January 24, 2018
PCH Executive Director Dr. Jeff Ball appeared on the “Addiction Today” radio program to discuss complex trauma and how it can often lead to addictive behaviors as a coping mechanism.
In the program, Dr. Ball discusses:
- What makes PCH Treatment a unique treatment provider
- How trauma and other mental challenges plays a role in fueling addiction
- Addiction as a form of self-medication
and much more. Take a listen to Dr. Ball’s appearance below and learn more about what causes trauma, the symptoms of traumatic stress, and techniques and therapies to help cope with and resolve trauma in healthy ways.
Addiction Today: Good morning. Welcome to the program. Good show for you today. If you tune into our radio program from time to time, you will hear me at some point say that alcohol and drugs and we could include sex, gambling, food, tobacco, and other addictive behaviors are not the problem, but a symptom of the problem. Addicts use substances and certain behaviors as their way to cope with the real problem, ease the pain, sooth the angst, escape. So the real quest for recovery professionals is to identify and then treat the real problem, which lies in the mind of the addict. Many guests on this program have said that the root of most addiction comes from trauma and trauma can happen in many forms, stemming from physical abuse, death of a loved one, divorce, serious illness, abandonment, severe injury, rape, battlefield stress, the list goes on and what might traumatize one person, may have only a minor impact on another. All could lead to what we commonly call PTSD or post-traumatic stress disorder. It’s no easy task to identify what may have traumatized someone and it may be buried in the subconscious and hidden from superficial probing.
So this morning we have the honor of having a PHD with us who specializes in trauma and focuses less on what is wrong with his clients and more on what happened to trigger this complex state of mind. Our guest this morning is a native of Los Angeles and a UCLA Grad where he received his PHD. He was an assistant prof. at USC and has been on the UCLA faculty for many years. He’s a clinical researcher. He’s also served as the chief psychologist at the West L.A. Veterans Hospital. He’s the former executive director of Bridges to Recovery that specialized in the treatment of psychological disorders and in 2009 co-founded PCH Treatment Center as CEO and executive director. And we have him on the phone this morning from Los Angeles. Dr. Jeff Ball, good morning.
Well tell us about PCH Treatment Center, what do you do there that makes you unique and who is your typical patient or client?
Dr. Ball: Well, we are an intensive psychological treatment center. So we do both residential and day treatment for depression, bipolar disorder, anxiety, OCD (we have a separate OCD program), and really any kind of psychological problems… personality issues, and certainly trauma. And we’re set up with homes and like I said, a day treatment center. And we have a full Assessment Clinic. We do a lot of family works, we have a full family program. The way that we’re a bit different is we also do psychiatry, but we’re really a psychological treatment center, so we’re more in a psychological model than a medical model.
Addiction Today: So treating addiction is not your main focus?
Dr. Ball: It’s not, although we do secondary to psychological problems or dual diagnosis.
Addiction Today: And are people referred to you from other centers and other places?
Dr. Ball: They are, they’re referred from psychiatric hospitals, private practitioners, other treatment programs, particularly a lot of the drug and alcohol treatment programs, where they’ve had people who’ve had several failed treatments, due to the underlying psychological issues, which we’re more expert with those issues. Our staffing are all doctoral level, highly experienced people, so we’re able to take much more complex cases than many programs.
Addiction Today: I read a piece that you wrote about personality disorders, would you define for us how the mental health community defines a ‘personality disorder’? And then tell us why you’re not happy with that label.
Dr. Ball: Defined as persistent maladaptive personality traits in which people have these long term ingrained difficulties that basically are lifelong and particularly there’s the most common personality disorder is borderline personality disorder. It’s really a very difficult kind of personality style where the person has a lot of mood lability, very dysregulated, has attachment issues and relational issues with people. And it’s really seen as the kind of client some people don’t want to treat, it’s very difficult to treat and it takes very long term treatment. And the problem I have with it is it’s a very pejorative pathologizing label. And it also pertains to when you look at the symptoms of complex trauma, they’re almost identical in that when people have experienced trauma over many years, they tend to be very dysregulated, they tend to have a difficult time with their anger, they tend to have difficulty attaching and relational kinds of problems. So I find it much more useful to look at people from the trauma perspective. In other words, what has happened to them versus the personality disorder which focuses on what’s wrong with them.
Addiction Today: Well, the thing that confuses me and I’m sure it does a lot of people listening too is the term ‘borderline personality disorders’, is there a full blown personality disorder? I mean borderline sounds like I got a little bit of a problem, but they’re not really over the edge yet.
Dr. Ball: No, it’s very full blown. I think originally the term was used to describe the borderline between neurosis and psychosis. And that’s where it historically came from. There have been many iterations of it, but it sort of evolved into the really difficult patients, basically. Then the problem with the definitions of it now is it’s really proposed as being a lifelong disorder. So people attach to it because it sort of explains their behavior, but it doesn’t give people much hope that they’re going to be able to resolve it and we found people can.
Addiction Today: So what you’re saying is it’s a lifelong disorder, something you’d try to keep at bay, but it’s always going to be there?
Dr. Ball: Yeah, you can teach tools to try to mediate it a bit, but the idea is it’s always going to be there and we found that’s not the case.
Addiction Today: Well the title of our program is ‘Addiction Today’, and recidivism is huge within the treatment industry and that’s probably where you get a lot of folks come in. And we’ve heard of folks that have been in treatment six, seven, eight, nine, a dozen times. So is most addiction the result of some traumatic experience, in your experience?
Dr. Ball: I would say a number of different factors go into it, but I think certainly one way of coping with trauma is through drug and alcohol use. Sometimes we’ve found people with a bipolar illness where they self-medicate. And I think one way to put it is many addictions are self-medication for other kinds of issues. I think those are the ones that tend to not do well with just traditional drug and alcohol treatment.
Addiction Today: Dr. Ball, what are some of the root causes of trauma? I ran down a list earlier about physical abuse, death of a loved one, divorce, serious illness, that sort of thing. In your experience, give us a like a hit list of what causes basic trauma?
Dr. Ball: We often look in terms of what we call big “T” or little “t” trauma.
- Big “T” trauma are the things like you described; it can be a rape, it can be war-like experience, the classic is PTSD from combat, which in World War One used to be called soldiers heart. They thought it was a cardiac condition, or called shell shock. And then now it is called PTSD or post-traumatic stress disorder in which many symptoms are sometimes delayed and sometimes they’re immediately following the trauma. So that if you’re in a car crash, if you’re in a natural disaster, if you’re in a hurricane, a flood, it’s likely in South Florida that’s a real common cause of PTSD. So those are kind of the big “T” traumas.
- Small “t” trauma are more emotional, kind of emotional abuse could fall into that category or even if someone has a very sort of sensitive predisposition to have a parent that doesn’t get them, that is constantly miss-attuned with them, for example. And so that can cause what we call small “t” trauma, which are the kinds of traumas I think that sometimes we’re dealing with complex trauma and what we tend to call ‘borderline personality’.
Addiction Today: Typically, how does trauma manifest itself in some way? What are the signs and behaviors?
Dr. Ball: Signs and behaviors can be dysregulation or a real emotional lability.
Addiction Today: Dysregulation meaning like an emotional rollercoaster, one minute laughing, the next minute crying kind of a thing?
Dr. Ball: Exactly. Often, we get people in our treatment center that are diagnosed outside as bipolar because they’re high and up one minute and they’re down and depressed the next. That’s actually often a misdiagnosis but in Bipolar Disorder, the moods don’t change within the day. Usually, the person is very high, and manic for a period of days, if not weeks, and then they sort of go into a depression. What we’re looking at with trauma in complex trauma is a person who can be triggered very easily into anger, can be in a good mood one minute and they’re in a terrible mood the next, they’re kind of hyper vigilance or any kind of slight or any kind of trigger, they can have trouble sleeping. There are all kinds of elements of trauma that really disrupt the person’s lives and make them difficult to live with, often.
Addiction Today: So without any treatment, what does that do to the body and mind over time?
Dr. Ball: Well, I think without any kind of treatment often it really depends, but when you’re talking about PTSD, people can have flashbacks of the traumatic event, so they’re constantly kind of re-traumatized and they may isolate, they’ll have difficulty in their relationships, they will lose jobs; we’ll have people who are constantly getting fired from jobs because they can’t maintain their temper, males who have trauma will often get in fights.
Addiction Today: So for those of us trying to figure out the best way to go about treating this. Do you sometimes recommend medication? Is that an effective treatment or do you pretty much stay away from that?
Dr. Ball: Issues around trauma, we tend to stay away from it. Sometimes outside psychiatrists will give people benzodiazepines or things like Xanax or valium or other kinds of tranquilizers. They’re terrible drugs. They’re the worst class of drugs out there and they may make your anxiety better in the short run, but in the long run when they were off, you’re more anxious, you take more of them and they’re incredibly addictive and dangerous to come off of. So that’s not a good way to treat it. Sometimes antidepressants are used, but the reality is that antidepressants don’t work very well and there’s research showing that they’re no more effective than placebo, for moderate and mild depression. And sometimes even people will be put on a low dose antipsychotic and it may be helpful in the short run in terms of being able to contain some of the anger and the rage, but in the long run they’re not really good for people either.
So, the best thing to do what we find is doing a relational psychotherapy with a very well-trained and skilled therapist who works within the relationship with the person and the kind of issues that will come up and try and help the person to understand them more. We do different somatic therapy, and one of them is called somatic experiencing, for example. And it’s the idea that in nature, when animals are traumatized, they need to shake the trauma off or they’re going to get eaten. And with humans, we tend to hold on to trauma in our bodies, we don’t tend to shake it off. And so these are different therapies that look more at how people are breathing, how they’re holding their bodies and will help them learn to discharge the trauma. We also do something called neuro-feedback, which is eeg biofeedback, which is very good with attentional issues, with anxiety, with insomnia. We do a lot of yoga in our center and research has shown that yoga really helps to realign body rhythms who have been traumatized and has been very effective. We do aerobic exercise which is more effective than antidepressants, typically. We do a number of different groups so people can experience within a group setting and get feedback about their behavior within it. We do trauma timeline groups so people can connect events with their trauma. I always say we throw everything I’ve ever seen work over the last 30 years at people with the idea that not everything works for everyone, but if half of it sticks, people get better.
We do some EMDR as well. The somatic approaches that we use tend to work a bit slower and I’m always a big advocate for people working at their own pace and not rushing things. EMDR is a bit more of a flooding of the trauma. And for some people it works very, very well. And for some people I think it can be a little re-traumatizing if it’s not done well.
Addiction Today: Well, it’s good that you don’t do a one size fits all.
Dr. Ball: We don’t, we really individualize treatment. Everyone is in core groups and has an individual therapist five days a week. But then we have specialty groups for different kinds of areas that people are dealing with. So we’re able to really individualize treatments.
Addiction Today: At the c-level that you are at Dr. Ball, do you still get in the trenches and do treatment yourself?
Dr. Ball: I don’t these days, I tend to consult with our cases and I do some supervision and then I work with my staff.
Addiction Today: So how difficult is it to identify complex trauma?
Dr. Ball: Sometimes, it can be difficult. It can be covered over by a lot of things. One thing with Trauma and with these sort of personality issues, people tend to what we call act out a lot, so it might be acting out through drug use, it might be being very sexual and promiscuous, it might be stealing, shoplifting, compulsive spending, there are number of things people can do which sometimes are also some symptoms of, as I mentioned, Bipolar Disorder. So sometimes differentiating those things could take someone with a lot of experience to do that. Sometimes like I said, people are self-medicating a lot, so it looks like a drug and alcohol problem. But usually when you look within the kind of relational context of their interpersonal relationships, you’ll see a lot of these issues come up. There are people who sometimes have a hard time being in groups so they monopolize the time or they’ll kind of become very dysregulated and angry. So at times they are not hard to identify, but they’re very hard to treat.
Addiction Today: Is denial a big issue? When you say, OK, we think this is it, Bobby or Jill, this is the problem. They go, that’s not me, that’s not my problem?
Dr. Ball: Yeah, I think that’s always an issue in psychotherapy and treatment. There’s a term called egosyntonic and egosyntonic means there are parts of you that feel like they belong to you, that they’re consistent with how you see yourself. As opposed to egodystonic, where there things about yourself that you don’t like, you wish you could change. When things are very egosyntonic, they’re very hard to treat because people don’t see any need to change them. You see that in sociopathy a lot, where people have very anti-social behaviors, but they liked those about themselves so they’re not really interested in changing them. And the same is true with trauma and personality issues where people feel very justified in how they’re feeling and they see the problem as being other people and not themselves. The person who has complex trauma or what we call these sort of ‘personality disorders’, often see the problem is the other people in the world and not them and then it becomes difficult to treat unless you’re able to get the person to buy in to the idea that some of it is caused by them.
Addiction Today: Well, I’ve learned three new words today, egosyntonic, egodystonic and sociopathy.
Dr. Ball: Sociopathy is also the same as antisocial personality or when we refer to a psychopath, but they’re all synonymous terms.
Addiction Today: And a psychopath meaning I just don’t have the feelings I need to have. I don’t have the basic, natural instincts in terms of what’s right and what’s wrong?
Dr. Ball: Exactly and the idea is that there is no empathy for other people. There’s no sense of a conscience.
Addiction Today: In your experience are there gender differences in terms of complex trauma, are women more subject to it than men or do men just hide it better?
Dr. Ball: I think men act it out in different ways. I think that, just as women may tend to externalize things where you see the behaviors, where the man who’s traumatized will drink a lot, for example, to cope with it. So you may see little differences in behavior, more in the acting out behavior. There might be different kinds of behaviors for men and women; where women may be in their relationships can be more easily triggered and they may be similar. I think you may see a lot of spousal abuse, where there are those kinds of issues and people typically, for example, who have been abused, where the men may become the abuser, and the woman may become a victim or find men who are abusive, so you see those things play out, sometimes differently, but sometimes they’ll do it in a similar way.
Addiction Today: How would you diagnose Harvey Weinstein?
Dr. Ball: Definitely a narcissistic personality and I think there’s a term that’s come around recently, partially in relation to the president, is a malignant narcissist and a malignant narcissist is when it’s really untreatable. It’s someone who is so self-absorbed and cannot see the world through anyone else’s eyes but their own.
Addiction Today: And they recognize that and think that’s part of their charm, right?
Dr. Ball: And I think you sort of see, and I imagine in Weinstein and in Trump that they don’t see anything wrong with their behavior.
Addiction Today: Malignant narcissist. Good terms today. Thank you so much. We’re out of time. I could talk to you for hours. It was really good stuff. You want to find out more by the way, and find out what PCH does. pchtreatment.com is the website, and their phone numbers is 888-724-0040.
Dr. Jeff Ball, founder, CEO, Executive Director, at PCH treatment Center. Thank you for being with us this morning.