Substance abuse professionals are increasingly challenged to find rapid, safe, and effective methods of treating the survivors of psychological trauma. Experiences of trauma have high correlation with substance abuse (Dayton, 2000, 2001), which is not surprising since survivors frequently turn to a variety of self-medicating behaviors to blunt the emotional pain and intrusive memories and images.

At the same time, substance abuse professionals have long struggled with an ongoing controversy. Should the addiction be treated first, while the clinician defers addressing the trauma until the addict has earned sufficient sobriety to face the past? Or should addiction and trauma be treated hand in hand Ñ since unresolved trauma is often a common trigger to relapse?

The Therapeutic Spiral Model (Hudgins, 2002) takes the perspective that trauma can be addressed safely when clinical structures are firmly in place. This clinically driven model has been employed throughout the United States and internationally for more than 15 years to work with survivors of trauma, including family abuse, crime victimization, war combat, and political unrest. It also has been adapted for successful treatment of addicts and alcoholics, even in very early recovery, as well as other conditions relating to addiction including HIV-AIDS and eating disorder treatment.
The model was developed to address limitations of both talk and action therapies. It provides professionals with rapid, safe, and effective techniques for treating trauma. It maximizes the effectiveness of psychodrama, the action method that is the root of role play (Blatner, 2000) that is used in group work (Beyer & Carnabucci, 2002). It stabilizes the client in a safe structure that supports containment with a variety of specific clinical interventions.

It also offers a conceptual framework to understand the trauma-based roles (Hudgins, 2002) that are put into place to protect against the pain and chaos of trauma. Finally, it identifies the strength-filled roles that must be developed to fortify the self so that the individual is not pulled into the chaos of traumatic memory, becoming vulnerable to relapse, dissociation, or other compulsive behaviors.

As addiction counselors help their patients fill the void when drugs are eliminated, the addition of these strength-building roles reinforce abstinence and continuing recovery. It is often not enough to learn to talk about feelings or to attend 12-Step meetings, especially when traumatic memories and body sensations begin to bubble forth as the haze of the chemical lifts. Patients also must develop internal resources to effectively manage their trauma triggers as well as the ability to reach out to appropriate "others" who will be genuinely helpful.

In the Therapeutic Spiral Model, strengths are identified as personal qualities (intrapsychic), interpersonal (supportive relationships), and transpersonal (a connection with a spiritual force). As such, the model is compatible with the 12 Steps.

After an assessment, counselors may find that the substance abuser's strengths are greatly contaminated by negative messages, low self-esteem, and a pervasive sense of failure. Through psychodramatic interactions, a client can move through this negativity to a position of awareness and empowerment. Concretizing the abstract strengths within simple specific roles at first - "I am the one who is able to think through my options" or "I am the one who is courageous" - allows the client to claim and experience useful parts of the self that will serve as important companions in recovery. Strengths are often confused with willpower, a quality that is easily overridden by the pull of addiction. A typical group session employs props, art, and experiential methods so participants can explore their traumatic experiences in a structure that emphasizes safety and containment. As the role, or identity, of "The Addict" is being reduced, the Therapeutic Spiral Model provides a set of additional new behaviors, which are called "roles" in the philosophy of the psychodramatic method.

In the model, these roles include the Observing Ego, Containing Double, Body Double, and Manager of Healthy Functioning that support conscious functioning. Each role gives the patient valuable training in developing new behaviors and attending to common struggles that appear in both traumatized and addicted individuals:

- The Observing Ego is the part of self that has the ability to step outside of the self to observe behaviors, feelings and situations and verbalize the reality of the situation in a non-judgmental way.
- The Containing Double is the part of the self that is able to use a three-step process of narrative labeling, cognitive processing and healthy anchoring of options in the face of emerging trauma material.
- The Body Double is the part of self that pays attention to movement of the body - including breathing, heartbeat and physical actions Ñ and verbally labels the experience, supporting the experiencing of the body in a healthy state.
-The Manager of Healthy Function is the part of self that has the ability to identify and support the use of healthy adaptive coping skills.

These roles and others are taught by name to group and individual patients. However, they are not merely discussed on the abstract levels; instead, psychodramatic techniques have the patients actually step into the roles, bringing these
concepts to life during role plays and longer dramatic vignettes.

Initially the roles are externalized - being played by other clients or staff members who serve as trained auxiliaries - and gradually integrated as the internal voice is established in the recovering person. The new behaviors and thoughts give the recovering person a concrete sense of constructs that will help them withstand the pull to use a substance or a behavior at a later date (Harrison, 2001). As these roles are integrated, the therapist may later introduce more roles in the model related to trauma that will need exploration and resolution: the abandoning authority, the good-enough parent, the victim and others.

However, in early recovery, the most important element is to connect with the Observer Self (First Step), in order to
recognize the unmanageability and powerlessness created by the addiction. Once the addicted individual can stand outside the self, he or she can begin to identify the defenses and choices needed by the Manager of Healthy Functioning for the transformations (Second and Third Steps) needed for sustained recovery.

Participants are assessed according to the type of session that will be produced, and they address core trauma material only when clinically appropriate. Sessions that address the actual trauma have clear boundaries and contracts for the routes of action. When the action touches directly on core material, the clinician follows principles that take the survivor-addict through a specific step-by-step process. Many of the techniques can be easily adapted to individual sessions and for clinicians using experiential and talk modalities.

Because the Therapeutic Spiral Model is self-renewing and taught and practiced by members of the community for that community, it has the power to promote change globally even as it adapts to each locality. Whether it is Belfast, Northern Ireland - where we have worked with former members of the paramilitary and their families - or Johannesburg, South Africa - where we have used the model to tend to poverty-stricken AIDS victims - people experience a place of greater healing, hope, and possibility.

References
Beyer, E.P. and Carnabucci, K. (2002). Group Treatment of Substance-Abusing Women. The Handbook of Addiction Treatment for Women: Theory and Practice. S.L.A. Straussner and S. Brown, Eds. Jossey-Bass: San Francisco, CA.
Blatner, A. (2000). Foundations of Psychodrama: History, Theory and Practice, 4th edition. Springer Publishing Co.: New York, New York.
Dayton, T. (2001). The Use of Psychodrama in the Treatment of Trauma and Addiction. Psychodrama with Trauma Survivors: Acting Out Your Pain, M.K. Hudgins and P.F. Kellermann, Eds. Jessica Kingsley Publishers: London.
Dayton, T. (2000). Trauma and Addiction. Health Communications, Inc.: Deerfield Beach, FL.
Harrison, C. (2001). Therapeutic Spiral Model Roles for Conscious Transformation in the Treatment of Addictions for Recovery from Trauma. Workshop Handout. Therapeutic Spiral International: Charlottesville, Va.

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