phobic feeling of we can’t prescribe opiates because we’re going to get arrested and go to prison when indeed the real reason should be is we just don’t need opiates beyond 90 days. But that’s not what’s happened. So let me play this video it’s it’s very rated R.

So if you want to if you want to mute your microphone and not hear this video, it’s OK. But that’s how important it is to me. So we’re going to start with this if I can figure out how to change the screen. You know, Macklemore was walking on stage and he fell and twisted his wrist and ended up having to go to an emergency room to have it looked at. And at the emergency room at, I think it was in Seattle where he did it. He was in pain, the first visit to the emergency room, his wrist wasn’t broken and they gave him a prescription for 90 Vicodin right there on the spot. Probably a little bit because who he is. But I’ve seen in emergency rooms in Houston and everywhere else around the country that this happens all the time.

Are Over-Prescribing Doctors to Blame for the Opioid Crisis in America?

You know, nowadays it’s not 90 Vicodin. I was in an emergency room here in Houston. Probably, I don’t know, six weeks ago talking to a group of E.R. doctors that were changing shifts and there was about 30 ER doctors going 15 coming off shift and 15 coming on shift. And we were doing an opiate talk and three of the doctors raised their hand and said, Listen, I totally understand what you mean about opiates and frequent fliers to the emergency room. But the easiest thing for me to do as a physician instead of clogging an emergency room is to write a prescription for 12 Vicodin and get the guy out of the emergency room. And that, to me, just blew my mind. And and here it is. After the Purdue Pharma settlement and after the OxyContin debacle, which really continues, but that E.R. docs are still writing these prescriptions. But I just think the words in the song are so powerful because addiction often does start with a prescription. When Purdue Pharma started selling prescription opioid painkiller OxyContin way back in nineteen ninety six, Dr.

Sackler, whose Sackler family owns are these single owners of Purdue Pharma, as people gathered at a lunch party and wanted them to envision a natural disaster like an earthquake or hurricane or a blizzard. And all of this was caught on video and in emails. The debut of OxyContin, said Dr. Sackler, will be followed by a blizzard of prescriptions that will absolutely bury the competition and the pain world, and they wanted to absolutely dominate the world when it came to controlling chronic pain. Five years later, when questions were raised about the risk of addiction and overdoses that came with taking OxyContin and opioid medications, Dr. Sackler, the owner, again outlined a strategy that critics have long accused the company of unleashing diverting the blame onto others, particularly the people who became addicted. Dr. Sackler said in an email to the entire staff and executive leadership at Purdue Pharma, we have to hammer on the abusers in every way possible. He wrote this in February of 2001. These people are the culprits in the problem, and they are reckless criminals. So instead of taking any action and looking inside and thinking, Wow, we have doctors out there writing one hundred and eighty OxyContin a month, that may be too much. That’s not what he did. What he did as he sent those doctors to Hawaii, sent them to Cuba, sent them to Puerto Rico, sent them all over the world, really fishing Cabo San Lucas and paid for these elaborate trips and subsidize the sales reps for Purdue Pharma and gave them huge awards and bonuses that the more prescriptions they were, their doctors wrote, the bigger their bonuses were.

So in September of 17, the CEO, the new CEO of Purdue Pharma, again noted in an email that there are too many prescriptions being written at too many high doses for too long at a time for conditions that don’t require OxyContin or that type of an opiate by doctors who lack the requisite training and how to use them appropriate. By the way, the second highest rider of OxyContin in the United States are dentists writing prescriptions for an opiate called OxyContin for dental pain. The state’s lawsuit, but this was Oklahoma, concluded The opioid epidemic is not a mystery that people who started it, meaning the Sacklers and Purdue Pharma, the defendants, knew exactly what they were doing. So in September 18th, September 18 of 2018, What did Purdue Pharma do? Instead of trying to go out and educate and give money and train people on addiction and talk to physicians about prescribing patterns? They decided to go out and get the patent on buprenorphine. Purdue Pharma, who killed hundreds of thousands of people in the United States, now owns the patent on Suboxone buprenorphine, which is just absolutely blows my mind so they own both in. So the spectrum at this point. But in February 2021, just this year, a federal judge approved a landmark $8 billion Purdue Pharma opioid settlement.

I don’t think $8 billion is enough. Purdue Pharma has many, many, many, many more billions of dollars than that, and the Sackler family themselves have. I think Forbes name the Sackler family, the 12th wealthiest family in the world last year, and all of that money was based on OxyContin sales. So addiction does often start with a prescription. Three hundred and seventy seven million prescriptions were written in the United States in 2019 for opiates. That’s the rate of sixty six and a half prescriptions for every one hundred people in this country. Four out of five heroin users report that their addiction started with a prescription. In other words, like our friend Macklemore, who sprained a wrist started with a prescription. Then it went into OxyContin. Then he tried heroin and then he got sober. Thank God. In twenty seventeen, more than a third of all adults in the United States were prescribed an opioid for chronic pain. What are some of the commonly abused pain drugs in general, not just OxyContin and not just Vicodin alcohol? Many people try to mask their pain with alcohol.

Addiction Tolerance to Opiates Leads to Other Addictions

Many people who have been taking Vicodin, many people who have been taking OxyContin for too long of a period of time develop a tolerance for it. And then they begin to drink more and more alcohol to help the effects of the OxyContin because they’re experiencing something called hyperalgesia, which doesn’t, which means they need to take more and more and more pain medication.

Thus, the hyperalgesia to have the same effect so they mask it again with alcohol. Of course, OxyContin and oxycodone, Demerol, Dilaudid, morphine, codeine, methamphetamine is becoming more and more used now as a pain medication and methadone. We just had a chronic pain patient that has multiple fractured old fractures and a spine, multiple surgeries, rods and a spine. And he says the only thing that helps me is microdosing with meth, and no one is going to be able to take me off of meth because when I when I smoke meth, my pain completely goes away. Of course, it goes away when you smoke meth, but it’s not the answer. But we’re seeing meth and heroin more and more and more because, of course, OxyContin is becoming more difficult to obtain in Doctors’ offices anyway. Commonly abused prescriptions, sleep medications like Ambien and Lunesta because chronic pain patients report that they sleep on average three to four hours, sometimes two hours before waking, and then get up and walk around the house and try to fall asleep and go back to walking and then go back to lay down. Non-addictive pain meds like ultram or gabapentin, Selma and then, of course, benzos Xanax, alprazolam, Klonopin to help bring the anxiety down that calms the nervous system. And when the nervous system is calmer, we see a lower level of pain typically.

But then we have the results of being knocked out by a benzodiazepine. Our bodies really begin to build a tolerance after about 90 days, that’s not very long, but after 90 days of acute onset of pain and being prescribed any type of pain medication again, whether it’s Vicodin or whether it’s Oxys or any other type of medication, our bodies and the chemicals in our brain become tolerant of it and they become dependent and we begin to form an addiction to that medication. Whether we have an addiction in our history, whether our family has addiction, whether we’ve had an addiction in our own life, we become tolerant of that pain medication and we develop a physical dependence. That’s an addiction to it. And then there’s also a category called pseudo addiction, where early on in chronic or early on in pain, even in the even in the acute phase of pain, you have pseudo addiction. Let’s just say post-surgical pain. Someone has surgery as a 360 degree cage put into their spine. That’s very, very painful. It’s a 12 hour surgery, and that person will absolutely need opiates, post-surgical first post surgery for a few days or a week at a time. But what happens is, is they begin to act as an addict because they’re chasing their pain, saying, I need more, I need more, I need more. And at that point, there is no addiction. It’s called a pseudo addiction because they’re trying to chase their pain.

But if they continue to act that way and the hospital continues to prescribe beyond a reasonable time, then it goes into the physical dependence, tolerance, increased tolerance or decreased tolerance and then an addiction. Tolerance really is a state of adaptation in which exposure to a drug induces changes that result in a diminished nation. Sorry about that of one or more of the drugs affects over time. So in other words, over time we need an increased amount of that opiate to get the same effect as we had previously. Physical dependence is really a state of adaptation and is a manifestation by a drug class very specific to withdraw syndromes that can be produced by abruptly stopping the medication. A rapid dose reduction decreased blood level of the drug and or administration of an antagonist. We experience that physical withdraw symptoms and start to begin to sweat. Our joints ache. We’re beginning to feel like we have the flu. And so what do we do? We grab that bottle and say we need more medication because we’re in that physical pain, not understanding what stage they’re really, truly in. Addiction, of course, everyone on here knows is a primary chronic neurobiological disease with genetic, psychosocial and environmental factors influencing its development and manifestations. It’s characterized by behaviors really that include one or more of the following impaired control over drug use. In other words, chasing that medication, trying to stay ahead of the pain, but staying way ahead of the pain.

Compulsive use saying Don’t stop this medication. Orthopedic surgeons nowadays will typically give three to four days of pain medication. And patients who have a tendency to have a low threshold for pain or low coping skills continue to call orthopedic surgeons saying, I need more, I need more, I need more, and they become compulsive users to try to chase that pain. And their brain is playing a trick on them, telling them that they’re actually in a higher level of pain than they actually are when it’s really caused by an anxiety attack, a nerve condition meaning there’s nothing actually wrong with the body. It’s in a repair process, but we feel like we have to have that medication to lower that, that that physical feeling or even perceived physical feeling and continued use despise harm despite harm and craving.

Pseudo addiction really is patient behaviors that occur when pain is under treated, patients with unrelieved pain may become focused on obtaining medications they clock watch, and they may otherwise seem inappropriately drug seeking again. Typically, this is in that acute phase of pain, either post-surgical pain when they’re experiencing that pseudo addiction and they feel like they’re drug seeking or the doctor feels like they’re drug seeking. Even such behaviors as illicit drug use and deception can occur in his effort or her effort to obtain relief. But they haven’t actually gone into that addiction phase quite yet, but the likelihood is very high if they continue to use.

So how did we get here? It’s an interesting question of how, you know, cocaine use and cocaine for chronic pain goes way, way back to the 1800s. But really, how did we get in the crisis and the trauma situation that we’re in today? And it’s it was an interesting phenomena that happened, and I think with with all of the best intentions. Bill Clinton met with Congress, met with political action folks from pharmacy companies, and they talked about the large population in the United States that were undertreated for pain and that doctors felt like if they couldn’t write enough prescription for pain medication, the doctors felt like they were going to go to jail. Hospital systems felt pressured to prescribe more pain, and they were afraid to prescribe more pain. So on October, the 31st of 2000. Again, I think with the best intentions, Bill Clinton signed a bill into law, and that bill said that all health care providers, not some, but all health care providers must not, can or should, but must treat pain adequately. So all health care providers must treat pain adequately. That means hospitals. That means private practice physicians. That means nurse practitioners. That means private practice offices. Anyone with the ability to write a prescription for pain medication must treat pain adequately. And then the Joint Commission, who we all are aware of through our treatment centers and in hospital systems in the United States.

The Joint Commission followed Bill Clinton and said If you do not adequately address pain, you will lose your joint commission accreditation. So for a hospital System Methodist Hospital in Houston, the largest hospital system, or Memorial Hermann, even in Houston, the largest hospital systems in the southwest United States, Southeast United States, if they lose their joint commission accreditation, what else do they lose? They lose the right to to to treat Medicare patients, and then they’re going to lose their right to treat insured patients and they’ll go out of business. So every single hospital room, every single doctor’s office, every single health care office in the United States began putting up a little picture on the wall of a hospital room, a private practice, a doctor’s office, a dentist office. And they were like, Sir, ma’am, can you look at the wall and you see these 10 faces? Where are you on this scale? Zero means no pain at all. Ten means the most pain that you could possibly experience if your rate your pain, I’ll put it in your chart. Well, most patients who rate their pain in a hospital system or go to see a doctor for pain are feeling or perceiving at least that they’re in a high level of pain and rate that pain 90 percent of the time, either a seven, eight, nine or 10 Joint Commission said if it’s high, that you must treat it.

So therefore, every time a patient reported a high pain level in a hospital system or a doctor’s office, they were written a prescription for pain medication. Or they were given a shot of morphine in a hospital bed and treated because of this law that went into effect on October, the thirty first of two thousand. That’s really when Pandora’s box was opened, when doctors began prescribing opioids more liberally way back even in the eighties. They thought only a fraction of patients would become addicted. Now we know otherwise, and I wish I was sitting in front of a live audience because I always like to see people raise their hands and answer this question. What is the single most quoted sentence in American literature? And I know you guys can’t answer right now. I can monitor the chat for you if you want, if you want to. Yeah, so sure. If someone knows what the single most quoted sentence in American literature is, that would be amazing. If Candy Finnegan is on this she’ll, surely no, because we talked about this hour, Louise Stanger, if Louise Stanger is watching this, she’ll surely know, but the single most, I’ll go ahead and not pause. The single, most quoted sentence in American literature is in the Journal of the American Medical Association, which is the highest rated, most respected medical journal in the world.

Very peer reviewed journal, very respected journal. And that sentence says OxyContin is not addictive. That is one sentence, and it has been used more and more literature and more articles and more advertising than any other sentence in history. And it opened again along with joint commission, along with the law that Bill Clinton signed into law and then jam, which every physician in the United States really the world subscribed to because it’s the most respected journal in Medicine said. Oxycontin is not addictive and and everyone use that and lawsuits when a patient would overdose and die. When patients sold medication and another person died, they would go back to the Journal of the American Medical Association and see right here. And lawyers who used it in cases and said it says Right here in JAMA. Oxycontin is not addictive. We did not intentionally kill that patient. And in fact, that was in the nineteen eighties and only two years ago did the new editor of JAMA. And I’d love to get a copy of this. I don’t have it, but the new editor of JAMA. Two years ago in the opening and his editorial letter apologized and of course, retracted that statement and said, What a horrible mistake it was that that sentence was posted or written in the most respected medical journal in the world. Because what happens is when you went to the doctor, and even today, this continues because of a mindset that we have physicians see 50 60 patients a day in their practices, sometimes more, and they come in the number one reason to see a physician as chronic pain or ongoing pain or acute pain.

And the easiest thing for the doctor to do is to say, I want you to take one of these every day until I think of something else, because hopefully this will keep you happy, keep you out of my office, and hopefully it’ll take care of your pain and you won’t have to come back as quickly. Also, doctors and patients feel that the patient comes in and says, I have a headache, a sore throat, a backing ache, my stomach hurts. And the doctor is often thinking this is a frequent flier in my office and he’s really a pain in my neck. I hear that thousands I have heard that thousands and thousands and thousands of times from some of the most respected physicians in the world that frequent fliers that come to Doctors’ offices with constant pain complaints really are just a pain in the neck. Drug overdose is the leading cause of accidental death in the United States, with sixty five thousand legal lethal drug overdoses in twenty eighteen. Opioid addiction even today post the Purdue Pharma debacle is the drive is driving the epidemic, with twenty thousand overdose deaths related to prescription pain relievers and thirteen thousand related to heroin from 2000 to 2019 overdose deaths and sells of substance use disorder.

Treatment admissions related to prescription pain relievers increased that much as well. The overdose death in twenty eighteen was nearly six times the 2000 rate, with more than one hundred and thirty million individuals suffering from chronic pain. It’s imperative we look at treating pain and addiction together as a seamless pain recovery program. And really, that’s what we do at Kemah Palms, and that’s what treatment centers around the United States and private practitioners who work with chronic pain patients really need to look at how to join a 12 step recovery approach or whatever their recovery approach is, whether it’s 12-Step or smart recovery or anything else. But wrapping it together within the ability to work with experts at treating chronic pain together. If you treat just the addiction, people can do extremely well. They can go to detox, they do well in detox, they go to a 12 step or other type program. They do fantastic in the program. They feel amazing. They feel on top of the world. They leave the program three weeks later. Two weeks later, their stress comes up, their pain comes back. Sometimes their pain comes back. Immediately, they make an appointment to go to their doctor. They talk about their pain and the doctor scratches his head and says, Well, why did you stop taking it? I prescribe it to you. You have two three mm herniated disc. Take this medication and the relapse rate for a chronic pain patient who’s been in a 12 step program that did not discuss or have an expert leading a pain recovery program is over 90 percent in the first year.

The Charleston Gazette reported that opioid host seller shipped almost 800 million. Eight hundred million oxycodone and hydrocodone pills into West Virginia over a six year period. That’s enough for four hundred and thirty three pills for every person in the state of West Virginia. Meanwhile, 1,728 West Virginians died of overdoses from those two drugs. So enough about how we got here. We all know we read it. We breathe it. We see it every single day. Opioids are a trauma and our country. Opioids have caused Purdue Pharma the Sackler family. Other big pharma companies who produce pain medications, physician practices who continue to prescribe pain have caused a tremendous amount of trauma in our country and a lot of death in our country. And and, you know, physicians, I believe, go to school with all the best intentions and they want to heal people and they want people to feel better. But when someone comes into the office and pain is completely subjective and my level of seven pain and your level seven pain are completely different. A physician can’t see it, can’t really understand it other than the look on your face. And that’s stupid. Zero to 10 scale. That’s all over the world that says what level of pain or you’re in.

Are you in? And they write a prescription. So how do we move beyond that? And how do physicians and private practitioners and substance abuse counselors and psychologists and psychiatrists and physicians and all of us that treat people? Thirty three percent of the population at least suffers from chronic pain at one point or another. So how do we look at it really is the disease class and how do we get rid of it? Pain, of course, is a very unpleasant sensory and emotional experience associated with specialized nerve endings that signal actual or potential tissue damage. Always subjective. My pain and your pain are never going to feel the same way. But I want to say this if a patient regards their experience as having physical pain and they reported as pain, we are no one to judge another person’s physical feeling. It has to be accepted as pain. We have to let them understand that we believe them, we trust them. We can see that they’re hurting, we can understand that they’re hurting. And we look at it as acute pain. Chronic pain. Acute pain is tissue damage where you fall off a curb and sprain your ankle or sprain your wrist. It’s a protective functioning saying Go to the doctor, put ice on it, put heat on it, and it resolves upon healing. Chronic pain is beyond 90 days. Our bodies were designed, I believe, by God to heal within about 90 days.

But pain, if it continues beyond that 90 days, it’s a chronic pain symptom and no longer serves a useful purpose. It changes and pain signals and detection in our brain, and it degrades our health and our function. We become depressed, we become anxious, we become lethargic, we become just sad. We have a great cloud sitting over us and we just don’t know what to do other than reach for a medication or try to feel better. Transition from chronic pain, though, there’s another level of chronic pain and that’s chronic pain syndrome. The likelihood of developing chronic pain syndrome is completely unrelated to pain intensity. So in other words, a person can have a level nine pain on a consistent basis and another person can have a level nine pain on a consistent basis. One person has chronic pain. The other person has something called chronic pain syndrome. Chronic pain syndrome is where psychological variables come into play, such as severe depression, severe anxiety, anger, somatic focus and self perceived disability consistently have been found to be the most accurate predictor predictor of subsequent pain syndrome development. And what it is you have acute pain, you have chronic pain, but people go to work, they thrive, they do things, they continue to function. Chronic pain syndrome is a failure to thrive. Krystle where am I? 10 minute warning. Great. Thank you. I’m going to I’m going to run through. I’m really going to try to get through this.

I’m so sorry. Anticipatory pain is conditioned, pain responses where we absolutely think if we get up and cut the lawn, we get up and do the dishes, we get off the sofa, we get out of bed. We’re going to have pain. Guess what, if we believe that we are going to have pain? It’s an internal physiological and psychological emotional trigger that activates our nervous system. The only way we feel physical pain is right here through our brain, and the way that we fill it into our brain is because every nerve in the body connects to the spinal cord that goes to the brain. And the more our nervous system moves and is triggered by anxiety, depression, fear, sleeplessness, poor diet, lack of exercise, all of that triggers our nervous system. Our pain level goes through the roof. The calmer our nervous system can be, the less physical pain that we’re going to feel. It’s all associated with previous episodes of pain and what we experienced historically from that trauma that later Eric is going to talk about in a few minutes. It’s biological. It’s a nerve signal that something’s wrong. It’s psychological, meaning we assign meaning to our pain signal. And it’s also cultural roles are assigned to the person in pain. Honey, don’t do the dishes. I’ll do them. You don’t have to cook tonight. I’ll cook. You don’t have to go to work anymore because you hurt.

Let’s get on disability, family and cultural beliefs about pain as well. And my twenty nine years of experience, I have literally treated less than five, probably less than three Asian people with chronic pain. And I have treated thousands and thousands and thousands of people with chronic pain. And it’s a cultural belief about chronic pain and how Asians create their own recovery method using meditation, mindfulness, tai chi and not abusing or going to doctors to doctor shop for opiate medication. Addictive disorders are related to opiate use, of course, other substance use disorders, depressive disorder, sleep anxiety, PTSD and trauma again, that Eric and other mood disorders are often co-occurring once you get into that chronic pain syndrome. And when we have anxiety, it produces sleep problems. Sleep problems increase and cause coping difficulties. And all of those things cause an increased level of pain, which causes increase anxiety, sleep problems, depression and lower levels of coping. And we get in this horrible spiraling cycle going downward. What is pain due to your body? It limits our thinking in our cognitive abilities. It increases our heart rate and our breath rate. Our blood pressure decreases, nutrients absorption increases, our blood sugar increases, the sticky platelets decreases our immune function, causes infertility, increases our aging and we look old and we feel old, increases obesity because all we do is lay in bed and eat or sit on a sofa and eat. And it’s associated with depression and it causes muscle tension.

And the more muscle tension we have, the tighter it’s on the on the nervous system and the tighter the nervous system is, the higher level of pain that we’re going to feel. And this is the typical profile of a pain patient fear, depression, anxiety, frustration and fury. I’m never going to get better. I want them to cure me. I can’t stand this. Why do I hurt? I’m useless. No one believes me. Quality of life, psychological social consequences and socioeconomic consequences all come into play. So many chronic pain patients think that their providers and their doctors say it’s in your head. Well, I always say it is in your head because this brain is telling you that you’re in the end here. Why should I see a mental health professional? Because we can help you overcome the physical sensation and the emotional responses to your pain that will lower the physical sensation? They say pain is medical. It is, but it also has a huge emotional and psychological overlay. And there are a lot of cultural factors involved in treating chronic pain. The rate of depression is five times higher among those with the general population. It’s repeatedly found to be one of the best predictors. Depression is of intensity of pain. The higher a person rates on the beck depression inventory, I can look at a beady eye and tell you what level of pain a patient is going to report to me before they tell me what level of pain that they’re at.

Is it a cause or effect? Are they depressed first or are they depressed secondarily? It doesn’t really matter. Depression causes more pain either way. Same thing with anxiety works just like depression. Clinicians often see and so to physicians, see back pain patients as angry anger is present, it exacerbates depression, it intensifies the pain and intensifies the stress. You have to report the patient, accept the patients. Report of pain, fear and avoidance is huge. But but this belief system in our brain is more disabling than the pain itself. We have to move people into an acceptance mode of their pain using ACT and DVT and allow people and help them and CBT allowing them and talking to them about catastrophizing and ending the catastrophizing phase that they’re in. That’s that pain cycle again. There is a huge relationship between catastrophizing and pain intensity. Pain causes sleeplessness, lack of intimacy is one of the highest things that pain causes somatic issues. Children act out cognitive issues, poor self-esteem kinesiophobia. Fear of movement helplessness. It strongly suggest the chronic for a chronic pain syndrome patient. With high depression and high anxiety is the biggest indicator that surgical intervention will not be successful. Harvard Mental Health newsletter put out a letter a couple of years ago in their journal that said that ninety seven percent of all spine surgery patients have the same amount or increased level of pain for years post-surgery with a depressed and highly anxious patient prior to surgery.

We want to move people from a cure me mode or cure me doctor to be an active participant. And again, that’s really what a good quality multidisciplinary pain program does is teach us someone from taking it away from the health care providers under yourself and being an active participant in healing your own body and healing your own mind, using things like mindfulness, going through an evaluation where you do a complete medical and psychiatric evaluation. Functional capacity where you see what level of mobility a patient has. Pain assessment, psychosocial testing, looking at their addiction history and nutritional assessment. And a spiritual assessment that helps guide the multidisciplinary team in treating a patient like we do at Kemah Palms Recovery. Different non medical procedures. Treatment really consists of a medically supervised detox, residential through outpatient. Medical and psychological and psychosocial and addiction treatment, individual and group therapy and a lot of family work helping people understand using these things chemical dependency, education, medication, education, psycho educational groups, biofeedback, cognitive behavioral therapy, DBT, , guided imagery, trauma work, EMDR, hypnosis, meditation, tai chi yoga, adaptive exercise. We always want people to move their bodies using yoga, tai chi, experiential therapies, equine therapy, again DBT and ACT, massage, chiropractic treatment, acupuncture, biofeedback and hypnosis, which are all things that we do at keema. And that’s what a good multidisciplinary pain program should utilize some active and passive approaches.

Providing referral sources, comprehensive pre admission evaluations, comprehensive multidisciplinary evaluations, residential rehab treatment should be about four to six weeks post detox. Using again, some of these therapeutic modalities. And Crystal, if we want an email this PowerPoint out to whomever would like it for things that I have not been able to talk about, we can certainly do that. Wonderful, because everybody’s been asking. The awareness that emerges through paying attention and mindfulness on purpose and the present moment in a non-judgmental way to the unfolding of experiencing the moment, right? That’s John Kabat-inn mindfulness based training is a key to managing your own chronic pain and teaching that to the patients with whom you work in your practice. Let me see if there’s anything else breath awareness, body scanning, there’s so much that I’m not getting to. I’m so sorry, I’ll end on this. This being human as a guesthouse every morning is a new arrival, a joy, a depression, a meanness, some momentary awareness comes from an unexpected visitor such as pain, welcome and entertain them all. Even if they’re a crowd of sorrows who violently sweep your house empty of its furniture still treat each guest honorably. He may be clearing you out for some new delight. The dark thought, the shame. They all meet them at the door laughing and let the men be grateful for whatever comes your way because each has been sent as a guide from beyond.

And so I’m so sorry that I’m out of time. But Crystal, thank you. Happy to answer any questions when you get there. Email questions. I’m happy to send this PowerPoint out, and Kemah Palms is an amazing pain program if we can help you in any way, I would love to. Maggie Chapman is one of the best pain therapists I’ve ever had. The pleasure of working with happens to be Tonya’s daughter and my niece, but she has learned from the best, I think, and we are very, very happy to be here. So thank you all. And Eric, I’m sorry if I ran a little bit in your time, so keep going. I’m still muted, I’m over here, blah blah blah. You’re good. Don’t stress it. We were going to take just a couple of questions. I’ve been kind of reviewing kind of what’s been coming in, guys. The PowerPoint is going to be sent out to everybody that’s here. Ok, so you don’t have to specifically request it or anything like that just so that, you know, because I know it’s popped up like a million times, which is great. It’s super useful information, but that will go out with the email link so everybody will get it. One question a person had asked was that they have a family member that is had spinal surgery as abusing alcohol. What steps do you suggest to acquire help? He’s become physically debilitated and recently had a heart attack and lives out of state? Yeah, absolutely.

I’m going to grab a book real quick. I’ll be right back in two seconds. I’m going to grab it on my shelf. I did a fellowship training literally 30 years ago. One of the best academic institutions in the world for working with chronic pain in a multidisciplinary way and and learned from these big, huge thick books, right, that we learn in academia and when we teach college and we’re professors. And twenty eight years later, I’m in London speaking and I run into this book in London and it’s a it’s an animated book and I read it and I sat down and I read it three times. I couldn’t stop reading it, and it was like, Oh my God, this is the best book I have ever read on chronic pain, and I’m such an idiot that I didn’t write this damn book. And I wish that I had. This isn’t the book, but it’s a similar book, but I’m going to hold it up. And it says anxiety is really strange and it’s an animated book. It’s it is just brilliant and the author is Steve Haines, and he wrote another book and it’s called Pain is really strange and it’s extremely expensive. It’s 11 dollars and you can buy it on Amazon. And I called this guy and hunted him down in London and spent half a day with him.

Just. And now we have an ongoing professional relationship. But these are two of the best books for chronic pain I have ever read in my life. And every pain patient I work with has to read these books three times before I talk to them after my first interview. And it changes their lives and they are simple. They are animated by an artist in London who is brilliant, and it just goes through all of the body and it’s just fantastic. And it is exactly what I learned in an academic program at one of the best universities in the world, simplified into an animated drawing by an artist. So Steve Haines pain is really strange and anxiety is really strange. I wrote it in the chat. For those of you that may have missed it, so that’s why that’s what I would recommend for her family member of the start. And then, of course, if that doesn’t work, then certainly you want to have an addiction assessment done and a pain assessment, and we would be, of course, willing to help with that. Yeah, you can definitely call Kemah Palms and we’re happy to help help walk you through any kind of help that you might need. So we’re going to do one more quick one and then I’m going to pass it off to Mr. McLaughlin. So I think this is an important one that I don’t want to miss.

Hopefully, I’m not cutting out. I still hear, Yeah, OK. I saw a thing pop up. It says, How do you talk to a counseling client about? About this psycho ED, without discounting their pain, whether their pain may be real or not. So this is exactly what I say is and it’s not a trick. It’s just the truth and they don’t realize what you’re doing as a clinician. But when you’re talking about their pain and they’re talking about their pain and how bad their pain is is for you to nod your head, acknowledge, say that must be awful. And then I say, gosh, that really must be causing some sleep problems. And they’re like, Oh my gosh, yes, I don’t sleep. And and your anxiety, it must be causing a ton of anxiety for you. Oh my god, it does. Yes. And you know what? It’s probably making you depressed. Oh my god. How do you know me? So yes, it’s making me depressed. And and you’re probably like angry. Frustrated. Oh my god, I am. Yes. How do you know this? And then I say, because that’s what chronic pain does. It makes your physical pain worse. And I say the way that we feel pain, physical pain is through our brain. You hurt. Yeah. But the things that make the pain worse or your nervous system and anxiety and sleeplessness and all of the things I just mentioned aggravate the nervous system, make it shake that you don’t even feel it shaking.

It’s so minimal, but it sends the pain signal up the spine 10 times faster and it amplifies the physical feeling you’re having making it worse. So if you and I can work together on some mindfulness, some meditation, some breathing, some exercising to really bring down your nervous system without medications, I promise you your pain level is going to come down. It’s brilliant and it’s not rocket science, but it just works. Well, thank you. For more information on the treatment of chronic pain at Kemah Palms Recovery, please call eight six six six zero four one eight seven three. And without further ado, I want to introduce you to Mr. Eric McLaughlin somewhere in the background in Hawaii. I know owners of Intervention 911 communities in Palm Springs. Hey, everyone, it’s really an honor to be here. Tonda mentioned, as we were preparing for this, that she has been wanting to do this for almost a year now and I feel very honored to be thought of as a professional in the field who could hopefully bring some good information to you guys. We’re really excited for the presentation. We love the work that Kemah Palms does, as well as all the professionals and always wonderful to hear from Dr. Flowers, the CEO and owner of Ken Seeley Communities and Intervention 911. We have a really strong family focus that’s informed by our intervention work, and that is kind of our specialty working with families.

If you have a family that you think, whoa, they’re not going to make it, there’s no chance for them to get going. We’re the place for you. We have a family integration model that starts at day one of treatment in which we view the family as the client. And that is echoed in kind of what Lauren was talking about with regards to our intervention trainings. We use that philosophy to underscore everything we do, always with a trauma informed approach, and we’ll talk today a little bit about the trauma egg process all our clients get to do and why that’s so valuable and how that integrates with that family approach in such a meaningful way. We’re located in Palm Springs, California. We’re in network with Aetna and Anthem, as well as several other smaller providers, and we’d love to be able to help you. And again, if you have that family that is really been kind of hit by addiction and needs more support than just getting their loved one to treatment, where the place for you? Thanks. Eric McLaughlin, CEO at Intervention, 9-1-1 is now going to present on the trauma egg. Hey, everybody, so my name is Erin McLaughlin. As I mentioned, I, one of the owners of Ken Seeley Communities and Intervention 9-1-1 and also working towards my licensure as a social worker. So after many years of being in recovery and working with people in recovery, I made a decision to investigate kind of how I could better serve the population we work with by developing my clinical skills.

And I had a really wonderful and amazing experience in school learning how to be a social worker with an emphasis on mental health issues and drugs and alcohol. But one thing school kind of significantly underrepresented was the impact of trauma, particularly in the field of substance abuse, mental health. And as we could see from Dr. Flowers, this amazing presentation pain. And we’ll talk a little bit about some of the way in which pain can influence can be influenced by the onset of trauma, whether that’s childhood trauma or whether that’s being in a car accident and why that kind of pulling that thing apart. That pain piece of art can be so challenging. And when he talks about increases in anxiety and depression as a result of pain, when you start to think about them as a complete picture, it makes a lot of sense. So thank you for a fantastic, fantastic lead-in. I would like to remind everyone because we are seeing this. The YouTube of the presentation will be available and I will send my presentation to Crystal so that she can share that with you. And you can get that. Thank you. You’re welcome. I’ll probably repeat it two or three times. So don’t worry, you will get all this great information.

So, you know, one thing I wanted to do is, first of all, thank some people who have been instrumental in my experience with trauma, and that would be Judy Crane from the Guest House, who has started a program for professionals and therapists who want to be more experienced in dealing with trauma. And she kind of tricks you and she tricks you by making you do your own work as you learn about different modalities for treating trauma. And so we’re going to talk today about the trauma egg as one of those modalities and a lot of what I learned was from her. The other person I learned a lot for was my husband and business partner, Ken. He has been instrumental in working with our therapeutic team to deliver the trauma experience to our clients. And one of the things I want to touch on in today’s presentation is exactly how how we do that as a clinician or a trauma professional, how do we look at the trauma eg as an opportunity to push someone’s recovery forward? And then how is that? How is that work with the family? How can we take those things and use that to examine the family system? We’re a big proponent of looking at addiction and mental health issues as a system oriented approach, and we look at that family system and that could be family of origin, family of choice, work, family, social family.

But we really take a very holistic and systems approach, and using the trauma can be very effective at better understanding family functioning. So the two things I want you to be thinking about as we go through this is how can I work with people who’ve experienced trauma using this device? And then how can I apply that to the system that they might come from and understand better how I can support that system in the healing and recovery process? So we’ll go ahead and share the screen. Give me one second. We’ll get back on. All right. So, you know, kind of looking at the trauma, Ken Seeley and how we do cracking down on trauma, one egg at a time that was through thank you for that cute title. And the idea kind of with the trauma egg is we’re going to take a little journey on what is trauma. And many of you are familiar with trauma and understand trauma. But I want to kind of give an insight as to kind of how we frame what trauma may be, because that’s an important piece of being able to utilize the trauma with clients. You will get many clients who say, I don’t really have any trauma. I was one of those and you will get many people who feel overwhelmed by their trauma and can’t begin to even process it.

And then you’ll get many people who want to dove right in and think, Oh my God, this is. I’ve been waiting to talk to someone about the path that brought me here and how it’s informed my life, right? So trauma can be defined as a deeply disturbing or distressing experience. And like with chronic pain and with pain, people experience things in all different sorts of ways. So what might be traumatic for me may not be traumatic or maybe processed in a different way than someone else. So two people can be in a car crash and two people can have different relationships to that experience. It can be the impetus the traumatic kind of event that launches substance use as a coping strategy to deal with kind of the the symptoms of that car accident. Or it can be something that someone in a very healthy way is able to process and kind of move through and not be impacted with. So like with pain, we don’t take the approach that your trauma is wrong or right. What we do is we take the approach is look back at your life and tell me what experiences changed your feelings. When did you feel distressed? When did you feel disturbed? When did you feel unsafe? When did you feel neglected? And again, we have to be mindful not to judge those experiences and say, Huh, that doesn’t seem traumatic because we have to think about our own system for being able to do those.

And I’m going to give you a brief example. So, you know, I mentioned, you know, we talk about trauma and everybody can kind of identify with with the big T. What we call the big trauma being in war, experiencing a fire, having a car crash, watching someone overdose or die. And you know, one of the things that Dr. Flowers was talking about was that the rate of overdose that we’re experiencing and and inherent in substance use is, I believe, an increased exposure to trauma. How can people who use substances often find themselves in situations where they may be more prone to traumatic things happening, such as overdose? And that can be something to consider. There could be pre substance use trauma and post trumps substance use trauma, and we’ll talk a little bit more about that. But there’s also what we call little PT trauma, and little PT trauma is any time you may have felt unsafe, you might have felt distressed and think of all the times you might have felt unsafe or distressed in your life. That’s a lot of times, right? You know, can often speaks about as a child, having the perfect parents, you know, and having no trauma. And as he started to do this work, what he understood was that growing up there was a lot of bullying that he experienced and slowly every day over time, year after year, going to school and kind of being afraid of what might happen develops.

Is that a trauma experience? Picture that person who’s at war and every morning they wake up? Am I going to have to kill someone today? Am I going to be killed? That constant kind of fear can be can can put us into our non verbal kind of reptilian brain, the amygdala where our fight or flight is and that can flood our system. And we’ll talk a little bit about the brain response, but an example of trauma. And I was thinking about this as I woke up at three a.m. this morning worried about the presentation. Oh, my god, is it going to go well? Am I going to be able to appear educated and professional? And, you know, all of these things and I was thinking about, you know, where does that come from? Why do I have that and was reflecting back on my trauma egg and realize? That I have this very specific memory of being in seventh grade and, you know, one of the one of the ways in which me and my father connected when I was young, there weren’t many. But one of the ways we connected was through stamp collecting. He was an avid stamp collector and kind of encouraged and supported me in doing that with him. And it was it was kind of a thing where, you know, he he was he was much more involved in this than I was, but he kind of brought me along.

So it was something I felt special about with stamp collecting. I felt I felt selected seeing I felt important because it was something important to my dad and he included me of that. So my relationship to stamp collecting was I took a lot of pride in it. I took a lot of happiness in it, and I didn’t realize it was kind of geeky from the perspective of other seventh graders. And so what happened was is in seventh grade, I went to a new high school in which many of the kids who I went to grade school with and were in my neighborhood did not go to. So I was kind of knew I was struggling to make friends. I was dealing at that time with the concept of fitting in. So I was kind of hyper vigilant. I was worried about is my body giving me away? Do people know I’m anxious? Can people see I’m gay? I started to have those thoughts. You know, will people like me? Am I smart enough to be here? I went to a high school that had a lot of gifted students in it, and I was fortunate to get put in those classes, but I never felt like I should be in those classes. So I was kind of in this state of hypervigilance.

And so we in seventh grade had to present on a hobby that we had. And so I said, Well, I’m going to present on stamp collecting. And I didn’t have much experience with doing presentations at that time. I was, you know, it first through six. You don’t do a lot of presentations. And my my peer group in first through six was people I grew up with in my neighborhood. I spent time with them after school and I wasn’t nervous. So I was very, very nervous for this presentation, like horribly nervous. And so I kind of collected myself and we’ll pretend that and I apologize. I don’t have a fancy background. We just moved and I didn’t want to cause anyone trauma by showing you the beautiful Hawaii background and all the warm weather we’ve been having. For those of you in Texas who’ve had during the past two weeks. So I’m using my office but pretend that this is a chalkboard back here. And so, you know, stamps, they come in really large size sheets. And so I picked what I thought was the most interesting sheets. And, you know, I was starting to experience a physical reaction. As I was sitting in class, I was starting to get sweaty palms. I could feel a little tightness in my chest. I got that sick feeling in my gut and that was my anxiety around presented right and I didn’t have a word for it.

I started to sweat. I was wearing a wrong shirt. I could see the sweat thing starting in my armpits and I. I was horrified that I was going to have to stand up in front of the class. All the cool kids were talking about travel. We are very middle class. Our travel was to New Hampshire to go, look at the forest and then drive back home in the same day. And actually, we did have really good vacations as a kid. But up to that point, my perception was I was missing out on all what these rich kids were getting. And, you know, they talked about travel, they talked about sports. I was as uncoordinated as they come. It was a point of contention for me. They talked about all these really cool hobbies, and I started to feel shame that I like stamp collecting. So I went up to the board and I had my little sheet and I started talking and my voice sounded like this. And as I put the stamps up, my hand was shaking. I was having a physical anxiety response and I kept trying to put the stamps onto the board. I got I got a good thing. There’s a ledge on the chalkboard and if I can, if I can put it on there, I won’t have to hold it and I can put my hands on the table in front of me.

So I put it on the chalkboard and it fell off. So then I had to bend over in front of everyone. I picked it up again, shaking. I could hear some chuckles in the class. I put it up on the chalkboard. It fell over again. So my first experience as a public speaker was awful. It was awful, but it wasn’t what most people would consider a big trauma. But what I realized this morning is that has informed my unconscious response. That happens every time I present, I have a trauma response. My palms get sweaty, I get a sick feeling and my crazy brain starts to think, you’re not good enough, you can’t do this, you’re going to disappoint. People are not going to think well about you. And the good thing is, now I have years of experience seeing the flip side of that. Ok, Eric, I can use my CBT skills. You can, you can. You can see, is this a realistic? Is this kind of a real response to be having? No, you’ve gotten good feedback on doing presentations. You’re you’re you can put two sentences together. You can present helpful information. You’re OK. So I have a coping strategy that’s much better than the anxiety. But what I’m experiencing is actually a trauma response. The patterns and the the the the storing of that trauma, that fight or flight, that what are we going to do? Kind of thing pops up every time I have to present.

It is like clockwork. It happens all the time. And so part of what we want to talk about is being mindful of that, but also kind of noticing what are the patterns that come up as someone is discussing the trauma and we’ll talk about that in just a second. So a little bit about kind of what does happen with trauma. And we’re kind of looking at this in a childhood trauma. But trauma is a lifelong experience. Trauma can happen at any point along the developmental process. And if you’re not familiar with the ACE study ace study, add adverse childhood effects. Please take a look at that. It can really kind of give you insight as to how people’s development can be impacted and result in all sorts of issues that come up for people. But I would really want to kind of point point out kind of talking about the three centers of the brain, the amygdala, which is kind of the reptilian center, the fear center, the fight or flight, the thing that protects us in our lives, which we don’t even have to think about the things that happen automatically. A lot of trauma response creates an overactive amygdala, which means that your body is flooding with hormones with stress hormones and your body is in a constant state of hyper vigilance. And what happens is that can become the dominating thing that happens any time we’re confronted with a fight, flight or flight.

So we may not have access to the under activated pieces of the brain, which develop with executive functioning and emotions and feeling. So this can be a real challenging thing, and it’s a lot of times why people talk about experiential and non talk therapy as a way to mitigate trauma for people. When we are in our amygdala and in our reptilian brain, it is not. There’s not a rational kind of thought there. It’s not a word based approach. It’s not a cognitive functioning. It transcends language. It’s it’s it’s a it transcends the active consciousness that we would expect out of an adult who is functioning and able to process things in a normal way. Trauma can impact depression, anxiety. It can be co-occurring when it when there is a pain issue. That trauma can can cause some of what Dr. Flowers was talking about in terms of kind of almost like intensifying the pain and creating more pain and perception of more pain in people. So, you know, it’s very, you know, I always take the approach and this is something that I learned from Judy is is is we’re not looking to we’re not looking to kind of necessarily say to to figure out kind of what causes the trauma. What we’re trying more to do is talk about how do we change the way in which we respond to similar events now than we did when we were traumatized, right? We can understand where the trauma came from.

We can tell the story right. We can look at. I was a young kid. I grew up in a two parent household. I was provided for. I didn’t suffer from feeling neglect what I would, what I would describe as neglect. I had a traumatic experience at 13, losing my father. He died of a heart attack in front, not in front of me, but I witnessed kind of my mother performing CPR on him. And my response was to disassociate, right? You can have a lot of losses as a result of the trauma. You can have a loss of self-worth. A loss of sense of self, a loss of physical connectedness to the body, a loss of intimacy, a loss of trust, a loss of danger, cues in a loss of safety and for me as that 13 year old, I really developed a disconnect between kind of emotional understanding as well as physical understanding. I kind of locked into that and there’s a great book. Crystal, I’ll make sure she has the title, but the body knows the score. By Russell, I’m sorry by Bessel van der the body keeps the score. Sorry by Bessel van der Clock. And what that states is that that trauma lives on in the body it lives on in the neural pathways that are developed in the brain. It lives in the effect of our stress response and how that impacts our body and functioning.

It can create pain. It can create tightness. It can create that, that that feeling in your gut. And there’s a lot of studies that show that an approach to treating trauma that allows for the unlocking of that unconscious response and multiple pathways to kind of experience or to re-experience or to release that are very powerful yoga, massage, somatic experience, experiential activities like the trauma eg. Those are all really good ways to deal with trauma. So. So onto the trauma. So Marilyn Murray had kind of a kind of an overarching sense of the role of trauma in human beings well-being. And it wasn’t a substance abuse approach, but it was an approach that kind of lent itself to looking at what has happened in our life and then what were the ways in which we responded to it? How did we cope with it? What were the strategies we put in place? Because oftentimes we an individual who experiences trauma, doesn’t have the coping strategies or the ability to process or deal with that in a healthy way. Maybe they have low resilience as a result of a high ace score. Maybe their resilience hasn’t developed. Maybe they’re protective. Factors aren’t there for them. So there’s lots of different ways. I know this is a little blurry on your screen and I’m going to send this attachment. So for those of you who are requesting the presentations, this attachment will be separate.

Included in that, but this is kind of what we we give to our clients so that they can begin the process of developing and creating the trauma egg. And so, you know, when do we do a trauma egg? Obviously, we want our clients to be somewhat stable, meaning that we want them to be detoxed. We want them to be engaging in recovery. We want them to be working with therapists, working with a case manager, working with a family advocate. And what we what we see a lot of is that people who come for mental health and substance abuse issues have a difficult time with emotional regulation. They’re oftentimes dysregulated. They don’t have a lot of skills for coping with now that drugs and alcohol become their coping skills, right? That’s a huge coping skill. And that’s why there’s such a significant tie to trauma as a contributing factor to substance abuse. You know, we can look and try and figure out where did this come from? Why? Why is Bobby abusing drugs and alcohol? And and I think that this is even a fair, fair way to look at those people who who transition from or who are prescribed medications and are more susceptible to trauma can make us more vulnerable to reaching for things that make us feel better because we’re constantly in a state of emotional dysregulation. And I think that’s a human experience.

I don’t think that that’s necessarily you have to have trauma to experience that. But when we look at trauma through the lens of any time you felt unsafe, any time you felt, any time you felt a disconnect or fear that can give us that can that can that can bind us in that kind of experience of what it’s like to be human. That’s a natural feeling for most people to feel. I have a hard I haven’t met many people who haven’t experienced something that that I think would qualify for trauma. So a couple of people ask, Is the Judy I’m referencing? Her name is Judy Crane. She has a facility down in Florida called the Guest House. She’s been a leader in trauma work for many years, and I’ve been very fortunate to do some training with her on becoming a certified trauma therapist. So developing tools to work with people in trauma, understanding trauma and how to do that. And so the trauma is kind of five different steps or clusters. What you do is you provide a piece of paper, you provide colored markers, color crayons. I will say there’s no there’s I want to say there’s no wrong way to do it from an egg. But there are certain things that you want to communicate as being integral to the traumatic process. So what we look at is, again, going back to our family approach that we use at KFC is we want to understand kind of the family system and family functioning because that will play an important role into future growth and future development of coping skills and coping strategies.

So what are the family roles? What are the unspoken rules or messages? So an unspoken rule or message. And if my mom, my aunt, my sister here, it’s great to see you. Thanks for being here to support me. If you’re not here and watching on the rewind, hello. But they focus primarily on unspoken rules, and one of the unspoken rules in my house was We have to appear good, right? No matter what’s going on, we want to. We want to be educated, we want to be financially secure, we want to be respectful. And that was a rule that my family had. We also want to take a look at family roles. What was your family role? Mine was a little bit the peacekeeper. I wanted to make everybody or the mascot is sometimes the term that’s used. I wanted to make everyone happy. I wanted to make. I wanted to smooth things over. I wanted to diffuse any tension. And this particularly became an issue when after my father died, you know, kind of with my mother and my sister, they struggled at times to get along. And that was very distressing to me, right? So my my goal was, how do I fix this? How do I fix this? How do I fix this? How do I keep everything levity and kind of how I’ve developed kind of a sense of humor as a first line defense to any stressful situation? My first thing is, how can I make someone laugh, you know, rather than kind of look inward in the bottom two corners, we want to put in kind of what our our paternal role caregiver was or.

And then in the right hand corner are, what are some characteristics of our maternal caregiver? So for some people, they didn’t grow up with a mom or dad, but they may have had someone who functioned in this role and just kind of words to describe their personality, and you want them to include both positive and negative. This is a key piece and insight again into the family functioning what we can see when we talk about trauma. We talk about the trans generational transmission or intergenerational transmission. And and it’s really a big kind of thing when you, you know, for those of you who’ve ever done genograms, you know, as an interventionist and as a as a family therapist and as someone who values the family systems. genograms can kind of unlock patterns within family systems that are, you know, that go beyond kind of the initial or nuclear family system grandparents, great grandparents, great great grandparents. And what we can see when we look at that is we can see the trauma history throughout the family system.

So when we look at the roles that mom and dad play, we do that with an eye towards how did they how, how, how suitable, how resilient, what perfect protective factors do they have in place to either prevent trauma, further trauma to to ignore trauma or. And I don’t mean this. I don’t want to take this in a wrong way or to facilitate even more trauma. And a lot of times trauma can be. Again, we talked about how a person receives something, and a lot of times caregivers have been traumatized themselves, and they don’t know how to do something that isn’t transmitting that trauma further. So we can gain some really good insight as to the perception of the person doing the trauma as to how their primary caregivers were. And then we get to the kind of the meat and the potatoes of the trauma egg, and that’s what goes on the inside. So if you remember earlier I talked a little bit about, I talked a little bit about what what the the kind of unconscious and nonverbal kind of piece the amygdala plays that fight or flight, that trauma response that many people have. The idea of using pictures is to kind of tap into that kind of nonverbal functioning in the brain and and to kind of unlock kind of some of the memories that you remember. I talked about a loss of ability sometimes to be connected.

A loss of memory can be a piece, and the drawing is hopefully gives them some tools to be able. To unlock that and you start from the bottom of the egg up and what you do is you put your earliest memories in which you felt distressed, which you felt unsafe, which you were hurt, which there was physical harm. Maybe there was sexual abuse. Maybe there was an unwanted, unwanted. You were unwanted. You did not want to participate in something and you were forced to participate in that. You can even include pre-birth events, kind of at the bottom below the egg. And one of the interesting things that I learned is I went through my trauma egg as well as my DNA as part of my own personal work and recovery and things that we do as kind of interventionists and family therapist is. I learned that there was a lot of financial stress in my family. In particular when I was being born, my mom had a lot of fear about, and I hope you don’t mind that I’m sharing all this. So she’s a wonderful woman and she was an amazing mom. She took really good care of me and my sister. And there was a lot of financial stress leading up to my birth, wondering How am I going to survive? I’m not working. I’m totally reliant on this other person. We have totally different ideas about money and how that should be used and managed.

So there was a lot of financial stress, and that was kind of a pattern that existed in a multigenerational family system of immigrant families kind of having no resources living through the depression. Do you talk about money? Do you not talk about money? And those things were repeating themes that repeated in my family’s system. We struggled a lot after my father died financially. I was horrified to think that my family qualify for food stamps. And thank God we did. At that time, you know, my mom made a really great decision to go back. She was my mom is like the smartest person I know, and what she did was she realized I’ve lost my husband. I have two young kids there. I want them to go to college. I need to support them. She was a nurse at the time she worked. The overnight she was a head RN, very successful. And she said to herself, You know, I’m going to have to do something different where I can support my family myself. And at 40, I think forty two or forty three years old, she went back to law school, you know, and she graduated to become a lawyer. She worked at some really amazing, top notch law firms, doing really amazing work as a lawyer, very successful second career, you know, and that resiliency that she had, some of that was a result of the trauma she experienced as a kid, and she helped me develop many protective factors to be able to kind of move forward in my own life, which is just been amazing.

So that again, that intergenerational looking at pre birth, what was going on kind of as you were born and then you level up, you go from maybe zero to three years, three years to six years, six years to 10 years, and you kind of put picture representations of what that trauma was. And again, it’s always what that trauma was to you. So you can see here some more kind of some of those pieces. You know, what is something you heard a lot growing up? What were family boundaries like a family rules, family rules and then kind of the details of what happens in the act? You know, any event that was traumatic, abusive, involved in band of abandonment or you felt or were powerless, that’s a really powerful one for people where they felt powerless, and it doesn’t mean that they had a terrible outcome. It doesn’t mean that something ended up badly, but that and that moment feeling powerless. What was that for? And you want to get a really good context of as much as they can remember. In my own personal experience with the trauma is that I had my first draft or my first run through was significantly lacking in multiple things. One of the I had finished the trauma egg and again was kind of dialing back to that presentation.

And I remembered kind of that concern about when others, when others, when I might be judged by others and I remember I’ll use the term, it flooded back to me almost literally in second grade, the teacher had said, You know, I’m going to be teaching now. There are going to be no more questions or interruptions from anyone. And my family rule was, you are respectful of adults. You excel in school and you don’t cause problems. So as she was lecturing in the second grade. I had to go to the bathroom, and so I sat there and I wrestled with the fact, do I tell her, do I get up and go, do I raise my hand? And what kept playing for me was that unconscious family message of, We respect our teachers. We don’t cause problems. We do what we’re told. And what she told us was to stay seated. And sure enough, about 20 minutes into that lecture, I wet my pants. I was mortified, horrified. In fact, to this day, I don’t remember exactly what happened. I remember ending up in the nurse’s station. I think they called my mom. I think I got a change of clothes or left home early. I can’t really remember what happened after that, but that feeling of horror of, Oh my god, I’m disappointing everyone. I’m disappointing the family. And now I’m vulnerable because I’ve done something that’s eight year old boys.

Don’t do, you don’t pee your pants. So a lot of shame and guilt and and you know, that’s informed that kind of feeling of, I get anxious, I get nervous still today when I don’t feel 100 percent confident in bringing something up or bringing something forward. And it’s interesting to see how after doing that trauma egg that’s informing Crystal, do we have a question? We’ve had a few pop up. I’ve made some notes, but I was just giving you a 10 minute warning. All right, perfect. We’re right on time. Awesome. So now what? I think what I feel could be most beneficial is is what do you do? Oh, here we have some trauma eggs. These are some clients and you can see across the trauma eggs the differences in the way people present that, you know, a lot of them use the shape. Someone did a more structured analysis, you know, with their pictures, that middle one is tense. And, you know, he is very open about his, his own family history and how those things impacted him. And then but you can see the ones on the right and the left have a different style, you know, the use of colors. And there’s a lot of it’s really fun to see how people take this on. And some people even go beyond doing an egg. They use different shapes. I’ve seen people use crosses.

I’ve seen people use coffins, all different types of shapes, and we want to encourage creativity. The one thing we don’t allow is for people to use words and right. We would send someone back to the drawing board. We really want them to tap into that visual kind of medium. So these are some sample trauma eggs. Just a brief reminder for those of you who may not have been listening, we will share this presentation. Krystle will send it out and you will have the directions to the trauma egg that we can send to you as an attachment. So, you know, how do we use the trauma eggs to help our clients? And I’ve talked a little bit about unlocking some insight into family functioning. But one thing is we got to remember that this person is sharing with them their experiences and what what we don’t want to do is revel in the actual experience. What we want to hear is how did they respond. If someone ends up at our treatment center, it’s a good chance that they have a significant drug and alcohol issue or a significant mental health issue. And if they’ve used drugs and alcohol as a coping strategy for the pain, for the emptiness, for the hurt, for the disappointment that they feel as a result of an underlying trauma, they’ve been very successful at coping with that pain. Many, many people who experience trauma end up killing themselves because they don’t have a way to cope with that pain, and drugs and alcohol are a very accessible, very there’s no, you know, when people use that as a solution, I can understand why it becomes difficult to stop using drugs and alcohol when when your only relief from what you’re feeling and you don’t even know what’s causing that feeling, imagine blacking out a memory that’s stored in your amygdala that doesn’t have words that’s flooding your body with stress hormones every time you see something related to that event, but you don’t know it’s related to that event.

Imagine how distressing that would feel. And then you take a sip of beer or you smoke a joint or you are given a pain pill. Imagine the relief that comes from feeling that. And so what happens is people develop a hustle or a response to deal with that underlying emotional issue. And that’s really what we’re looking for. What are the coping strategies? What are the skills, what are the things that they’ve put in place? And this is really when I talked about learning from Judy. This is where I’ve really learned from Ken is he’s super, super perceptive at this and he’s learned to be able to listen to the story and identify the underlying themes that are popping up. Where are the scenes? Where are the coping strategies, where are the behaviors coming into place? And then how can we develop an awareness of our own emotional state when we’re dysregulated and then use those coping strategies, but in a healthier manner? That’s more recovery oriented, right? And Dr.

Flowers talked about all those really great interventions, from mindfulness to CBT skill development to DVT skills to emotional regulation. All of those things are things that we would want to provide our clients in an effort to kind of come up with new coping strategies. But what I find is that people who are who make it through to the doorway to recovery are already already imbued with resilience. They found a way to survive, and it may not always been the best way to survive now that they have an awareness of of what they did and and maybe how that hasn’t been as healthy as possible, but the fact that they survived is a testament. I watch these trauma eggs and I get so. So overwhelmed when I look at what people have endured and the fact that they’re here today means that they have all the tools already, and what I’m giving them is just additional tools. What I’m giving them is, you know, additional ways to to be able to kind of continue to work. But they’ve already got it. And that’s that hustle. And, you know, sometimes people say, how can you use your powers for good? I don’t want to create more trauma. You know, I often worry when I mention Ken that that he likes me to say things a certain way.

So this could be traumatic for me and putting it in the middle of my presentation. But no, I mean, what did you say? Yeah, no. I love it when you’re talking about because the trauma that people go through is when you lose the genogram and you do the trauma egg you’re able to see. We just did a training this past weekend and Caroline Smith, that’s part of our trainings. She had a picture of a tree with a beautiful house on top of, you know, on this property and underneath it was all the roots. And so that was all the family’s hustle, their traumatic experiences that are brought up to their offspring’s. And so when you do a trauma, you’re able to see that hustle like mine, that hustle and that hustle has been rooted in their family tree for so many generations that that’s the problem. And everybody, when they go to treatment, it’s the identified person’s problem. It’s the identified person’s problem. But in all reality, it’s a family system problem. One hundred percent. And that’s what I love about what Eric’s been doing in our treatment center. Every Tuesday, he does a family group therapy session where the family gets into treatment because the trauma is so intense with the identified person. But the family members had their trauma, and if we could treat the whole family, then we’re we’re making headway in creating a safer and a healthier environment for the system instead of just the individual.

Yeah, it’s it’s going on and you kind of already did. The last slide, which is gaining clinician takeaway is, you know, we have the case manager, we have the therapist we have can we’ll have the family advocate all sit in on the trauma egg and even we’ll invite the family to participate if that’s appropriate. And it is such a gift to that system and to be able to kind of take a multidisciplinary approach across different ways to ensure that we’re being trauma informed. We’re treating them with care and respect, but we’re also challenging them to find new ways of functioning is is really important. And my family session on Tuesdays at five p.m. Pacific is open to everybody. You do not have to be a family at KSC to participate, but so we’d love to see you there. I’ll get Krystle the information on that and I’d love to. I just have a little bit one more slide for some. Oh, just talk about the family approach, from intervention to treatment to aftercare the trauma informed piece in that please kind of keep that in mind. You know, our our motto is, you know, be clear, it’s a year and we involve the family system from the start. So any time we get to partner with other individuals who are providing great care, we love to do that. And here’s some contact information for me, and I’m sure Krista will share that and would love to leave a little bit of time for some questions.

Yeah, thank you. I haven’t got to I know that a tornado is more familiar with your trauma stuff and has told me how amazing it is, but I haven’t personally got to see it, so it was very interesting. I did write down a couple of questions. There were several different ones that popped up, but I wrote down a couple that I thought were maybe important. So someone said, Can you clarify something is suggesting that a missed care, that miscarriages are consequences and results of trauma? Like, is it is that OK? I guess they’re saying, is that OK? Yeah, I don’t know that I would say that a miscarriage is a result or cause of trauma, although significant trauma can lead to health issues. But for sure, having a miscarriage could be perceived by the person as a traumatic experience that impacts them. So for sure. Someone also asked how to get more. I thought this was really important because I think a lot of people want to know this if they how they could get more information on the trauma eg. Yeah. So there’s a lot of good resources online. You can also call me where trying we’ve been. We’ve been thinking, you know, for professionals who work in the field, oftentimes we become the helper and we can still benefit from the help.

So we’re coordinating with Lauren and Caroline about how we might be able to offer this to professionals kind of in a six week rolling course. But certainly, you know, you can reach out and find a certified trauma therapist or certified trauma professional who may be able to help you kind of experience that. You know, it’s by no means a be all and end all to resolving trauma, but the windows that it opens an insight that you gain can be unbelievable, even just watching one, not even doing it yourself. Yeah. And then we’ll do this one more that I think is super important. They asked, Is the trauma done individually? Can it be done in a group? And then about how long does it take to complete? Yeah, that’s a great question. And Ross, who just put something in the chat we see you. Don’t worry, everyone will get a copy of this presentation. Dr. Flowers presentation our contact information. I get sit. I’m going to send it to everybody. If you if you signed up, you’re going to get the keys to. It’s just a wonderful thing. So they take care of everything. So thank you, Crystal. Yeah, we I believe I’m a big fan of group therapy and this was thank you for asking that because it is one thing I left out. We always do them in a group setting. And the reason for that is because what that offers an opportunity is it’s kind of like that two way dynamic that happens in group therapy one the the participant or witness to the trauma eg can give you.

Some can give the person who’s doing the trauma, eg some feedback. Wow. I really identified with how you dealt with when you were sexually abused because I was sexually abused, too. So there can be some connection, there could be some shame reduction. All of those things can can be a benefit. The other thing is is that it can it can really kind of open up a discussion about some really difficult or painful things that people often are shy about talking about and whether that’s because they feel that they’re the only one or they feel that it’s not appropriate. It gives permission for some really to dig deep and allow people to feel confident in bringing that stuff up. We always do them in group setting. Anything else to add on the group dynamic and the feedback the feedback that the individual gets from their peers is so powerful. So yeah, that’s a really good question. I don’t I don’t really agree in doing them alone with one on one with someone. I think the group is really the only way to get the fullest out of what the experience could be for the individual. Thank you, Richard. Thank you. Thank you again to Dr. James Flowers and Eric McLaughlin for this amazing continuing education presentation. If you would like to be added to our CSU emailing list, please email CSU at Kemah Palms. Thank you for tuning in, and don’t forget to hit that subscribe button. See you again soon.