Miramar’s Trauma-Informed Care Model
Treating both the psychological and physical aspects of substance use disorder within a trauma-informed approach.
The Facts on PTSD for Veterans and Active-Duty Military
According to the DoD/VA, 7% of veterans and active-duty military experience Post-Traumatic Stress Disorder (PTSD) in their lifetime. This varies by service era. PTSD is more common among female veterans (13%) versus male veterans (6%).
Of the 5.8 million veterans served by the VA in 2024, about 14% of men and 24% of women were diagnosed with PTSD.
And of greatest concern, in 2023, there were ~17.5 veteran suicides per day, with PTSD being a major factor.
Learning about trauma and PTSD is a major step in the healing process.
Our Veteran-Owned Treatment Environment and Philosophy
Miramar Health is a Veteran-owned and operated recovery program exclusively serving Veterans. Our mission is to free veterans from America’s mental health and addiction crisis and empower them to create a better future for themselves and their families.
A substantial portion of our team consists of members from all services.…We’ve been there.
We provide the highest quality, top-tier mental health and addiction treatment available, all in a close, family-like environment with accountability, structure, and compassion.
Miramar Health provides superior evidence-based addiction treatment programs for treating trauma. Our patients gain essential, tailored recovery tools and a new lease on life. No two recovery journeys are the same. Our clinical services reflect that.
Insurance Coverage Options for Veterans and Active-Duty Military
At Miramar Health, we believe financial concerns should not be a barrier to recovery. We’re committed to making our comprehensive treatment services accessible to all active-duty personnel, veterans, and their spouses.
We accept the VA-eligible insurance plans, TriWest for veterans and Tricare for active-duty members and families. Our dedicated admission specialists are here to assist you in understanding the details of your coverage and will help you navigate the complex process of insurance claims.
We also accept most major commercial policies
Types of Trauma Veterans Suffer
Veterans and active duty military can experience trauma stemming from a combination of intense, life-altering experiences during military service, including:
Experiencing life-threatening situations, seeing death, or being exposed to acts of war can create lasting psychological impacts.
Any sexual harassment or sexual assault that occurs while a service member is in the military.
Emotional and psychological distress that occurs when a service member experiences, witnesses, or participates in actions that violate their personal moral or ethical code.
Sustained stress responses that are not resolved can lead to hypervigilance or a constant state of alert.
Life can be a challenging process with high levels of stress.
Due to emotional numbness or anger issues can result in symptoms of PTSD.
Can lead to worsening of symptoms.
Service members do not need to be in combat to develop PTSD. Other traumatic experiences, such as training accidents, physical assaults, or natural disasters during service, can also lead to PTSD.
How to Know if You Have Trauma
Anger is often a central feature in PTSD, with sufferers feeling irritable and prone to angry outbursts with themselves, others around them, and the world in general. Many Veterans feel let down, abandoned, and judged by others.
They may have a sense of betrayal about the way they were treated on their return home or about things that have happened since. These feelings of betrayal often result in bitterness and anger.
Three Types of Trauma Symptoms
Trauma presents itself in three major ways, summarized below:
Intrusion
Reliving the traumatic event through flashbacks, nightmares, and frightening thoughts that can result in physical symptoms such as racing pulse, sweating, pain, feeling sick, and tremors. Overall, these “intrusive” symptoms cause intense distress and can result in other emotions such as grief, guilt, fear, or anger.
The main intrusive symptoms include:
- Distressing memories or images of the incident
- Nightmares of the event or other frightening themes
- Flashbacks (reliving the event)
- Becoming upset when reminded of the incident
- Physical symptoms, such as sweating, increased heart rate, or muscle tension when reminded of the event
Avoidance
Memories and reminders of traumatic events are very unpleasant and usually lead to considerable distress. People with PTSD often try not to think about, or talk about, what happened, and attempt to cut themselves off from the painful feelings associated with the memories.
As a result, those with trauma intentionally avoid a wide range of feelings, people, and places that trigger recall of the traumatic event.:
The main avoidance symptoms are:
- Trying to avoid any reminders of the trauma, such as thoughts, feelings, conversations, activities, places, and people
- Gaps in memory– forgetting parts of the experience
- Losing interest in normal activities
- Feeling cut off or detached from loved ones
- Feeling flat or numb
- Difficulty imagining a future
Arousal, hypervigilance, and reactivity
People with PTSD may frequently feel “on edge,” always “on alert,” tense, jittery, and anxious, resulting in irritability, trouble sleeping, being easily startled, angry outbursts, difficulty concentrating, self-medicating, or self-destructive behaviors.
The main arousal symptoms are:
- Sleep disturbance
- Anger and irritability
- Concentration problems
- Constantly on the lookout for signs of danger
- Jumpy, easily startled
These may all be accompanied by negative thoughts or mood, such as experiencing negative thoughts and feelings about oneself, the event, or others; loss of interest in hobbies; and frequent feelings of guilt, shame, or blame.
How Does Trauma Affect The Brain?
Emotional trauma results in changes in brain structures, neural pathways, and stress responses due to extreme fear or distress. Brain structures and function can be altered, although not typically permanently, following therapy. The main brain areas affected are:
Amygdala Hyperactivity
The amygdala is the brain’s fear center. It becomes overactive, triggering the fight/flight/freeze responses. This results in intense emotional and physical reactions.
Prefrontal Cortex (PFC) Dysfunction
The PFC, the center of the brain’s rational decision-making activity, weakens and with it a loss of control over emotions and fear responses. This may lead to impulsiveness, emotional outbursts, and difficulty calming down.
Hippocampus Shrinkage
New memories form in the hippocampus. With chronic stress, the volume of the hippocampus reduces. This impacts the consolidation and storage of memories, leading to flashbacks or fragmented trauma memories such as vivid nightmares.
HPA Axis Dysregulation
The stress hormone system known as the hypothalamic-pituitary-adrenal (HPA) axis, stays stuck in overdrive. The “stress hormone” cortisol keeps the body in a heightened state of alert, causing exhaustion.
Neurochemical Imbalances
Norepinephrine, a neurotransmitter, surges, resulting in hypervigilance and insomnia. Disruptions in serotonin and dopamine, both neurotransmitters, can lead to depression, emotional numbness, and risk of addiction.
Altered Brain Connectivity
Communication between the amygdala, PFC, and insula (responsible for body awareness) is disrupted by trauma, resulting in dissociation, emotional numbness, or exaggerated startle responses.
Long-Term Effects
Trauma responses are reinforced by these structural changes making it harder to recover without therapy. Through treatments such as therapy (CBT, PE) and medications (SSRIs), neuroplasticity allows healing.
How Does Trauma Affect Mental Health?
PTSD is not the only psychological response to trauma. The most commonly associated problems with trauma are anxiety, depression, and alcohol or drug use. These can be very disabling to the person suffering from them and may affect family members and co-workers.
Anxiety
Is a state of apprehension and worry that something unpleasant is about to happen. Physical symptoms in the form of panic attacks, which can be frightening, are often experienced. Anxiety can be related to specific situations, such as crowded spaces, public transport, or social events, or it may be a general state of worry. Symptoms are very unpleasant and may cause a high level of distress.
Depression
Is a general state of low mood and a loss of interest or pleasure in activities that were once enjoyed. It is often accompanied by guilt, shame, and remorse related to military experiences.
Substance abuse
Is a common characteristic of those with PTSD as they seek to manage their emotions and thoughts related to their trauma. Often a person may have a co-occurring disorder with mental health issues, causing substance abuse or vice versa. Around 50% of males and 25% of females with chronic PTSD have major problems with alcohol and drugs; the figures for veterans are even higher.
What Does Trauma-Informed Mean?
SAMHSA defines trauma-informed care as “a trauma-informed approach incorporates three key elements:
Realizing the prevalence of trauma
Recognizing how trauma affects all individuals involved with the program, organization, or system, including its own workforce
Responding by putting this knowledge into practice, resulting in trauma-sensitive or trauma-responsive services
What Is Trauma-Informed Therapy?
Trauma-informed therapy begins with a strengths-based approach by shifting from asking “What’s wrong with you?” to “What happened to you?. In doing so it creates a compassionate space for healing.
SAMHSA (Substance Abuse and Mental Health Services Administration) defines trauma-informed care as follows:
Safety
Both physical and emotional safety are key, avoiding triggering language or re-traumatization.
Trustworthiness & Transparency
Clear transparent communication that builds trust through honesty.
Peer Support and Collaboration
Encouraging the therapist and client to work as partners and incorporating support groups or peer support is core.
Empowerment & Choice
Offering choices helps clients regain control over their lives combined with highlighting resilience not just symptoms.
Cultural, Historical & Gender Sensitivity
Respect diverse backgrounds and identities and how systemic oppression can compound trauma.
Understanding Trauma’s Impact
Recognize how trauma affects memory, emotions, relationships, and physical health.
Core Principles of Trauma-Informed Care
Several core principles of trauma-informed care are:
Avoids Re-Traumatization
Doesn’t push clients to relive trauma before they’re ready.
Avoids Re-Traumatization
Doesn’t push clients to relive trauma before they’re ready.
Power Dynamics
Therapist acts as a collaborator, not an authority figure.
Benefits of Trauma Informed Care
Here are six key benefits of trauma-informed care (TIC):
Avoids triggering such as forced retelling of trauma and prioritizes emotional safety. Creates a supportive environment where clients feel in control.
Improves Treatment Engagement & Outcomes
Builds trust, increasing willingness to participate in therapy and addresses root causes of symptoms.
Empowers Survivors
Focuses on strengths, resilience, and client autonomy to help individuals regain a sense of agency over their lives.
Addresses Whole-Person Healing
Recognizes how trauma affects the mind, body, and relationships and uses body-based and emotional therapies.
Promotes Cultural Sensitivity and Equity
Acknowledges systemic trauma and tailors care accordingly while reducing stigma.
Benefits Providers & Systems
Lowers burnout among clinicians by fostering collaborative, compassionate care, and is more effective for organizations.
Understanding the Unique Needs of Veterans
Veterans face unique trauma-related challenges due to military service, requiring specialized understanding in mental health care. Veterans need care that honors their service while addressing invisible wounds. Trauma-informed providers should adapt frameworks to military culture and prioritize trust, safety, and mission-aligned goals. Examples include:
1. Military-Specific Trauma Exposure:
- Combat Trauma
- Military Sexual Trauma (MST)
- Loss of Comrades
Trauma-Informed Response:
- Avoid assumptions
- Use evidence-based therapies for combat PTSD.
2. Challenges Transitioning to Civilian Life
- Identity Loss
- Social Isolation
- Physical Injuries
Trauma-Informed Response:
- Help rebuild identity through vocational support and peer groups
- Address physical and mental health together
3. Barriers to Seeking Help
- Stigma
- System Distrust
Trauma-Informed Response:
- Normalize help-seeking
- Offer confidential, non-VA options
4. High Risk of Suicide & Substance Use
- Veterans are 1.5x more likely to die by suicide than civilians (VA, 2023).
- Self-medication with alcohol/drugs is common.
Trauma-Informed Response:
- Safety planning + crisis resources
- Treat substance use as a coping mechanism, not a failure
5. Family & Relationship Strain
- Secondary Trauma with spouses/children
- Divorce Rates
Trauma-Informed Response:
- Include families in therapy
- Teach communication tools
Key Adjustments in Trauma-Informed Care for Veterans
- Language Matters
- Structure & Clarity
- Peer Support
Resources for Veteran-Specific Trauma Care
- VA PTSD Programs: www.ptsd.va.gov
- Give an Hour: Free counseling from civilian providers.
- Cohen Veterans Network: Low-cost therapy for post-9/11 veterans.
Supporting Families as a Whole
Supporting veteran families as a whole requires recognizing that military service impacts every family member—spouses, children, and even extended relatives. Veteran families heal best when treated as a unit, not just the veteran alone. Effective support includes:
- Education (how trauma affects the family)
- Communication tools (to rebuild trust)
- Community (to combat isolation)
- Crisis preparedness (to ensure safety)
Trauma-informed care for these families should address shared stressors, communication barriers, and collective healing. Safety planning in the form of a crisis plan with the whole family (e.g., safe words, emergency contacts) is helpful to reduce anxiety and conflict.
Hotlines:
- Veterans Crisis Line: 988, then press 1 (or text 838255).
- National Domestic Violence Hotline: 1-800-799-SAFE (7233).
Hotlines:
- VA’s Coaching Into Care Program (helps families encourage veterans to seek help): 1-888-823-7458.
- Tragedy Assistance Program for Survivors (TAPS): Support for families of fallen service members
Addressing Co-occurring Disorders
Co-occurring disorders are very common among veterans and active-duty military. Substance abuse and mental health issues often reinforce one another. For this reason, a trauma-informed treatment approach that addresses these together is currently the best practice.
How We Apply the Trauma-Informed Care Model at Miramar Health
By carefully adopting the core principles and therapeutic practices described above, Miramar strives to help veterans and active-duty military overcome trauma and PTSD.
- Acceptance and Commitment Therapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy
- Family Therapy
- Group Therapy
- Holistic therapies: Art therapy and others
- Motivational Interviewing
- Neurofeedback
- Relapse Prevention
- The Social Model
FAQs
Does trauma affect memory?
Yes it can affect memory in various ways. This depends on the type and severity of the trauma, individual differences in coping, and neurobiology. Trauma can both enhance and disrupt memory in complex ways. While some people remember trauma vividly, others may have gaps or distortions.
Trauma can alter the hippocampus, responsible for memory consolidation, the amygdala, where emotional memory is stored, and the prefrontal cortex (memory retrieval). High stress hormone (cortisol) levels during trauma can enhance or suppress memory formation since extreme stress can disrupt the brain’s ability to encode and store memories properly.
And the brain prioritizes emotional survival over accurate recall, leading to fragmented or suppressed memories.
What insurance do you accept?
Miramar Health is a VHA “in-network” Community Care Network (CCN) Provider through TriWest Healthcare Alliance, and we are contracted by them to provide Substance Use Disorder and Mental Health Treatment on behalf of every Veterans Affairs Medical Center in CCN Regions 4 and 5. These regions encompass all U.S. states in the Pacific Time Zone, Mountain Time Zone, Alaska, Hawaii, and the U.S. territories of Guam, American Samoa, and the Northern Mariana Islands. For active-duty members and family coverage we accept Tricare.
What does trauma-informed care mean?
It is based on the following core concepts: safety, trustworthiness and transparency, peer support and collaboration, empowerment and choice, cultural, historical, and gender sensitivity, understanding trauma’s impact.
What about family support?
This is key for veteran’s families. Effective support includes:
Education about how trauma affects the family.
- Communication tools to rebuild trust.
- Community to combat isolation.
- Crisis preparedness to ensure safety.
Contact Miramar Health to Get the Help You Deserve
Veterans Crisis Line:
988, then press 1 (or text 838255).
National Domestic Violence Hotline:
1-800-799-SAFE (7233).
VA’s Coaching Into Care Program (helps families encourage veterans to seek help):
1-888-823-7458.
Tragedy Assistance Program for Survivors (TAPS): Support for families of fallen service members
We also accept most major commercial policies