Trauma Bonds in Residential Treatment Settings

One of the most common obstacles to the treatment process of those struggling with addiction is the trauma bonding that occurs within the treatment process.  This process can have many different scenarios; simply the forming of an exclusive relationship within the treatment process can be grounds for trauma bonding.  Trauma bonds by definition comprise of dysfunctional attachments occurring in the presence of danger, shame and exploitation.  The exploitation of the vulnerable population tends to be the breeding grounds for trauma bonds, it is safe to say that residential treatment settings comprise of a vulnerable population, some of which for the first time are experiencing separation from the conflictual relationship of their addiction, yearning to seek self regulation with a replacement.  Often noted in an addiction interaction disorder, addicts will replace one addiction for another with majority of the similar emotional and behavioral features.  This can be presented as the addict replacing the substance use for the forming of an addictive relationship in the treatment setting, often a dysfunctional attachment that to the addict continues to receive chemical responses to their neurobiology, much like addiction where fantasy of the relationship and bond provides chemical changes to the brain.   The addict remains conscious of omitting the primary compulsive behaviors presenting as the catalyst to engage in the treatment setting.  I reference primary as the primary substance abuse issue is often what has addicts coming to chemically dependent treatment settings that have the addict remaining in delusion that simply abstinence from their “drug of choice” will provide them with the means to receive the appropriate treatment needed to sustain recovery post treatment.  The truth of the matter is that addicts that form trauma bonds within the treatment setting are simply responding out of a trauma response to the withdrawal of their primary love relationship with addiction and replacing it with another.  Addicts will go to many risks, often risking discharge from treatment settings that have strong boundaries around forming such inappropriate relationships.  In my ten years of experience working in a residential treatment setting, I have witnessed patients, choosing to trauma bond and form high risk relationships in treatment settings, only to be discharged causing them the loss of employment, their marriage and family.  This aligns with the presenting symptom of trauma bonds which has individuals in these patterns continually seeking individuals who they will know to cause them further loss and pain.  This motivation is rarely conscious but consciousness is problematic as it breaks the denial process.  Other presenting symptoms of trauma bonds are:

• Obsessing about the exclusive relationship formed in the treatment process, even if they have left the treatment facility and continuing to contact them
• Continuing to seek contact with this individual knowing that it will disrupt the treatment process
• Going “overboard” to be helpful and in contact with this individual during treatment.
• Continuing attempts to get this individuals attention even when the are clearly using you
• Trusting this individual even though they prove to be unreliable
• When you believe that this is the only one who understands you
• When you are unable to retreat from this unhealthy relationship (most times clearly not seeing it as unhealthy, even after being confronted by peers and staff of the treatment center)
• When you choose to stay in an exclusive relationship with this individual even though it would cost nothing to the individual to detach from the relationship.
• When you keep secrets, pass notes or go “underground” to maintain connection of the relationship when told to stay away from one another

These are just a few of many symptoms that arise in the presence of trauma bonds in treatment settings.  Many treatment settings have various protocols that can be seen as clinical strategies to address trauma bonds, these can look like:

• No contact contracts signed with clear consequences for breaking the contract
• Teaching strategies for detachment (boundary setting etc.)
• Group process designed to provide perspective
• Teaching concepts of bonds, attachment and systemic repetition
• Explore the pay-offs of the bond
• Disrupt the beliefs, impaired thinking and cognitive distortion around  the “uniqueness” of the relationship
• Support grief through ritualization around change

To conclude, it is imperative to have a protocol around this type of dysfunctional bonding in the treatment process, having the clinical team all informed of the symptoms of these types of bonds, how to address them and clinical strategies around treatment for trauma bonding are necessary for the patients as well as the health of the environment needed in the treatment facility to facilitate effective treatment of addiction and trauma.

Mike Quarress CSAT