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In Episode 9 of our ASAM Criteria Unplugged series, we invited Dr. Michael D. McGee to discuss the need and benefits of trauma-integrated addictions treatment. Check out the highlight video below:
About special guest, Dr. Michael D. McGee
Dr. McGee received his M.D. from Stanford University School of medicine and completed his residency in psychiatry at Harvard Medical School. He is Board Certified in General Psychiatry, Addiction Psychiatry, and Psychosomatic Medicine.
Dr. McGee has directed several treatment programs, participated in government-funded outcomes research, and has published in the areas of spirituality, addictions, and clinical treatment. He provides consultation and training nationally on best practices in treatment and in cultivating clinical excellence. Dr. McGee is the author of the multi-award-winning The Joy of Recovery, and 101 Things You Need to Know if You’re Addicted to Painkillers.
Sitting down with The Change Companies Chief Program Officer Valerie Bagley and Train for Change Senior National Director Scott Boyles, Dr. McGee shares his perspective on trauma-integrated treatment in the context of addiction recovery.
Q: What is trauma? How do different types of trauma impact psychiatric conditions and addiction?
Dr. McGee: Trauma, in the context of addiction treatment, can be defined as any harmful or wounding event, biologically, neurologically, or psychologically, that has lasting negative consequences. Trauma doesn’t just include severe events like combat trauma or sexual assault; it also encompasses more subtle, chronic experiences, such as emotional neglect, social exclusion, sociocultural trauma, bullying, harassment and oppression.
Trauma exists on a spectrum from mild to severe. Severe traumas, like natural disasters or physical abuse, are obvious. However, there are also "little t" traumas—subtle yet impactful experiences like neglect or feeling socially excluded. Trauma is universal, and it manifests in various ways, including psychological, sociocultural and interpersonal harm. I’ve come to realize that even if trauma isn’t the direct cause of a psychiatric condition or addiction, living with these conditions can be traumatizing in itself. In essence, trauma and psychiatric conditions are deeply interconnected.
I like to think about trauma as having two broad categories, one being destruction and the other being deprivation. And so neglect and deprivation are also harmful, especially during early childhood development. Over time, I've come to see trauma as a root cause of psychiatric conditions like depression, anxiety and especially addiction.
Here’s an example: I worked with a young man who, on the surface, seemed to have no history of trauma, but struggled with various addictions and compulsive behaviors. Through careful, trauma-focused inquiry, we uncovered deep-rooted feelings of exclusion and inadequacy stemming from cultural expectations and childhood experiences of being an outsider. This understanding allowed this patient to experience a significant breakthrough, realizing that his struggles were not his fault, but rather a result of trauma that had shaped his emotional world.
Q: How do we provide trauma-centric treatment, and how does it differ from a trauma-informed approach? What are the stages of trauma-integrated treatment?
Dr. McGee: Trauma-centric treatment takes a more structured, stage-conscious approach than trauma-informed care. While trauma-informed care emphasizes awareness of trauma and its effects, trauma-centric treatment involves actively addressing and processing trauma in a clinical setting through a phased approach.
I've expanded on existing trauma recovery models to create a four-stage approach, which is essential for treating addiction in a trauma-centric way:
Stage 1: Acute Stabilization: This stage focuses on creating a sense of safety and stability for the patient. This includes helping them achieve sobriety, reducing stress, and establishing a trusting therapeutic relationship. Many individuals with trauma struggle with self-regulation, so the goal here is to teach basic coping skills and provide immediate support.
Stage 2: Restoring Functionality: In this stage, the focus shifts to helping patients regain pro-social functioning. This may involve teaching life skills, such as maintaining a job or managing relationships, which many people with trauma have difficulty navigating.
Stage 3: Processing the Pain: Once a patient is stable, we begin the difficult work of helping them process their trauma, including grief, anger and sadness. This is a delicate stage, requiring careful timing to avoid overwhelming the patient. It is critical to understand trauma’s deep roots in psychiatric conditions and address it with compassion.
Stage 4: Growth and Recovery: The final stage involves helping the patient move toward personal growth, spiritual awakening, and the creation of a fulfilling life. This stage emphasizes the long-term process of healing and developing a sense of purpose and meaning.
Q: In many communities, trauma isn't often acknowledged or even named. Circumstances are simply seen as life’s challenges or unfortunate events. What is the value in labeling these experiences as “trauma” for your clients?
Dr. McGee: In many cultures and communities, trauma isn’t something that is explicitly named or addressed. But labeling these experiences as trauma can be a powerful step in the healing process. It helps individuals recognize that their struggles are not a reflection of their inherent worth, but rather the result of harmful experiences and societal pressures.
For example, in our society, many people live with the consequences of status hierarchies — always feeling like they’re not enough, like they don’t measure up. This contributes to widespread low self-esteem, which then feeds into conditions like addiction. When we help patients see the connection between their life experiences and their struggles, it lifts the burden of shame and guilt. It shifts the narrative from "What’s wrong with me?" to "What happened to me?" — and that can be incredibly liberating.
Understanding these dynamics within the context of trauma, combined with a compassionate therapeutic relationship, gives patients the space to heal. It’s not just about labeling; it’s about helping them make sense of their pain and guiding them toward recovery with empathy.
Q: How do trauma and addiction interact in the healing process?
Dr. McGee: Trauma and addiction are often intertwined. Trauma creates shame, mistrust, and emotional dysregulation, which can lead individuals to self-medicate with substances. In many cases, addiction becomes a way for individuals to cope with the pain of unprocessed trauma. When treating addiction, it’s essential to address the underlying trauma. Without this, the patient remains vulnerable to relapse. Trauma-integrated treatment provides a framework for addressing both the addiction and the trauma in a holistic and compassionate way.
Q: How can non-clinicians support trauma-integrated care?
Dr. McGee: Anyone, whether or not they're a clinician, can help by recognizing that many individuals struggling with addiction or psychiatric conditions have a history of trauma. It’s important to move away from labeling people as "difficult" or "resistant" and instead understand their behaviors as symptoms of unprocessed trauma.
As non-clinicians, the first thing we must do is transcend our natural urge to react negatively or judgmentally. This "tit-for-tat" response is deeply ingrained in our neurobiology as social species —we tend to want to hurt others when they hurt us. But to truly help individuals in trauma, we need to rise above this reaction and approach them with empathy, understanding and kindness.
Q: What are your recommendations for someone who wants to help and is looking for skill-building resources?
Dr. McGee: The skills to focus on are regulation skills, relational skills and adaptive abilities. These include things like job-seeking skills, life management skills, trigger management, craving management, stress management and relational skills. Many of these are common in the addiction treatment field, especially when it comes to self-regulation.
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