Secondary Traumatic Stress Among Substance Use Disorder Professionals

what is Secondary traumatic stress (STS)

Secondary traumatic stress (STS) is a phenomenon whereby individuals who come into continued and close contact with trauma survivors become indirectly traumatized through vicarious exposure, such as vivid details expressed in therapy. A person with STS may experience disruptive emotions and behaviors resulting in the knowledge of a traumatizing event experienced by an individual they care about. This stress emerges from helping or wanting to help a traumatized person.

Professionals who provide services to and care for those with substance use disorders may be at risk for developing STS. According to an NCBI article on Concurrent Treatment of Substance Use and PTSD, substance use disorders (SUD) and post-traumatic stress disorder (PTSD) are chronic conditions that frequently co-occur. The article also states that there is evidence to suggest a strong association between the two, likely due to those with PTSD self-medicating to mitigate symptoms. Whether or not trauma is adequately recognized and treated among those with a substance use disorder, this still places SUD professionals in a position where they may experience STS. 

STS As a Potential Occupational Hazard

In search to find out what the prevalence of secondary traumatic stress among those in substance use disorder services is, research published in May 2015 found that “despite the high volume of traumatized clients accessing AOD services, less than two-thirds of AOD workers reported having ever received trauma training… and the prevalence rate of STS was 19.9%” of the 412 SUD professionals studied in Australia. This study also suggests the need to provide adequate trauma training to these professionals to maintain their health and well-being and ensure the best treatment for their clients. 

Another study in 2019 that examined 383 Norwegian substance-abuse therapists found that 22% of respondents reported experiencing secondary trauma, and “more than 72% of therapists had also been exposed to patient direct threats.” This study concluded that these findings indicate a high prevalence of trauma symptoms in substance-abuse therapists. 


Although symptoms may vary in severity depending on an individual person and their experiences, some signs that a substance use disorder professional may be experiencing STS are:

  • Cognitive 
    • Lowered concentration
    • Apathy
    • Rigid thinking
    • Perfectionism
    • Preoccupation with trauma
  • Emotional
    • Guilt
    • Anger
    • Numbness
    • Sadness
    • Helplessness
  • Behavioral
    • Withdrawal
    • Sleep disturbance
    • Appetite change
    • Hyper-vigilance
    • Elevated startle response
  • Physical
    • Increased heart rate
    • Difficulty breathing
    • Muscle and joint pain
    • Impaired immune system
    • Increased severity of medical concerns

Prevention and Treatment Suggestion 

According to the U.S. Department of Health & Human Services, addressing secondary traumatic stress should occur at both the individual and organizational level through prevention and treatment. Professionals can adopt lifestyle and work habits that help them set personal boundaries that can protect them. However, even after doing this, some of the most experienced and personally balanced professionals may find themselves struggling with STS. 

Personal Strategies:

  • Lifestyle balance – maintain a diversity of interests, relationships, and activities. 
  • Relaxation techniques – ensure adequate time to rest by meditation or breathing practices. 
  • Connect with nature – remaining connected to the outdoors can help maintain a healthy perspective of the world.
  • Creative expression – activities such as painting, cooking, photography, writing, or playing an instrument can help expand emotional experiences.
  • Assertiveness training – learn to say “no” and set limits when necessary.
  • Self-reflection– regularly evaluate yourself and your experiences and apply problem-solving techniques to any challenges.
  • Focus on self-care – maintaining a healthy diet, exercising, and getting regular sleep can reduce adverse stress effects.
  • Journal – writing about challenging feelings can help make meaning out of negative experiences.
  • Seek professional support – working with a counselor specializing in trauma may help process distressing experiences and provide additional perspectives.

Organizational Prevention Strategies:

  • Create a culture that recognizes and normalizes the potential effects of working with trauma survivors and those with a substance use disorder.
  • Promote and support self-care practices among staff members. 
  • Provide STS education, training, and allow honest conversations about STS. 
  • Make counseling resources and Employee Assistance Programs (EAP) available and accessible to all staff. 

It is essential to understand that although not all individuals who have a substance use disorder also have past trauma, these two conditions frequently co-occur. This means that professionals in the addiction recovery field may be treating those who also have symptoms of PTSD or had traumatic experiences in the past. Thus, it is vital for professionals to take the necessary precautions to avoid experiencing secondary traumatic stress. 

Treating those with a substance use disorder can take a toll on an individual’s mental health and wellbeing. It can potentially lead to experiencing secondary traumatic stress if the individual they are treating also suffers from past traumatic experiences. If you are a SUD professional and find that you are experiencing secondary trauma symptoms, there is hope. It is crucial to maintain healthy coping mechanisms such as having a balanced lifestyle, maintaining physical health and self-care practices, and seeking professional support when needed. Prevention strategies and treatment options at the organizational level can also promote education and services for those in the workforce. At Alta Centers, we have the highest commitment to each human being, both at the staff level and those who receive treatment here. Nestled in the Hollywood hills, Los Angeles California, we provide a safe space to unblock and focus while staying close to the city lights and embarking on the journey towards recovery and wellness. Call us at (888) 202-2583. We are here for guidance and support.

About Alta Centers Detox

Alta Centers Detox is  Addiction Treatment Centers with Alcohol Rehab and Drug Rehab in Los Angeles California