Addiction is often the result of someone trying to self-medicate away the pain of a traumatic experience. A three-phase initiative, known as WORTTH, in the Addictions Program at UHN’s Centre for Mental Health is supporting women to end the cycle of substance use and return them to meaningful lives. (Logo: UHN)

The reasons for substance use and addiction are numerous and complicated, but in many cases, personal trauma plays a role. An addiction is often the result of someone trying to self-medicate away the pain of their experience.

As healthcare continues its shift to also address the external factors that contribute to overall health, this approach has been particularly important in treating substance use, which is often a symptom of a deeper issue.

At UHN's Centre for Mental Health at Toronto Western Hospital (TWH), a new initiative in the Addictions Program called WORTTH (Women Optimizing Recovery Through Trauma Healing) is aiming to break the cycle between trauma and substance use for female patients.

According to the program's data collected in 2018-19, 35 per cent to 45 per cent of women accessing TWH's substance use treatment had a history of trauma. It is also well established that underlying trauma, if left untreated, can lead to relapse of substance use.

"The gap in services to address these issues, which should really be treated together, has been obvious for years," says Jim Skembaris, Senior Clinical Manager, Addictions Program at TWH. "There aren't enough trauma services for women and we would have to refer our patients elsewhere.

"We are excited to now be able to offer them support in this area."

Thanks to a donation from an anonymous Toronto General and Western Hospital Foundation donor, patients at TWH's Addiction and Mental Health Program and Women's Own Withdrawal Management Centre can access trauma support services through WORTTH's three phases:

  • Engagement: This phase is open to all and acts as a safe space that patients can access at any stage of their recovery. In this phase, patients attend group-based therapy to learn about trauma and start making connections between addictions relapse and trauma. Patients are welcome to stay in this phase as long as they like, and are not required to graduate to the next phase.
  • Treatment: When patients feel ready, they can graduate to the next step where they receive one-on-one counselling from a psychiatrist and pharmacological treatment as required.
  • Integration: Though recovery from addiction is important, the WORTTH initiative seeks to pair that recovery with making good quality changes to a patient's life.

"We want them to return to something meaningful, whether going back to school or back to work," Jim explains. "It's important for patients to move beyond recovery for recovery's sake, and build real meaning into their lives."

Since its launch last October, interest in participating in WORTTH has been strong and an additional staff member has been hired so more group therapy sessions can be offered.

As with pretty much all aspects of regular life, the arrival of the COVID-19 pandemic in March 2020, changed the way the group could meet. As hospitals across Ontario limited non-essential visitors to their sites in the name of safety, the WORTTH team offered virtual one-on-one supportive counselling to the clients who were already in this program.

As hospitals start to re-open the team hopes to offer virtual group sessions in Phase 3.

Despite these recent challenges, the value of WORTTH is best summed up in the words of one of its patient's own words: "Coming to this program provides me with hope, hope that I will not have to repeat the same cycle of substance use, depression and anxiety, and actually address what is lying deeper that has caused it in the first place." 

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