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Wednesday, August 26, 2015

Childhood Trauma Increases Potential For Drug Addiction

For a long time now, research has confirmed an established link between childhood trauma and psychiatric symptoms in adulthood and also evidence to suggest a link between such early life experiences and substance misuse.

(J. Briere, J. and M.  Runtz. "Childhood sexual abuse : long term sequelae and implications for psychological assessment." Journal of Interpersonal Violence, 8. 1993.)

Contemporary psychoanalytic theories of addiction also emphasize the relationship between experience of early life trauma and later substance misuse, proposing that drug use is an attempt at self-medication, or a chemical means of inducing a dissociative state, so often apparent in victims of child abuse. Researchers find that substance misuse offers an external means of discharging painful internal states, through immediate action.

(L. Wurmser. "The role of superego conflicts in substance abuse and their treatment." International Journal of Psychoanalytic Psychotherapy.10. 1984.)

(J. McDougall. Theatres of the Body : A Psychoanalytical Approach to Psychosomatic Illness. London. 1989.)

Why is understanding this information so important for those concerned about stopping addiction and overdose? I believe it is vital to examine all risk factors for addiction. For example, in schools, counselors, psychologists, and Human Service officials work together to identify and treat trauma and psychiatric disorders suffered by students. These people must stay up-to-date on findings related to their clients.

Proper attention and timely intervention for children who live with trauma not only can prevent their drug addiction but also can save their lives. Understanding how severe stress and trauma can lead to addiction and other mental illnesses should ultimately help lead to better treatments. 

Much research now confirms that severe trauma can lead to drug addiction.

One study of children who attended the 10 middle and high schools closest to the Twin Towers at 9/11 ground zero found that the greater the number of trauma-inducing factors children had experienced, the more likely the kids were to increase their use of alcohol and other drugs. These factors included their knowing someone who had died, being personally in fear for their life or that of their loved ones during the attacks, and how close their school was to the towers. 

Compared to those with no exposure factors, teens with one were five times more likely to increase alcohol and other drug use, and those with three or more factors were a stunning 19 times more likely to increase their alcohol or drug use. The youth who increased their use had more difficulty with their schoolwork, lower grades and more behavior problems, suggesting that they weren’t just using drugs but had developed drug abuse or even potential dependence.

(Claude M. Chemtob, Yoko Nomura, Louis Josephson, Richard E. Adams and Lloyd Sederer. "Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks." Disasters, 33. July 2009.)

The Adverse Childhood Experiences (ACE) study, which includes some 17,000 participants in California’s Kaiser Permanente insurance program, found multiple, dose-dependent relationships between severe childhood stress and all types of addictions, including overeating.

Adverse childhood experiences measured included emotional, physical and sexual abuse, neglect, having a mentally ill or addicted parent, losing a parent to death or divorce, living in a house with domestic violence and having an incarcerated parent.

Compared to a child with no ACEs, one with six or more is nearly three times more likely to be a smoker as an adult. A child with four or more is five times more likely to become an alcoholic and 60% more likely to become obese. And a boy with four or more ACEs is a whopping 46 times more likely to become an IV drug user later in life than one who has had no severe adverse childhood experiences.

The type of adverse experience doesn’t make a large difference in the results, according to Dr. Vincent Felitti, head of the study. What seems to matter most is the cumulative effect of multiple types of stress. For example, having been both physically abused and neglected is worse than having been physically abused alone.

One factor does stand out, however. “I would have assumed before we looked at it that probably the most destructive problem would be incest—but interestingly it was not, it was co-equal with the others,” says Felitti.

Instead, he notes, The one with the slight edge, by 15% over the others, was chronic recurrent humiliation, what we termed as emotional abuse,” citing examples like parents calling their children stupid and worthless. (The study did not look at bullying by peers, but other studies have found that such abuse can haver similarly negative health effects.)

Among other of the most negative stress response are the following:

* The feeling of being helpless, combined with ongoing "emotional abuse,"
* Chronic neglect,
* Caregiver substance abuse or mental illness,
* Exposure to violence, and
* The accumulated burdens of family financial hardship -- without adequate adult support.

Ironically, humiliation is a common theme in addiction treatment, where tough confrontation to “break” addicts remains a frequent practice, despite research showing its ineffectiveness and harmfulness. Some so-called therapeutic-community programs, for example, place people on a “hot seat,” where they are confronted about their personality flaws and other negative qualities, sometimes for hours on end. Other programs force people to wear humiliating signs or even diapers. Indeed, people traumatized as children can actually be re-traumatized by this form of treatment, exacerbating both post-traumatic stress disorder and addiction.

Felitti insists that the best way to treat addiction is with empathy and compassion. “I would argue that the person using [drugs] is not using them to have a problem, they’re using drugs to find a solution,” he says.

Nearly 3 million U.S. children experience some form of maltreatment annually, predominantly by a parent, family member or other adult caregiver, according to the U.S. Children’s Bureau. The American Academy of Pediatrics in 2012 identified psychological maltreatment as “the most challenging and prevalent form of child abuse and neglect.”

A growing body of research, including a new study published by the American Psychological Association, concludes that children who are emotionally abused and neglected face similar and sometimes worse mental health problems as children who are physically or sexually abused, yet psychological abuse is rarely addressed in prevention programs or in treating victims.

(Joseph Spinazzola, PhD. "Psychological Trauma: Theory, Research, Practice, and Policy."
APA Journal. 2014)

Although some addicts have no apparent childhood trauma, at least half have suffered at least one form of severe childhood stress and many have experiences multiple exposures. Among people with the most severe addictions, trauma histories are ubiquitous. And emotional sensitivity, which varies widely with genetics, may make experiences that would not be traumatic for most children intensely traumatic for some.

(Maia Szalavitz. "How Childhood Trauma Creates Life-long Adult Addicts." Study by Vincent Felitti. September 25, 2011.)

(Vincent J Felitti MD, FACP, Robert F Anda, Dale Nordenberg MD,  David F Williamson MS, PhD, Alison M Spitz, Valerie Edwards, Mary P Koss. "Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults." The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998.)

One study found maltreatment caused actual changes in children's brains. Researchers at the University of Texas studied 32 teens, 19 of whom had been maltreated in childhood but did not have a current psychiatric disorder.

The researchers defined child trauma or maltreatment as any type of significant abuse or neglect lasting six months or longer, or a major traumatic experience like life-threatening illness, witnessing domestic violence or losing a parent before age 10. The other 13 participants in the study served as the control group, having no history of major child trauma or psychiatric problems.

Using a brain-imaging technique that measures the integrity of the white matter that connects various brain regions, the researchers looked for any differences in the teens’ brains when they were first enrolled in the study, before they had developed any psychiatric problems.

This is what the admittedly small sample study found:

"The scans showed that kids who had been maltreated showed connectivity problems in several brain areas, including the superior longitudinal fasciculus (SLF), which is involved in planning behavior and, usually on the left side of the brain, in language processing.

"Another affected region was the right cingulum-hippocampus projection (CGH-R). This tract helps connect the brain’s emotional processing regions with those involved in more abstract thought, ideally allowing the person to integrate both types of information and to regulate their response to emotional stress.

"The teens who developed depression had the most significant reductions in white matter in their SLF; those who developed drug problems were more likely to show greater white matter loss in the CGH-R. These changes suggest that depression-specific vulnerability may be linked to rumination and processing of language that is focused on the negative, while addiction susceptibility may be linked to an inability to regulate emotions more generally."

(Hao Huang, Tejasvi Gundapuneedi, and Uma Rao. "White Matter Disruptions in Adolescents Exposed to Childhood Maltreatment and Vulnerability to Psychopathology." Neuropsychopharmacology, 37. 2012)

Data from the National Survey of Adolescents and other studies indicate that one in four children and adolescents in the United States experiences at least one potentially traumatic event before the age of 16, and more than 13% of 7-year-olds -- one in eight -- have experienced posttraumatic stress disorder (PTSD) at some point in their lives.

(D.G. Kilpatrick, B.E. and Smith, D.W. "Youth Victimization: Prevalence and Implications." U.S. Department of Justice, Office of Justice Programs,
National Institute of Justice. 2003.)

Most, if not all, young people have access to a wide range of psychoactive substances that can both dull the effects of stress and place teens at increased risk of experiencing trauma. It is estimated that 29% of adolescents -- nearly one in three -- have experimented with illegal drugs by the time they complete 8th grade, and 41% have consumed alcohol. 

For many adolescents, such early experimentation eventually progresses to abuse of -- or dependence on -- illicit drugs or alcohol. Every year, approximately one in five American adolescents between the ages of 12 and 17 engages in abusive/dependent or problematic use of illicit drugs or alcohol.

(Substance Abuse and Mental Health Services Administration. Results from the 2006
National Survey on Drug Use and Health: National Findings. Rockville, MD: Department of
Health and Human Services. 2007.)

(J.R. Knight, S.K. Harris, L. Sherritt, S Van Hook, N. Lawrence, T. Brooks, et al. "Prevalence of positive substance abuse screen results among adolescent primary care patients." Arch Pediatr Adolesc Med, 161. 2007.)

There is also evidence that youth who are already abusing substances may be less able to cope with a traumatic event as a result of the functional impairments associated with problematic use. In one study, investigators found that even after controlling for exposure to trauma, adolescents with substance abuse disorders were two times more likely to develop PTSD following trauma than were their non-abusing peers.

The researchers suggested that the extensive psychosocial impairments found in adolescents with substance abuse disorders occurred in part because they lacked the skills necessary to cope with trauma exposure.

(R.M. Giaconia, H.Z. Reinherz, A.C. Hauf, A.D. Paradis, M.S. Wasserman, M.S., and D.M. Langhammer. "Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents." Am J Orthopsychiatry, 70. 2000.)

Of course, physical abuse is a trauma that is a major contributing factor to substance abuse. Women who are sexually abused during childhood are at increased risk for drug abuse as adults, according to NIDA-supported research conducted at the Medical College of Virginia Commonwealth University.

(K.S. Kendler. "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and co-twin control analysis." Archives of General Psychiatry, 57. 2000.)

Trauma and Substance Abuse: Myths and Facts:

MYTH: Since most adolescents who use drugs and/or alcohol have experienced some kind of trauma,
there is no need to treat trauma as a unique clinical entity.
FACT: Although not all youth who experience traumatic events develop PTSD, it is important to be
prepared to address the multiple ways youth respond to trauma. Traumatic stress and PTSD are
associated with unique (and challenging) symptoms that require targeted, trauma-informed treatment
to optimize recovery. (For more information, see Understanding Traumatic Stress in Adolescents: A
Primer for Substance Abuse Professionals.) Effective treatment approaches and interventions have
already been developed for patients suffering from traumatic stress and PTSD. Making use of these
techniques as part of a comprehensive treatment plan offers the greatest hope of treatment success
for adolescents dealing with the effects of substance abuse and traumatic stress.

MYTH: When dealing with an adolescent who has a history of trauma and substance abuse, you need to treat one set of problems at a time.
FACT: Because the symptoms associated with traumatic stress and substance abuse are so strongly
linked, the ideal treatment approach is to address both conditions. Unfortunately it is not uncommon
for substance abuse programs to deny admission to patients with PTSD, and for trauma treatment
programs to deny admission to patients who have not achieved sobriety. The decision about which
symptoms and behaviors to address first therefore requires a careful assessment of the relative threat
that each condition poses to a youth’s safety, health, and immediate well-being.

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