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Trauma Healing Our Addictions: Adaptions to EMDR and Progressive Counting for Addictions

It has long been understood in the EMDR community that trauma resolution would help with addictive behaviors. It is seen in Shapiro’s early writings and in her encouragements for the development addiction protocols (Shapiro & Forrest, 1997; Vogolmann-Sine, Sine, Smyth, & Popky, 1998; Shapiro, 2001). Now DeTUR (Popky, 2007) and FSAP (Miller, 2012) have been developed to help address cravings and positive states of addictive behavior and/or drug. These protocols are extremely helpful tools that can tackle the felt effects of the drug and impact the relationship to the drug but appears to limit their abilities to address the whole addiction in the context of it being traumatic or a learned behavior. To solve this, these protocols are delivered in a larger context of treatment but more could be done to support addiction treatment, particularly from a trauma-informed perspective. In my practice, I use the Fairy Tale Model developed by Dr. Ricky Greenwald (Greenwald, 2007; Greenwald, 2013).

In my last blog post, I showed how the definition of addiction implies trauma and why targeting the roots of addiction memories is so important when addressing the condition of addiction. However, when I started to use trauma resolution I did not see a direct and effective way of doing this. So I sought out Dr. Jamie Marich for supervision and she simply stated, “anything can be targeted” (personal communication, November 16, 2016). For this clarity, I am grateful but through my own process of addiction and recovery, I knew that there were philosophical obstacles to applying the standard EMDR protocol. After listening to my ideas, she acknowledged that it is important for the clinician to have a firm understanding of addiction and recovery to perform trauma resolution in addiction treatment (personal communication, November 16, 2016). I could not agree with her more and felt that I could provide some practical information for clinicians on what I have had to do to rearrange the trauma healing therapies of EMDR and Progressive Counting to address the whole condition of addiction.

It is not widely known that the actual drug use is traumatic from the body and mind perspective. I invite you to look at drug use as a trauma from a medical, biological, and psychological standpoint. The moment the drug is introduced into the body and mind, it pollutes them like a biological toxin or psychological trauma. Nature wanted us to remember toxic experiences like these so we would not repeat them but also positive experiences that helped us survive and thrive.

I often think of Cameron from the TV show House M.D. when she is messing with Chase’s head about sex. “Sex could kill you. Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets, respiration becomes rapid and shallow, the brain fire bursts of electrical impulses from nowhere to nowhere, and secretions spilt out of every gland, and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent. It’s ugly. And it’s messy. And if God hadn’t made it unbelievably fun, the human race would have died out eons ago (Shore, 2004).”

I have not had a client who could not identify that their drug use was traumatic even though it was pleasurable. In hindsight, it is hard not see the carnage and wreckage that first use represents. It is seen as the beginning to the end or, as I am coining and presenting the term here, the Original Learned Addictive Behavior (OLAB). I define this as “the moment when the toxic relationship to the addictive behavior was created.” In layman’s terms, it is the original “f@$! it” moment when the person surrendered to the “need” of the behavior, drug, or relationship. Underneath this memory is Shapiro’s (2001) feeder memory but with the mental twist of “what feels good is bad.” I struggled to apply EMDR and Progressive Counting because I knew that there was more to the recovery process then just desensitizing cravings or triggers due to the philosophical mind game being played. Utilizing my own path to recovery I had to make some minor but important changes given this context.

Before I present how EMDR and Progressive Counting can assist in addiction treatment, please be make sure that you are trained and experienced in trauma methods, addiction, and recovery before you perform these techniques. The client could start to process their whole addiction (particularly in EMDR), which sometimes can be overwhelming if the client is not well resourced, if they are not truly in an action stage of change/recovery, or if you have not cleared major traumas before addressing the addiction in this way.

Here is how I untangle the pain/reward pathways and over stimulation of addiction with EMDR and Progressive Counting. First, in the history taking, I find the OLAB by asking, “When did you find this (addictive behavior) was the solution or when did you fall in love with this (behavior)?” Second, when the time comes, I have the client perform a floating back from the first drug use to where they first learned to feel like this. Usually, within the processing of OLAB memory, the client acknowledges that they are emotionally substituting the drug for a person, to gain social acceptance, or numb some other type of pain, which is great for addressing the addiction with the context of their life. If there are traumas before the OLAB, I address those first but they are usually entwined on some level. For each trauma resolution method, I treat each drug as a cluster and do first, worst, and last.

In Phase 3 of EMDR (Shapiro, 2001), I simply switch the Positive Cognition (PC) and Negative Cognition (NC). What happens in the processing is that they start balancing out the relationship to the addictive behavior, reprioritizing the importance of the behavior, and then identify that the behavior was not good for them or was an emotional crutch. The processing allows them to separate themselves from the behavior, untangle their mixed emotions about a relationship, add context and perspective, and have compassion for their original “decision”. In Phase 5, Installation Phase (Shapiro, 2001), I keep it the same but usually, they have another belief present that needs to be installed. The PC’s become more like, “Now, I understand,” “I can forgive myself,” and “I can be that without the behavior.”

With Progressive Counting, “For the movie, what would the beginning be, before anything good happened?” and “What would be the ending, after the good part was over?” I find Progressive Counting to be more of a contained method and more of a direct process that has specific benefits for this population. Clients who are addicted are known for being abstract and Progressive Counting helps minimize tangential wonderings. Another benefit for this population is that it is well-tolerated by the client and easy for the clinician to master (Greenwald, 2013).

There are many more nuances to applying trauma resolution in addiction treatment but at the core of the process is trauma healing. What is interesting is that they are processing a “positive” experiences, however, what they find is the truth about their relationship to the addictive behavior and that can become unsettling because the toxic guilt and shame come up. Make sure that they are ready for that part of the process. I have found that by addressing the OLAB first it allows for the person to address the guilt and shame before they tackle their whole addiction. Overall, I find addressing the OLAB first to be safer for the client.

The minor adaptations to these trauma resolution therapies are grounded in my theory that addictive behavior is traumatic because the OLAB impacts the body and mind the same way as event trauma, Szalavitz’s (2016) conception that addiction is a learning disorder, and also Mate’s (2010) stance that the root causes of addiction is trauma. Each client presents with different needs that need to be addressed but they all begin with pain. Trauma healing redefines therapy especially for addiction treatment because it gets the job done. There is urgency in addiction treatment that the client feels and that as clinicians we need to honor. Trauma healing is what clients are expecting when they come to treatment, even though they may not exactly be ready for it. It is our job to get them ready but I will continue to argue that clients in addiction treatment need more trauma-informed preparation, let alone trauma healing. However, many of the clients have been through multiple treatments and are ready for trauma healing but might not know it yet.

Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.

Greenwald, R. (2013). Progressive Counting: Within a phase model of trauma-informed treatment. New York, NY: Routledge.

Marich, J. (2016, November 16). Personal communication.

Miller, R. (2012). The feeling-state addiction protocol. Retrieved on 8/11/17 at

http://www.fsaprotocol.com/microsoft-word—the-fsap-4.pdf

Popky, A. (2007). Retrieved on on 8/11/17 at http://www.emdrtherapyvolusia.com/downloads/lynda_documents/forms_protocols_and_scripts/DeTUR.pdf

Shapiro, F., Forrest, M. (1997). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic Books.

Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.

Shore, D. (writer), & Singer, B. (director). (November 30, 2004). Occam’s Razor. House M.D. Los Angeles, CA: 20th Century Fox Studios

Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. New York, NY: Picador.

Vogolmann-Sine, S., Sine, L. F., Smyth, N., Popky, A.J. (1998). EMDR Chemical Dependency Treatment Manual. EMDR Humanitarian Assistance Programs.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.

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Defining Addictions from a Trauma Perspective

The first time I got high, I came home and my sister asked me “who is she?” She thought I was in love. Well, I was, but with the experience of freedom to different underlying issues that I had been experiencing my whole life. After the drug wore off and the psychological cravings started, then the biochemical reminders of adrenaline and serotonin began and the voids of loss felt like the vastness of space. Emotional confusion was compounded by love withdrawal and this lingered for weeks until I was able to hook up with the drug again.

Addiction is the paradoxical two-way mirror into the human condition and to avoid the reality of it is to deny its’ existence. Addiction takes hold when a “want” is labeled as a “need” and you need more to satisfy it. Addiction is a rollercoaster ride you feel like you can’t escape because it threatens your very existence.

From a psychological perspective, addiction is toxic passion. Passion drives us to get our emotional need met. We all have been in an intoxicated state of passion so we know what it feels like. In the case of addiction, a behavior or substance meets our unmet needs and fulfills the role of healthy relationships. Maybe more accurately, the behavior or substance replaces our basic human needs, supposing they were met before. The question becomes: Why do our needs need replacing?

What I continue to purpose in my blogs is that we are addressing addiction at the root when we conceptualize that the drug use (or learned relief behavior) as a/the trauma. Again addiction is paradoxical in that what feels good is not actually good for you. Now, I know that some will say that trauma is not in root in every case, but I would argue that if trauma is subjective, then no claim could be laid to that. I would agree that not all traumas equal Post Traumatic Stress Disorder (PTSD) however, I have yet found a person with an identified addiction not have a trauma whether it be real, perceived, witnessed, or existential in nature. As Gabor Maté (2010) stated, “not why the addiction, but why the pain.” The main culprits of pain stem from early childhood environment with school, parenting styles, and/or the family dynamics. If miraculously a trauma is not there, then the introduction of the toxin, behavior, or drug to the body becomes a trauma.

Defining addiction is often paradoxical, especially if we do not take into account the trauma that happens in everyday life. When we take trauma into account, defining addiction becomes clearer. Under the lure of security, hope, desire, pain relief, and/or unconditional love, addictive behavior progresses and grows into dysfunction. The definition of addiction appears to be firmly rooted in trauma but it is not widely recognized by people who do not interact with active addiction or people in recovery from their addiction. This blind spot effects governmental policy and perpetuates the stigma of addiction. Ultimately, it affects how we treat addiction because we spend so much time educating on what addiction is, rather than treating the root causes.

American Society of Addictive Medicine state “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors (ASAM Board of Directors, 2012).”

On the whole, I agree with this definition because it reveals the underlying trauma used to define it; but also the solution. “Dysfunction” in the brains “memory and related circuitry” is the underlying trauma. And, the solution is: if the client changes their relationship to the memory, can you heal the dysfunction? The answer is yes; I have done it. And to be fair, ASAM does recognize that trauma and stress are involved in addiction (ASAM Board of Directors, 2012).

In his book Anatomy of Addiction (2016) Dr. Mohammad points to a medical definition of disease and identifies genetic predisposition and excessive triggering of the pain/reward pathway as main ingredients to creating an addiction. To support this position Dr. Mohammad states, “overstimulation of the reward circuitry factor significantly in addiction but it creates false memories of the experience. The brain regards the experience as ‘better than expected,” even when the experience wasn’t all that great. Because the memory is a permanent part of your mental makeup, anything and everything that reminds you of that memory also remind you that the experience was better than expected and triggers an instant desire to re-experience something that perhaps wasn’t anywhere as good as you remember (p. 56).”

If trauma resolution has shown me anything, it is that our memories and relationship to them is anything but permanent. Memories, reminders, triggers, objects, people, places, and things can be desensitized to help stop enactment because ultimately it is our relationship with them that changes. Addiction and relapse are a form of trauma re-enactment and it can be treated more effectively with trauma resolution. Trauma resolution is done through memory reconsolidation (Ecker, Ticic, & Hulley, 2012) and the therapies that exemplify these are Eye Movement, Desensitization and Reprocessing (EMDR) (Shapiro, 2001) and Progressive Counting (PC) (Greenwald, 2013).

Addressing memory in the context of a human beings life addresses the root cause of any behavior. The coping skill of addictive use is what is stuck in the body and brain like a trauma and it can be alleviated through trauma resolution. Addiction alters the brain and its accompanying guilt and shame can be seen as a trauma. People who are addicted, their families, and communities who have been impacted by addiction, know that at some point the addiction becomes traumatic. Addiction is a rollercoaster that you feel like you cannot get off. Actuality, you can, but you have to climb on another one, which also has its twists and turns, its highs and lows. This other rollercoaster is the ride of life.

References

ASAM Board of Directors, 4/19/2011. Retrieved on 8/11/17 at http://www.asam.org/for-the-public/definition-of-addiction

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.

Greenwald, R. (2013). Progressive Counting: Within a phase model of trauma-informed treatment. New York, NY: Routledge.

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Books.

Mohammad, A. (2016). Anatomy of Addiction: What science and research tells us about the true causes, best preventive techniques, and most successful treatments. New York, NY: Perigee.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford Press.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.

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Outpatients are Not Treating Addiction

When a client comes to treatment for addiction, in an outpatient or residential setting, we obviously explore their symptoms. Tolerance, cravings, withdrawal, unsuccessful attempts at stopping, reoccurring dangerous situations, and increased amount of time thinking or obtaining the drug are not typically cited as reasons to come to treatment by the client. These are not symptoms that individuals directly identify with because they are not the most pressing concerns to the client. On some level, clients in treatment recognize these diagnostic symptoms and their drug use as an issue but more often they recognize the underlying emotional issues. If we are to meet the client where they are at, the underlying emotional stress is where it is.

The rollercoaster of diagnostic addictive symptoms seems elusive to the client because they are medical and existential in nature. First responders, ER’s, detox units, and in-patient deal with active addiction. So do families, friends, community members, employees, and employers. “Addiction” is happening at breakfast, lunch, and dinner. “Addiction” is happening on Friday night happy hour, Wednesday night bingo, 2 a.m. coke binge, and at family functions. “Addiction” is happening on a boat, on a plane, on a stage, and in a cage. It is happening in the normal hustle and bustle of day-to-day life. In the outpatient setting, the problem is separating the outside world from the therapy setting. This begs the question: what are we really treating in our outpatient and residential settings?

What are the psychological symptoms that clients experience days, weeks, or months, or even years after their last use? Clients may say “I can’t stop using,” I don’t want to be here.” “I don’t want to go back,” “I can’t cope,” and “I can’t control it.” In other words, they report that they are experiencing intrusive thoughts, avoidance of remembrances, negative alterations in cognition and mood, and alterations in arousal and reactivity. These are post-traumatic stress symptoms.

I prefer to conceptualize active addiction more like Acute Stress Disorder (ASD) because people are not typically in their right state of mind. It is similar to walking away from a car accident. People may be shaky, confused, disoriented, stunned, and/or limited in some way, but could return to a baseline if given enough time away from the event and the ability to make sense of it with their support system. Indeed, we are all “under the influence” of biochemical responses in the body and brain after a life-threatening event and any reintroduction to the stressor would bring us back to the event causing impairment if left unprocessed.

The body and brain know that it is in for a rollercoaster of a ride physically, psychologically, socially, and spiritually when a drug is taken because they remember it. Whether it is actual, perceived, medical, or existential; all drug use is replicating learned behaviors and threatens the life of the organism. The body acts accordingly to any threat or stressor (positive or negative) and each use, cue, or trigger acts as a reset for the body to return back to the original event.

So outpatients are treating the memory of active addiction, which is not an addiction by our diagnostic standard. For the most part, I would say that they are treating the echo of life events i.e. best conceptualized as trauma. However, many outpatients and residential settings are not using trauma therapies or at minimum trauma-informed care directly. They could start seeing better outcomes if they did.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.

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Treating Addictions with Trauma Resolution

As a therapist, I utilize the trauma healing therapies of EMDR and Progressive Counting to address addiction, trauma, and mental health conditions. Treating addiction and trauma is a passion of mine and I continue to see clients make positive gains when they address the impact of these conditions using trauma resolution. However, what I would like to see more trauma resolution therapy in addiction treatment. There are some helpful existing ways of applying trauma resolution to the treatment of addiction, but I feel that there are some critical philosophical misunderstandings regarding what addiction is and these misconceptions are obstructing trauma resolution from being applied a wider scale. By exploring these misunderstandings and exploring how else to apply these therapies, I believe that it would help more clinicians to apply trauma resolution with certainty.

I treat addiction with trauma resolution because I see trauma and addiction clinically as the same side of the coin. Philosophically, and quite literally, they represent pain. The other side of the coin is healing and recovery, which philosophically usually represents pleasure. The coin really represents the human condition. The relationship between pain and pleasure creates our human drama. Acknowledging the relationship that is created between pain and pleasure (really between any polar experiences), gives me the opportunity to introduce the name of the blog. Mutual Arising is a Taoist concept that recognizes that things come into existence together and they create a relationship that is symbiotic, interdependent, and inseparable (Watts, 1975). For our purposes here: where there are wounds, there is healing. For me, healing and trauma resolution are synonymous because of what I witness almost daily. The importance of acknowledging this relationship is critical to our understanding of how to address addiction/trauma and the human condition.

I came to apply the healing practices of trauma resolution to addiction from personal experience and academic study. I have found drugs absolutely fascinating ever since I first took them in 9th grade. I had heard about them in D.A.R.E. class when I was in 5th grade. Even at that age, I remember feeling like that there was an escape route and when I had a chance, I took them. 2 dollars for 10 hours of seeing cartoons like images, tasting bright colors, opening new ways of thinking and different doors of perception was not something to pitch to someone looking for an escape.

Now, 5th-grade D.A.R.E. class may not seem like a trauma by any standard definition, but I came to see it as one when I did a floatback intervention. A floatback (Shapiro, 2001) is a therapy technique used in trauma resolution therapies where the client “floats back” from a similar memory to an earlier one. When I was learning about EMDR in my graduate studies, I started to see that drug use could be “stuck” in the memory system and could impact the body in the same way a trauma does. So, I was not surprised when I landed back in the 5th grade again and could see myself getting high simply off the idea of drugs, however, my floatback did not finish there.

My floatback went back further to when I was 2-years-old and was in different medical offices with my parents seeking relief for a genetic skin condition that was triggered by environmental stressors that shook my healthy attachments. This personal experience helped me see how these types of memories can help clients during the trauma resolution phase of treatment. I have been targeting these learned relief behaviors that symbolically represent the relief of the drug and clients have reported benefit. I also will treat it as a theme or memory cluster (Greenwald, 2007) and then target the first drug use all the way up to the most recent use. Similar to my experience their floatbacks lead to different times when they were not responsible for their “choice” of taking a drug or relief behavior. Clients have also identified their parents giving them alcohol for an illness as a child, stealing sips of alcohol on the route back from the fridge, and early medical operations as the moment that they first fell in love with the effects of the drug or learned that the drug was a practical solution to an emotional pain problem. Other clients have identified with excessive exercise or sports involvement, sibling relationships, parental perfectionism, their designated family role, and observing other relief behaviors as targets to address. Clients will identify that they transfer their learned relief behavior from food, sex, or risky behaviors. Conversely, clients also report that their traumas are things that did not happen, for example, emotional connection, parental guidance, or supportive socialization.

All of these can be seen as developmental traumas because they change the course of the development and can be treated with trauma resolution if they still hold emotional value (positively or negatively). All traumas create an emotional imprint for learning addiction and this conceptualization supports Gabor Maté’s (2010) stance that addiction is rooted in trauma and it also supports addiction as a learning disorder by Maia Szalavitz (2016).

I view addiction, and most mental health conditions, in the diagnostic category of a Trauma and Stress-Related Disorder. Also, as outlined in my story above, addiction may be the poster child for a possible sub-diagnosis of Developmental Trauma Disorder, which has been presented by Bessel van der Kolk (2014). There is further evidence in my story that stress triggers physical disease as stated by Gabor Maté (2003). These may not be the linchpin for every case because there are other factors like major trauma, socialization, temperament, genetics, and epigenetics that impact the development of an addiction, but philosophically knowing how to identify addiction-related developmental traumas, supported by reason and clinical observation, allows us to treat it with trauma resolution. This may not be new to most clinicians reading this, but it does offer the philosophical foundation of this blog.

To establish the philosophical foundation further, all experiences are neutral and it is how and when we emotionally learn our relief behaviors that we create different personal values on them. These lessons learned under emotional stress are coded and hardwired in the memory system to be remembered for the benefit of our survival (Ecker, Ticic, & Hulley, 2012; Szalavitz, 2016). So, a drug use or relief behavior is a neutral experience but can take either a positive or negative value, dependent upon the relative point of view of the observer. Targeting these memories with trauma resolution methods like EMDR and Progressive Counting has improved my client’s recovery process and my own. How I specifically address this will have to be discussed in later blogs.

This blog will continue to explore the relationship dynamic that mutually arises when we see addiction and trauma as the same side of the coin and healing/recovery as the other. It will advocate for ending the stigma of addiction and mental health as anything other than normal human behavior within a spectrum of human conditions. The implications reach much farther so we will have to explore them as well.

References

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their  roots using memory reconsolidation. New York, NY: Routledge.

Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.

Maté, G. (2003). When the body says no: Understanding the stress-disease connection. Hoboken, NJ: John Wiley & Sons, Inc.

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Books.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford Press.

Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. New York, NY: Picador.

van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York, NY: Penguin Books.

Watts, A. (1975). Tao: The watercourse way. New York, NY: Pantheon Book.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.