Traumatic Experiences in Correctional Facilities:   Who Has it Worse?  Correctional Staff or Those who are Incarcerated

Traumatic Experiences in Correctional Facilities:   Who Has it Worse?  Correctional Staff or Those who are Incarcerated

When thinking of what it would be like to be incarcerated, the lay person can base their perception on any number of popular televisions shows or movies; abusive staff, gangs, stabbings, rapes and a pervasive culture of violence.  While these things do occur, in some facilities much more than others, many short term, low custody sentences may not experience these things firsthand.  However, the constant fear of the above referenced items coupled with poor (if not disgusting) food quality, strip searches, group showers, unsanitary conditions, lack of access to family/friends, lack of sleep due to keys, doors, and cell checks, and reduced/delayed access to medical and mental health may in fact lead to greater negative emotions and trauma.  Any piece or combination thereof can lead to PTSD upon release back into society.  In addition, “Other factors are interwoven into the pathogenesis of this condition, including the many risk factors that underlie the behavioral and thought patterns of many criminals. These include childhood traumas such as extreme poverty, child abuse by their parents or caregivers, experiences of neglect, physical and sexual abuse, as well as other forms of mistreatment” (Thomas, 2019).

According to various research projects:

• Even before entering a prison or jail, incarcerated people are more likely than those on the outside to have experiencedabuse and trauma (Thomas, L, 2019).
• An extensive 2014 studyfound that 30% to 60% of men in state prisons had post-traumatic stress disorder (PTSD), compared to 3% to 6% of the general male population (Wolff, N, et al, 2014).
• 7% of womenin state prisons experienced childhood abuse, compared to 12 to 17% of all adult women in the U.S.. (BJA, 1999).

The below chart is from the Prison Policy Initiative article titled No escape: The trauma of witnessing violence in Prison:

The above charts and studies, however, only examined the effects of correctional environments on those who were incarcerated inside by judicial order and did not consider those who work inside the facilities, often for long and mandated shifts.  Not as many studies could be found on correctional staff related trauma.  But trauma and stress amongst staff can easily be imagined: reviewing horrific case files; witnessing traumatic events; mandatory overtime; role ambiguity; and constant disrespect by the inmate population.  “According to a 2015 article by the National Commission on Correctional Health Care, correctional employees experience higher rates of stress-related illnesses that contribute to low levels of job satisfaction, which has been linked to burnout and is thought to lead to compassion fatigue” (Pittaro, M., 2020). 

In addition, a study conducted and published this year found that correctional officers self-reported significantly higher exposure to potentially psychologically traumatic events than other medical and wellness workers. Moreover, correctional staff also self-reported greater rates of symptoms of mental disorders, including PTSD, social anxiety, panic disorder, and depression, among others (Fusco, N., et al, 2021). 

Based on the above referenced data and numerous additional uncited studies, it is evident from the research and probably obvious to the average law abiding civilian, that both correctional staff and inmates are exposed to the unimaginable and unfathomable behind the walls.  Typically, opposing sides prevent the evolution and availability of growth for each of these populations:  those who may believe that inmates deserve this and should not be afforded anything when being punished and those that may feel that correctional staff are tough and know what they sign up for.  Acknowledging the equality in the two groups and making available trauma informed approaches to care for the inmate populations and programming for self-care for staff is critical to reduce these numbers and ensure smooth transitions for each in society.  The truth is, that nearly all inmates will one day be released into society and, in addition, will be existing with us.  Moreover, staff as well are living amongst us, on their often-limited time off, and should as well be able to ‘leave it at the gate’ in terms of their work stressors.  To that note, similarly, one a sentence and work shift is complete, any individual should be, and we should want them to be, functioning, healthy and productive members of the society in which we all live. 

References:

Bureau of Justice Assistance (BJA).  1999.  Prior Abuse Reported by Inmates and Probationers. https://bjs.ojp.gov/content/pub/pdf/parip.pdf. 

Fusco, N., Ricciardello, Jamshidi, Carleton, Barnim and Hilton.  (February 15, 2021).  When Our Work Hits Home: Trauma and Mental Disorders in Correctional Officers and Other Correctional Workers.  National Institutes of Health.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917131/. 

Pittaro, Michael.  March 24, 2020).  Correctional Officers and Compassion Fatigue.  Psychology Today.  https://www.psychologytoday.com/au/blog/the-crime-and-justice-doctor/202003/correctional-officers-and-compassion-fatigue. 

Thomas, Dr. Liji.  (February 27, 2019).  Prisoner Post Traumatic Stress.  Medical Life Sciences News.  https://www.news-medical.net/health/Prisoner-Post-Traumatic-Stress.aspx.   

Widra, Emily. (December 2, 2020).  No escape: The trauma of witnessing violence in Prison.  Prison Policy Initiative.  https://www.prisonpolicy.org/blog/2020/12/02/witnessing-prison-violence/#lf-fnref:1. 

Trauma Informed Policing by Frederick Morse

In recent years perhaps no profession has received as much scrutiny as law enforcement. Americans are redefining social norms and expecting more professionalism and accountability from law enforcement. One of the areas in law enforcement that has been beneficial, yet not without growing pains, has been the proliferation of body-worn video cameras. An additional facet of American life that has also received a fair amount of attention is trauma and mental illness. Research has shown that early childhood trauma can result in hindered growth resulting in uncontrolled anger, inappropriate behavior, disregard for rules, and drug or alcohol abuse (Rousseau, 2021). These precursors often result in contacts with law enforcement.

In the United States, a growing number of service requests for law enforcement similarly involve police interaction with vulnerable individuals or those experiencing a psychologically based crisis.   A recent study in Scotland revealed that approximately 80% of all calls for service for law enforcement were non-criminal in nature (Gillespie-Smith, 2020).

With this dynamic in mind, scholars in Scotland conducted research where they exposed police personnel to trauma informed practices. Specifically, the study chose one police division and showed them the documentary “Resilience: The Body of Stress and Science of Hope.” The documentary explained how chronic stress releases hormones within the body of children which then results in dysfunction in the minds and bodies of youth. After viewing the film, the police personnel were given an overview of the 1998 Adverse Childhood Experiences (ACE) study and scores. There was a panel of experts available for questions and to provide further context for the data.

Police personnel learned that in Wales, individuals with an ACE score of four or more were twenty times more likely to be incarcerated at some point in their life than the general public (Bellis, 2015).  Similarly, the officers learned that approximately 89% of the prisoners in Wales reported at least one ACE (Gillespie-Smith, 2020). Police personnel who received the trauma informed training were then questioned as to their attitudes and understanding about suspects, witnesses, and victims. The researchers then compared the answers with answers from officers from another police division that did not receive the trauma informed policing training. The answers were not significantly different (Gillespie-Smith, 2020). Many of the officers who received the training expressed confusion about the ACE score research. The officers indicated that the trauma had occurred before their involvement and they failed to see how the new knowledge could benefit their current role. This was a common theme in the feedback from the participants (Gillespie-Smith, 2020).

On its face, the scholarly work in Scotland appeared to be unremarkable. However, if law enforcement agencies in the United States could build upon this trauma informed approach to policing and combine it with the technology of body worn video, real progress could be made. Law enforcement personnel have countless contacts and calls for service with individuals with mental health needs. A trauma informed approach to these calls for service could curtail any use of force and would result in decreasing further trauma to the individual in crisis or the officer.

Law enforcement administrators need to seek out strategies for improved professionalism and techniques for de-escalation. With the use of body worn video, contacts with individuals in crisis or mental health decompensation can be reviewed by law enforcement trainers and mental health professionals to improve officer responses and protocols. All contacts with citizens with mental health needs would be given a unique computerized clearance code making it easier to identify and retrieve the incidents for later review. The review of body worn video would be for educational purposes only, with the goal of improving trauma informed practices for law enforcement personnel. Police agencies could generate training videos from body worn video footage from actual interactions. The videos would include instructional narratives from mental health professionals and would be disseminated to other stations and personnel.  A secondary objective would be to ensure that law enforcement personnel are getting the necessary and timely assistance from mental health agencies. If both agencies can work in a collaborative manner, individuals in crisis might receive professional intervention and proper care instead of a trip to the county jail.

Submitted by: Frederick Morse

Works Cited

Bellis, M. A. (2015). Adverse Childhood Experiences and their Impact on Health-Harming Behaviours in the Welsh Population. Wales: Cardiff: Public Health.

Gillespie-smith, K. B. (2020, August). Moving Towards Trauma-Informed Policing: An Exploration of Police Officer's Attitudes and Perceptions Toward Adverse Childhood Experinces (ACEs). Retrieved from https://www.research.ed.ac.uk/en/publications/moving-towards-trauma-informed-policing-an-exploration-of-police-#:~:text=In%202018%20Ayrshire%20Division%20of%20Police%20Scotland%20announced,perceptions%20and%20attitudes%20towards%20becoming%20a%20trauma-in

Rousseau, D. (2021). Trauma and Crisis Intervention. Module 2 Study Guide. Boston University.

Liquid Trauma Treatment and Law Enforcement

For most professionals, when colleagues ask to grab a few drinks after work, this is seen as a friendly gesture to build relationships at the workplace. For law enforcement this can be seen and used as a way to cope with the stress and trauma from the job or to self medicate for anxiety, depression or post-traumatic stress disorder. While the exact number is hard to calculate, it is estimated that approximately 23% of all police officers in the United States are alcoholics. To put that into perspective, there are an estimated 800,000 sworn officers in the United States which would mean approximately 184,000 officers are considered alcoholics. Some officer’s may have already been or will eventually become alcoholics, prior to being hired, due to genetic predisposition or the environment they were raised in. While this may be true, it is easy to see how the job and the lack of mental health resources available would lead to such troubling statistics. 

The day I was hired and sworn in as a police officer, a family friend, who was an active duty police officer at the time, told me that I now had “a front row seat to the greatest show on earth.” Without knowing what the job entailed and the mental health issues that face police officers, I find it somewhat ironic that my family friend and I were drinking at the time. I saw the occasion as a celebration while he may have seen it as a way to self medicate to ease the pain of  the demons he carried with him as a result of being a cop. The idea that I could sign up for a job where every day, every hour, and every minute was different sounded too good to be true. And at first, this was exactly what it was like for me every time I pulled that bullet proof vest over my head, buttoned up my uniform shirt, and shined my boots. Today, every time I put on that vest, I am quickly overcome with stress and anxiety of the unknown. The adventures of the job and the adrenaline filled incidents that I yearned for quickly became mundane and I felt as if I was becoming complacent which is a killer in this job. “The very nature of police work includes regular and ongoing exposure to confrontation, violence, and potential harm. Exposure to potentially traumatic experiences on a regular basis sets the stage for a series of mental health complications, including posttraumatic stress disorder (PTSD)” (Maguen et al., 2009, p. 754).

Perhaps it was because of the COVID lockdowns without much else to do, or perhaps it was me subconsciously self medicating from the stress of the job, but I soon found myself drinking almost every night. My fiancé recognized this and quickly made me realize that it was becoming a problem. I am extremely fortunate and grateful that my fiancé had the courage to speak up and confront me about my drinking habits. For many this resource is not available and they are left searching for help while fighting to stay anonymous. The search may continue long enough where officers feel they don't have any options and end up take their own lives. “Law enforcement suicide is real and is the number one killer of police officers,” occurring “1.5 times more frequently than suicide in the general population” (Rousseau, 2021, p. 7).

The stigma around mental health and its subsequent treatment is extremely prevalent in law enforcement but the more alarming issue is the lack of resources available to officers. This may be because of the stigma but leaders within the profession have a moral and ethical obligation to do better. I have heard from some classmates that their departments offer mandatory mental health services without questions asked and their colleagues are far better for it. This is an example of forward thinking leadership while combating the stigma that surrounds mental health. The country needs more leaders like this to step up and take care of their own. This will not only lead to healthier officers but it will also lead to better relationships with the public they serve. 

Bibliography:

“How Common Is Alcoholism with Police Officers? - The Recovery Village.” The Recovery Village Drug and Alcohol Rehab, The Recovery Village Drug and Alcohol Rehab, 22 Dec. 2020, www.therecoveryvillage.com/alcohol-abuse/related-topics/facts-alcoholism-police-officers/. 

Maguen, S., Metzler, T. J., McCaslin, S. E., Inslicht, S. S., Henn-Haase, C., Neylan, T. C., & Marmar, C. R. (2009). Routine Work Environment Stress and PTSD Symptoms in Police Officers. Journal of Nervous & Mental Disease, 197(10), 754–760. https://doi.org/10.1097/nmd.0b013e3181b975f8

Rousseau, D. (2021). Module 6 Study Guide [Notes]. Boston University Metropolitan College.

Self-Care and Trauma

People who experience trauma deserve to be free from the weight and pain that it bears upon them. Throughout this class, we have discussed multiple treatment methods that can work individually or that can be used together to find the best treatment plan for the individual. Not all treatments are as widely accepted as others and one that seems to walk on that fine line is self-care. Self-care however is an important part of healing from the trauma, but it should be started when the individual is ready for that experience. Trauma affects our entire body, mind, and our whole being. When all of these aspects are affected we have a harder time being present, connecting, and relating to others. By focusing on ourselves through self-care, our mind and body can work together again to create a healthy and happy lifestyle that may have not existed before. 

Highland Springs Clinic mentions that on one’s journey to healing and recovering from a traumatic event, it is important to remember the practice of self-care. They also wrote that “self-care is not commonly the first method survivors think of when they are overcoming a traumatic experience, however, it is a critical part of healing”(Hood,2020). Before starting any kind of trauma therapy, it is important to understand what trauma is and how it may present itself in you. Knowing when to start self-care is dependent on the individual and they have to allow themselves to be ready. Self-care is not the same for everyone, but listening to your body and mind and what it needs is a first step for starting this journey. Our body usually recognizes what we need and will signal to us when the time for recovery is here. Highland Springs Clinic mentions some areas of self-care that are good to start with are get more rest, find someone to talk to, journal about it, use exercise as a tool, and find engaging hobbies (Hood, 2020). While this is only a shortlist of self-care options they are good places to start for people who are ready to treat their trauma by loving themselves. 

Whitney Goodman LMFT, a licensed psychotherapist brings up a good point that self-care is supposed to make us better in the long-term and that it is not a quick fix. In society now, the term “self-care is officially a commodity, and people are buying it off the shelves to prove that they care about themselves”(Goodman, 2019). It is important that people who chose self-care to help them with their trauma understand that learning to love yourself and take time for yourself is not an easy process. Goodman stated “real self-care happens in the decisions you make every day and it requires practice, commitment and putting yourself first and getting in touch with what you really need, not just what you really want”(Goodman, 2019). Her short list of self-care is: get in touch with your feelings and actual needs, practice kindness, and ask yourself “what do I need at this moment”. One big point that Goodman and Highland Springs Clinics mentioned is staying away from drinking or using substances since it is not self-care. There are so many different kinds of self-care out there, that experimenting with them will help us find which ones work for us. It is important that people who have experienced trauma believe that they deserve self-care before starting to practice it. 

Everyone that goes through a traumatic experience reacts differently emotionally, psychologically, and physically. Being able to accept and be ready for the step of self-care is important to accept the responsibility for yourself, your body, and your mind. Finding a positive self-care routine when ready to embark on the journey will help the overall healing process. It is important to remember that there is no right or wrong way to self-care, it is all about what helps that individual after trauma to become whole again. Dr. Bessel Van Der Kolk writes “the full story can be told only after those structures are repaired and after the groundwork has been laid: after no body becomes some body”(Van Der Kolk, 2015, p.249). Trauma is stressful, but acting on self-care can alleviate that stress. As well as realizing that the trauma needs to be dealt with in a positive way and wanting to deal with it will help accomplish the first step with the journey of self-care.

References

Goodman, W. (2019, July 12). When Self-Care Becomes a Weapon. Psychology Today. https://www.psychologytoday.com/us/blog/healing-together/201907/when-self-care-becomes-weapon. 

Ph.D., D. Julia. Hood. (2020, January 27). The Importance of Self-Care After Trauma. Highland Springs. https://highlandspringsclinic.org/blog/the-importance-of-self-care-after-trauma/. 

Ocrcc. (2020, October 12). self-care Archives. OCRCC. https://ocrcc.org/tag/self-care/.

Van Der Kolk, B. (2015). The Body keeps the score brain, mind, and body in the healing of trauma. Penguin Books.

Acupuncture as Trauma Therapy

Over the relatively short period of time that trauma treatment has been studied, there has been a myriad of different methods proven to help trauma victims in one way or another. Despite this, there is yet to be a cure-all that works completely for every individual and every trauma. To fully accept the reality of a trauma and be free from the weight it bears, multiple treatment methods working in tandem with one another is the best approach for healing.

One treatment method that is less often discussed but proven effective is acupuncture. Acupuncture is an ancient Chinese practice that utilizes small needles placed along pressure points on the body to help with energy flow and pain relief. Chinese documents dating as far back as 100 BCE describe the system of diagnosis and treatment that is now recognized as acupuncture (White & Ernst, 2004). The original idea of flowing meridians in the body has given way to modern neurology’s explanation that the needles stimulate nerve endings and brain function (White & Ernst, 2004). While the practice is centuries old and has been utilized in cultures across the globe, there is surprisingly little research on its effects.

Although there is little research on the subject, other forms of therapies have developed from its principles. Emotional Freedom Techniques is a more common method that, while self-administered, relies on the same bodily energy flows as acupuncture and has also been proven to cure the physical and psychological effects of trauma. In a survey following the September 11^th attacks, the 225 individuals questioned said that acupuncture was the most effective method in helping them overcome the immediate trauma of being in the Towers (Van der Kolk, 2014). Acupuncture has also been found to be a “promising treatment option for anxiety, sleep disturbances, depression and chronic pain” as related to the trauma spectrum responses (Lee et al., 2012). While more research is needed to identify the mechanism of action between the needles and the actual relief, the success stories speak for themselves and make the practice a worthy contender for comorbid treatment.

The way acupuncture can aid in trauma recovery is by alleviating the symptoms either directly or residually caused by the event. For example, after a car accident, an individual might suffer pain in their neck and experience anxiety whenever they are in a car again. Acupuncture can help to relieve the neck pain that both hinders quality of life and acts as a constant reminder of the accident. Chronic pain is also a common side effect of adverse childhood experiences. When an adult comes in for therapy with a long history of repeat traumas, alleviating physical pain is a great starting point to begin recovery. This allows for a greater sense of control in one’s own body and opens doors for further therapeutic practices like yoga and exercise that would not have been possible with chronic pain. Acupuncture may not be the cure-all that therapists and researchers are looking for to help their patients overcome past traumas but its longstanding history and overwhelming success rate for non-trauma related pain demands more research be conducted on the practice’s effects on trauma.

References:

Lee, C., Crawford, C., Wallerstedt, D., York, A., Duncan, A., Smith, J., Sprengel, M., Welton, R., & Jonas, W. (2012). The Effectiveness of Acupuncture Research Across Components of the Trauma Spectrum Response (TSR): A Systematic Review of Reviews. Systematic Reviews, 1(1). https://doi.org/10.1186/2046-4053-1-46

Van der Kolk, B. A. (2014). The Body Keeps the Score. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781101608302/

White, A., & Ernst, E. (2004). A Brief History of Acupuncture. Rheumatology, 662–663. https://doi.org/10.1093/rheumatology/keg005.

Internet and Sexual Offenders

Back in model five it was discussed that technology has increased the numbers of sexually based crimes. Producers of child pornography is statically more likely to be someone the child knows, who has complete and legitimate access to the child. Technology has also led to more sexual grooming. Research into online sexual grooming has largely been focused on the stages of grooming, typologies of offenders, or comparisons with people who download abusive sexual images of children. Extraordinarily little attention has been paid to internet affordance and the role these might play in the offending behavior, the development of expertise, and the avoidance of detection. There was a qualitative study done on 14 convicted men, those convicted of online grooming. Analysis indicated that the internet served to create a private space to engage in purposive, sexual behavior with young people. The internet aided in the fantasy, and for some was precursor to an offline sexual assault. Grooming is the process by which an individual prepares a child and their environment of sexual abuse to take place, including gaining access to the child, creating compliance and trust, and ensuring secrecy to avoid detection. (Craven, Brown, and Gilchrist, 2006). Sexual grooming pre-dates the internet, Lanning (2001) described grooming activities in relation to the internet, individuals attempted to sexually exploit children by seducing their targets with attention, affection, kindness, and gifts. Between 2000 and 2006 showed a 21 percent increase in online predators.

Are online sexual offenders different than other sexual offenders? There are studies how argued that online sexual offending is simply what happens when conventional sexual offenders have access child pornography through mail-order services or through personal trades now access large volumes of child pornography online. Similarly, those who might have approached children in public such as malls, are now contacting children through social network sites, messaging, and other technologies. However, there is a counter study that states that the internet has created a different type of sexual offender. Specifically, the anonymity of the internet, accessibility of child pornography; and greater opportunities to trade child porn, contact potential victims, and engage in conspiracies to commit sexual offenses have facilitated illegal sexual behavior.

Quayle, Ethel, Allegro, Silvia, Hutton, Linda, Sheath, Michael, & Lööf, Lars. (2014). Rapid skill acquisition and online sexual grooming of children. Computers in Human Behavior, 39, 368–375. https://doi.org/10.1016/j.chb.2014.07.005

Seto, Michael C, & Karl Hanson, R. (2011). Introduction to Special Issue on Internet-Facilitated Sexual Offending. Sexual Abuse, 23(1), 3–6. https://doi.org/10.1177/1079063211399295

What 9/11 Taught Us About Trauma

September 11, 2021 will mark 20 years since the terrorist attacks in New York City. Since then, we have learned how to communicate when phone and cable lines are down, and also what to do when evacuation routes are blocked as well as when roads to the nearest medical facilities are blocked. Not only did we learn important life saving lessons, but we also learned a lot about trauma and PTSD.

The powerful emotions that erupted from that day were not only felt in New York City or in surrounding states, but also across the United States and around the world. Two women who were in different parts of the city that day both experienced PTSD. Marcy Borders, who became known as Dust Lady, struggled for the decades following the attacks from depression as well as addictions to alcohol and crack cocaine. She is unfortunately one of many survivors who have struggled with mental illness and substance abuse since then. Esperanza Munoz witnessed the towers falling from a distance, but that doesn't change her experience. To this day, she still has flashbacks and nightmares as well as anxiety whenever she hears sirens or a plane flying overhead. She can't even step into New York City without panicking.

Many studies have been done on the affects of 9/11 and the first 9/11 trauma study was conducted on October 29, 2001. The team interviewed a huge range of survivors from the first responders, the recovery workers, those who survived the attacks themselves, and to those who lived in surrounding areas. They found that 96% of the survivors reported having experienced at least one symptom of PTSD 2 to 3 weeks after the tragedy. Of that 96%, a majority were still experiencing multiple symptoms 2 to 3 years afterwards. Another study on 9/11 focused on about 11,000 first responders and it was completed over a total of 8 years. They found that during the first year, at least 70% had actually never met the diagnoses criteria for PTSD but years later had many symptoms. Their study told them that the timelines of Post Traumatic Stress Disorder symptoms varied and hit people differently. They also found that these timelines are affected by the duration of the traumatic experience, the trauma-related medical experience, and also any prior psychiatric problems.

Not only have we learned in the almost two decades since then that PTSD symptoms rise up at different times for everyone and that trauma can be experienced by everyone, but psychologists themselves have learned new ways to react to major traumatic events like this one. Shortly after the terrorist attacks of September 11, 2001, psychologists themselves would ask those who were on Ground Zero or in the surrounding areas how they felt and if they were experiencing any symptoms. Years later, they have learned that not everyone is going to be traumatized and that everyone processes trauma differently. A new method that psychologists have come up with is called Psychological First Aid. Instead of asking the individual how they feel in the aftermath, the psychologist will offer the survivor services and give them information for the services. This not only allows flexibility, but it is also still reducing the distress caused by the event or events.

Unfortunately, that September day changed everything. Airport security is even tighter, rates of mental illness and PTSD have risen, and rates of substance abuse have risen. But at the same time, there have been positive changes that are allowing the country to prepare themselves for the next traumatic event or even to change the mental health field.

Resources

Cook, J. (2016, September 09). September 11th attacks: What we learned about trauma. Retrieved April 27, 2021, from https://time.com/4474573/911-september-11-trauma/

Pearson, C. (2011, November 09). 10 years after 9/11: What we now know about trauma. Retrieved April 27, 2021, from https://www.huffpost.com/entry/911-and-mental-health-a-n_n_951060

Researcher finds 9/11 attacks led to new understanding of mass trauma. (2011, August 31). Retrieved April 27, 2021, from https://news.columbia.edu/news/researcher-finds-911-attacks-led-new-understanding-mass-trauma

Surviving 9/11: Trauma and substance abuse. (n.d.). Retrieved April 27, 2021, from https://www.drugrehab.com/featured/9-11-trauma/