Christine’s Clinical Corner: Volume 2 Getting to the Root of Addiction – The Power of Case Conceptualization

Vol. 2: Getting to the Root of Addiction – The Power of Case Conceptualization

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At Resilience Lab, we remain committed to asking the deeper questions: What is clinical quality? What truly facilitates healing and thriving? And how do we ensure our treatment is both individualized and effective?

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As we continue to explore these themes through the Resilience Methodology, our focus this month has been on addiction—a condition often oversimplified in clinical practice as behavioral excess or chemical dependency. But through our lens, addiction is not a singular diagnosis; it is a multi-layered, biopsychosocial-spiritual-cultural condition that requires nuanced understanding, collaborative treatment, and, above all, compassion.

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Addiction: Not a Choice, But a Communication

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A large component of the current mental health crisis is addiction. And yet, addiction remains one of the most misunderstood and moralized conditions we treat. It is not about willpower. People aren’t using substances or compulsively engaging in behaviors to “get high.” More often, they’re trying to get away—from pain, from emptiness, from a physiological state of dysregulation that has been misunderstood, misdiagnosed, and mistreated for years.

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The CDC recently reported a 27% decline in predicted drug overdose deaths in 2024, a hopeful trend attributed to expanded treatment access and public health interventions. But while this progress is worth celebrating, addiction persists in evolving forms: compulsive use of pornography, social media, gambling, food, drugs and alcohol—each shaped by demographic, cultural, and systemic variables. Addressing the root cause of addiction cannot be done at the population level. It requires a deeply personal, trauma-informed approach.

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The Resilience Methodology: Addiction Treatment Through a Holistic Lens

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At Resilience Lab, we believe that no disease in humans is purely biological or psychological—it is biopsychosocialspiritualcultural. And nowhere does this holistic truth come closer to home for me than in the presence of addiction.

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Our approach involves:

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✅ Trauma-Informed Case Conceptualization
We explore addiction through the client’s full life context: family history, epigenetics, attachment wounds, cultural and systemic influences, and often, unrecognized trauma. This is about far more than symptom reduction or abstinence—it’s about understanding the why, and creating a treatment plan that aligns with purpose and meaning.

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✅ Team-Based Care
Addiction can’t be treated in isolation. We emphasize collaborative treatment teams—including client, clinician, supervisor, and prescriber—working from an integrated plan with continuous communication.

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✅ Nervous System and Trauma Education
Addictive behaviors often arise as coping strategies from a dysregulated nervous system. Understanding the science of trauma and dissociation enhances our clinical interventions and improves outcomes.

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✅ Harm Reduction
We support clients in reducing harm while working toward long-term healing. Detoxification or abstinence may not always be the first or only step. As with any chronic condition, timing and readiness matter. We would never explore the root cause of a manic episode during mania. Similarly, addiction recovery must be paced, not moralized.

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A Personal Case: My Sister’s Story

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This month, I want to share something deeply personal. With my father’s blessing, I’ve begun sharing the story of my sister’s life and death with my students and colleagues—not to focus on tragedy, but to illuminate how trauma-informed care could have changed her outcome. It is my hope that this story helps prevent future pain by guiding more effective, integrated treatment.

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I knew my sister from her first breath, and she unreservedly shared her internal world with me in ways few others have, including clients.  Her addiction journey lasted nearly 20 years—but it began long before her first substance. When she was just 2 years old, she experienced what we now believe to have been a sexual trauma by someone close to the family. From that point forward, she could not tolerate being held or looked at by any man other than our father. The trauma encoded itself in her nervous system, silently shaping the trajectory of her life.

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What followed were signs that went unseen or were misattributed:

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• At ages 3–5, mealtime became a nightly 3–4 hour ordeal, resulting in nutritional deficiencies and stunted growth.
  
  
• In early school years, she repeated kindergarten and experienced chronic headaches and stomach pain, yet no organic cause was ever found.
  
  
• As a teen, she developed perfectionism, extreme self-consciousness, and social phobia.
  
  
• In college, she began using crystal meth at raves, which evolved into daily use, then to alcohol, cocaine, and ultimately heroin.
  
  

She tried treatment—medical detox, residential programs—but the trauma was never addressed. On day 26 of a 28-day program, she fled. She went missing for a week and was found bludgeoned on the streets of San Francisco, unconscious and unidentified. She was admitted as Jane Doe to a neurological unit, her jaw wired shut, her brain severely injured.

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And yet—she survived. Through the unlikeliest of catalysts—an attack that kept her confined and substance-free for months—she broke the physical hold of addiction. In recovery, she found solace and structure through the philosophy of Buddhism and the strength of the sober community. She remained drug-free for five years.

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But what remained unhealed was the root. Her trauma had never been integrated. She never found the purpose she so deeply sought. In her words, “I finally feel clear—but I still don’t know who I am.” Her life had been a quest—from the perfection of adolescence to drug-induced confidence, then desperate escape. In the absence of meaning, even sobriety wasn’t enough.

Seven years ago, at the age of 40, my sister ended her life.

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Clinical Reflections: What I Wish I Knew Then

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If I had understood then what I do now about trauma and addiction, I would have:

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• Looked beyond the substances to see the strategy
  
  
• Treated dissociation, not just depression
  
  
• Explored spiritual connection as a legitimate, clinical need
  
  
• Advocated more fiercely for an integrative, coordinated care team
  
  

And I would have validated what she had tried so hard to communicate: that she was not weak or “choosing” this. She was in pain.Addiction: Not a Choice, But a Communication

Clinical Tips: Treating Addiction with the Resilience Methodology

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✅ Normalize Trauma Education: Many clients don’t identify their experiences as trauma. Use neuroscience and psychoeducation to validate their survival strategies.

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✅ Understand Dissociation: Especially in clients with fragmented memory, missed milestones, or somatic symptoms. Dissociation is often the bridge between trauma and addiction.

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✅ Build Meaning: Explore not just sobriety, but purpose. Help clients locate values, roles, and existential anchors to move beyond symptom management.

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✅ Prioritize Safety: Relational trust is the first step in any addiction treatment. Without a felt sense of safety, healing cannot happen.

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✅ Collaborate with Compassion: The clinician cannot hold this alone. Build a wraparound team that includes psychiatry, family (when appropriate), supervisors, and alternative providers.

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Final Thought

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This month’s Amplified Learning Series on Addiction has reminded us that true healing doesn’t happen through force or abstinence alone. It happens through understanding, integration, and connection.

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My sister taught me that recovery isn’t the absence of drugs—it’s the presence of meaning. As clinicians, we must meet our clients not with judgment, but with a fierce and informed curiosity. Only then can we help guide them back to themselves.

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Until next month,
Christine