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Monday, March 27, 2017
Is addiction caused by drugs alone? Or do chronic stress and trauma in childhood play the determining factor in predicting who will lose control once they start using drugs?
As our society still tries to deal with the consequences of 9/11 a full fifteen years after the attacks, the continuing role of childhood trauma in addiction gains increasing scientific traction. Early life experience programs the brain and body for the environment it encounters: a calm, nurturing upbringing will orient a child to thrive in most conditions, while a stressful, barren one will predispose it to conditions of scarcity, anxiety and chaos. Not all stress is bad, however. Learning requires some stress, and coping with intermittent, mild doses builds the system up, like a muscle. Stress crosses into the hazard zone of trauma only when it comes in "doses" that are too large or too unpredictable or too sustained over which the person has little or no control. Paradoxically, early neglect—an absence of parenting—can be as traumatic as overt abuse.
One study of children who attended the 10 middle and high schools closest to ground zero where the Twin Towers stood found that the greater the number of trauma-inducing factors they experienced, the more likely the kids were to increase their use of alcohol and other drugs. These factors included knowing someone who died, being personally in fear for your life or that of your 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 werea stunning 19 times more likelyto 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.
This research confirms a whole body of literature showing that the more stressful your childhood experiences—and the more different your types of stress—the greater your odds of later life addiction. 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.
“These are extraordinarily strong relationships,” says Dr. Vincent Felitti, a founder of the ACE study and the former chief of preventive medicine at Kaiser Permanente in San Diego. “You read the newspaper and the cancer scare of the week is about something that raises risk by 30%. Here, we’re talking thousands of percentage points.”
The type of adverse experience doesn’t make a large difference in the results, according to Felitti: 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.)
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. Sexual humiliation, such as forcing men or teenage boys to wear drag or women pose as prostitutes, is not uncommon. Although mainstream programs like Phoenix House and Daytop have worked to eliminate such degrading practices, they persist in the industry, particularly—and tragically—with adolescents.
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. 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. Though all addiction is certainly not caused by trauma, it is becoming increasingly clear that it can be a big part of the disorder.
Fortunately, the same key factor that provokes resilience in children coping with chronic stress also spurs recovery in from addiction. That’s social support: whether it comes from a 12-step program like AA, from family members, a loving spouse, friends, other support groups or civic and religious organizations. Safe, familiar people buffer us against stress: the physiology of our stress systems is designed to calm down with a nurturing word or touch from someone we trust. If we want to prevent addiction and promote recovery, we need to love more and stress less.
Maia Szalavitz is a columnist at The Fix. She also is a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).