Summary by Ellen Ford, Psy.D.
Dusty Miller, Ed.D. author of numerous articles and several books including Women Who Hurt Themselves, gave a presentation at NESTTD’s quarterly meeting on Sat., September 30, 2006. Her major focus was to share her model of treating addiction and trauma in a concurrent and integrated way.
To illustrate the historic blunders common in the practice of treating the dual diagnosis of PTSD and substance abuse, Dusty told her own story of numerous detoxes, hospitalizations, and well-meaning attempts by mental health professionals to change her behavior and heal her wounds. The ATRIUM model of treating addictions and trauma was born from her painful personal experience as well as from her years of clinical experience.
ATRIUM (Addictions and Trauma Integrated Recovery Model) is a biopsychosocial form of treatment that integrates cognitive-behavioral and relational approaches, stressing mind, body, and spiritual health. It is generally utilized in the format of a 12-session group but can also be adapted for use in individual therapy.
ATRIUM’s theoretical underpinnings connect to Dusty’s previous concepts of the Triadic Self and Trauma Re-enactment (TR). The Triadic Self describes the trauma survivor as having internalized as parts of self three aspects of the traumatic experience: the Abuser, the Victim, and the Non-protecting Bystander. Trauma Re-enactment occurs when the survivor, for example, drinks alcoholically (Abuser), creating much pain and suffering (Victim), and makes no attempt to remedy the harm (Non-protecting Bystander). The central element of ATRUIM is the development and internalization of a Protective Presence.
A Protective Presence is built with clients in small increments by helping them to incorporate moments from either their lives or their imaginations that are experienced as protective. These moments are elaborated in their fullness, including on a somatic level, and are brought to bear on their current dilemmas as related to past trauma.
The four basic principles of trauma recovery in the ATRIUM model are:
(1) Recognizing and reinforcing resilience
(2) Achieving abstinence from addiction
(3) Recognizing and healing the wounds on non-protection
(4) Creating a sacred connection to the world beyond the self – creating a “reverence for life” coupled with a sense of social purpose.
Addiction is a perfect, if unfortunate, fit with trauma: it provides numbing of hyperarousal; it provides a relationship; it provides an illusion of control; and it provides expression of the trauma story. Treating addiction separately from the trauma or trauma separately from addiction is bound to result in failed recovery from either. Dusty Miller’s ATRIUM approach is one way of integrating the treatment of both.