Enduring adversity in childhood presents both challenges and opportunities in later life. But it is known that experiencing significant trauma in childhood considerably increases the risk of misusing drugs and/or alcohol. Research tells us that our early life experience programmes the brain and the body for the environment that it encounters. So a calm, nurturing childhood is likely to orientate a child to thrive in most conditions, while a highly stressful, bleak, abusive one will predispose it to conditions of anxiety, insecurity and chaos. What is interesting is why some individuals do not suffer from addictive behaviours and mental health problems, while others do.
Abuse and trauma in childhood take many forms and are categorised under physical, emotional and sexual harm. Much under reported but very common, is the impact upon children of a low level but pervasive parental vacuum, where there is a significant absence of real parental engagement. This can be because the parent is preoccupied with their own problems, such as depression or mental illness; or it can be because they are dangerously immature, and therefore more concerned with having their needs met than nurturing their child and overseeing their teenager. Even more damaging to a child can be the chronic recurrent humiliation of emotional abuse – being told that you are useless or not good enough.
The term ‘child’ refers to pre-birth from the time of conception, through to the age of 18. Some parents consider that their role as vigilant and nurturing carers ends when their child reaches ten or 12 years. But young people require love, care and actual parenting until they are adults themselves – and beyond. Many young people find themselves becoming increasingly involved in drug and alcohol misuse, but this can be overlooked, minimised or rationalised by a parent until it is too late.
In my 35 years of practice in this field, the most common factor I have come across when talking to those suffering from substance misuse and mental health problems, is that there has been some very significant trauma in their lives that they have not fully revealed before, and certainly not recovered from.
Research bears out that those who misuse drugs or alcohol have so often been victims of sexual abuse. Such victims suffer post-traumatic stress disorder leading to poor coping skills, anti-social behaviour, depression, anxiety, low self-esteem and problems in forming trusting relationships. Substances can be used to cope with or escape the trauma and memories of sexual abuse, and as a way to reduce a sense of isolation and loneliness. They become a form of self-medication, to boost confidence and improve self-esteem, or a form of self-destructive behaviour and self-harm. Either way, an individual has raised the red flag asking for help, and as practitioners we need to respond quickly.
A significant percentage of those who have a substance misuse problem also have a recurring mental disorder such as depression, anxiety and/or post-traumatic stress disorder. Process addiction, such as gambling, disordered eating and internet addiction, has been found widely in those who report childhood sexual abuse. Of course one of the difficulties of this kind of abuse is the difficulty for survivors in acknowledging and reporting it, and it is also difficult for caregivers to identify.
Research confirms that the more adverse childhood experiences encountered, and the higher the types of stress, the greater the odds are of an individual suffering with later life addiction. The adverse childhood experiences (ACE) study included 17,000 participants and found multiple relationships between severe childhood stress and all types of addictions, including under and over-eating. These adverse experiences included emotional, physical and sexual abuse, neglect, and living in a house where domestic violence had taken place. Compared to a child with no adverse childhood experiences, one with six adverse or more experiences is nearly three times more likely to become a smoker as a child; a child with four or more is five times more likely to become an alcoholic and 60 per cent more likely to become obese. A boy with four or more ACEs is 46 times more likely to become an IV drug user in later life than one who had no severe childhood experiences.
An adult survivor of child sexual abuse cannot be categorised easily. There are complex dynamics at play and deep trauma at work. Generally speaking, adults will normally have one or two outlooks on life after such abuse. They will either collapse or they will attempt to rise above the abuse. The collapsed outcome is an adult who has easily recognisable symptoms and problems that stop them from being functional in more than one area of their life. They have depressive, addictive or victim status personas, and require ongoing medical and other assistance to cope.
The second outcome often includes those who dissociate from the abuse by ‘soldiering on’ and maintain, for some time, an intact functional life in work and social settings. But they often withdraw or have serious impairment issues in intimate relationships.
Behaviours and coping mechanisms common to both groups can include impulses to abuse another person in some way; promiscuity, frigidity, suicidal thinking, self-mutilation or absence from relationships. There is also a body of evidence that psychosomatic medical disorders often accompany sexually abused children later in life. Survivors can experience unexplained pelvic pain, irritable bowel syndrome, cervical cancers and rashes. The issues are complex.
The good news is that the same key factors which cause some people to misuse drugs and alcohol also provoke resilience, i.e coping with chronic stress and coming through it, developing inner controls and self regulation when provoked. The same factors spur recovery from addiction, finding and maintaining social support, developing a confiding relationship with someone, becoming a loving partner or parent, and being involved in groups or religious organisations. Safe, familiar people in whom an individual can confide buffer against stress since our stress systems are designed to be calmed down with a nurturing word or touch from someone we trust.
It takes courage to talk about an adverse childhood experience, especially when it may have become muddled or confused, and particularly if it was a sexual experience. Encouraging individuals who are suffering as substance misusers to speak about their early life experiences is often the start of helping them to become released from the burden – and the real beginning of the healing process.
Elaine Rose is a child and family psychotherapist with a background as a social worker. She is in private practice in Kent, specialising in work with all in the adoption triangle.
Breach of trust
I was sexually abused by my mother. Every part of me felt ruined by this, all the way through me, right to my soul. I thought I was the only one. It was something I was certain I would never and could never speak about. I didn’t even see it as sexual abuse when I was a child as I only heard of uncles abusing or perverts in parks, not a female, let alone a mother, so I saw myself as having the most vile, terrifying and disgusting things happen to me.
But it must have been my fault because it never happened to anyone else in the world ever, and that’s why I thought I was the most disgusting thing on the planet. Even though I tried to stop it in any way I could think of, I was also dependent on this person for my life, food and shelter.
My first memories of it were as a five-year-old and I still can’t get the contaminated feelings and taste out of my mouth from what she made me do.
I feel I didn’t have a childhood. I have felt so horribly isolated and alone in a world that was unsafe, especially at home in any room, at any time. I tried to speak out when I was five, but nothing was done and it just made it worse, as I was told by my mother that no one wanted to know and no one would believe me.
As a young child I felt completely different to everyone else. I knew I only had myself to depend on. I cannot remember any moment in my childhood being truly happy.
Self-annihilation, utter isolation, shame, self-disgust, extreme trauma, anxiety, depression and anger are all things I have lived with throughout my life; with the resulting self-harm in many forms through having no value to my life, and addictive tendencies to keep away from my inner reality and beliefs.
Waking up screaming in the middle of the night or not sleeping at all for very long periods, or indeed being overwhelmed with flashbacks, visual and non-visual, day and night, as if in my worst nightmare, and resulting suicide attempts. These were all my symptoms of complex post-traumatic stress disorder.
The horror of the years of abuse, which was emotional and physical also, at times torturous on all levels, still haunts me. The horrid, contaminating, vile, and most disgusting thing that could happen and the betrayal by the person who brought me into the world – breaking what I believe should be a sacred bond.
One in Four provides support and resources for those who have experience of sexual abuse, www.oneinfour.org.uk
Cohen L.R., Tross, Pavlicova, Hu, Campbell, Newns, Substance Use Childhood Sexual Abuse and Sexual Risk Behaviour among Women in Methadone Treatment. A.M. J. Drug Alcohol Abuse 2009, 35, 305-310.
Freeman, Collier, Pirrill, Early Life Sex Abuse is a Risk Factor for Crack Cocaine Use in the Sample of Community Recruited Women at High Risk for Illicit Drug Use, 2002, 28, 109-131.
Edwards Lee & Lyvers, Childhood Sexual Abuse and Substance Abuse in Relation to Depression and Coping, General Substance Misuse 2008, 13, 349-360.
Manigilio, The Role of Child Sexual Abuse in the Aetiology of Substance Related Disorders, J. Addict Dis. 2011, 30, 216-228.
Dillon L., Chivite-Matthews N., Grewal I., Brown R., Webster S., Weddell E., Brown G. and Smith N., Risk, protective factors and resilience to drug use: identifying resilient young people and learning from their experiences, (OLR 04/07)