In 1992, Judith Herman published her influential book Trauma and Recovery ¹. She argued that trauma was a response to a wide range of experiences, not just limited to war and natural disasters. She described how traumatic reactions could also be related to experiences of physical and sexual abuse as a child, childhood neglect, sexual assault as an adult, domestic violence, witnessing violence, unexpected losses, and many other life events.

Since then, many other researchers, service providers, and service users have continued to expand on Herman's work to understand the relationship between trauma, substance use, and women's overall health. From physical health symptoms such as chronic pain to mental health symptoms such as insomnia, dissociation, self harm, depression and suicidality, survivors of traumatic events may present with a bewildering array of symptoms or adaptations to their experiences. These symptoms or adaptations can greatly affect women’s ability to access, engage with, and benefit from substance use and mental health treatment. 

We have also come to see the relevance of offering trauma-informed services, that is services that take into account this understanding of trauma in all aspects of the service delivery and place priority on trauma survivors’ safety, choice and control. The work of researchers involved in the Women’s Co-occurring Disorders and Violence Study [See for example, ², ³, ⁴, Stephanie Covington ⁵, Laura Prescott ⁶, and many others have helped us see how trauma-informed services can be particularly important for women, given the high prevalence of trauma, related to high rates of early childhood abuse and later gender-based violence in relationships ⁷.

Recently, as part of a one-year project, researchers at the BC Centre of Excellence for Women's Health interviewed service providers, program planners, and policy makers across Canada to learn more about trauma-informed approaches being used to assist women with mental health, substance use and violence concerns.  In general, the project found widespread awareness of the long-term effects that trauma can have on women throughout their lives. The project also noted:

• While many service providers and agencies did not use or were unclear about the definitions of “trauma-informed” and “trauma-specific,” many were taking steps to offer supports which take into account women's experiences of violence/trauma.
• Many service providers and agencies were exploring ways to provide culturally safe and competent services for women of First Nations, Inuit and Métis descent. Support for women of Aboriginal descent included a recognition of the effects of colonization and residential schools as well as intergenerational trauma. Several service providers noted how many programs’ structure, rules and regulations can be retraumatizing for residential school survivors.
• A number of substance use treatment programs, based on their understanding of the interconnections of trauma, substance use and mental health concerns, have incorporated education about trauma into their programs. For example, offering brief skills sessions on grounding and containment for coping with trauma effects, as a part of their intake and overall services.
• Some shelters and residential services have been making changes to the way they deliver services to address the needs of women with trauma histories. These shifts included: allowing women in residential programs to sleep with their doors open at night and have the lights on; providing a safe home-like atmosphere and with snacks available during the day (i.e., not adhering to strict mealtimes); providing clients a safe place to stay, even when intoxicated, in order to reduce further harm to the women.
• As well, awareness of the interconnections between women's experiences and their efforts to cope has led to efforts at a system-level to build partnerships between anti-violence, mental health and substance use sectors.