As therapists, we’ve always known that trauma and addiction are two interlinked concepts, but it’s time to do a deep dive into the topic and gain a stronger understanding of just how childhood trauma can lead to addiction in adults.
Brighton Therapy Partnership recently hosted a workshop on Numbing the Pain: Making the Link between Childhood Trauma and Addiction. The workshop was run by the wonderful Christiane Sanderson a Psychologist and Consultant in domestic and sexual violence and interpersonal abuse, as well as a published writer.
Her in-depth workshop focused on the effects of childhood trauma and how it shows up later in life. Christiane offered extremely informative insights over the course of the day in regards to connecting how traumatic childhood experiences leaves a person vulnerable to addiction. We’ve done our utmost to condense as much of that learning as possible into this article.
The nine things to know about trauma and addiction
Dutch Psychiatrist Bessel van der Kolk points out that there is almost a direct correlation between childhood trauma and addiction. ‘People that feel good about themselves don’t do things that endanger their bodies… Traumatized people feel agitated, restless, tight in the chest. You hate the way you feel. They take drugs in order to stabilize their bodies.’
Here we summarise and share with you 9 things that, as therapists, we need to think about when making connections between childhood trauma and addictions in adulthood with the clients that we support.
1. The Theories of Addiction
Does a person have an addictive personality? Is it genetic? Are people are just ‘wired that way’? Do those suffering from chronic pain and being prescribed powerful pain killers go on to become addicts? Can early experimentation with illegal substances get a person hooked? There are many, many theories to addictions.
It’s important that, as therapists, we think about our own attitudes to addiction when working with clients. To not make moral judgments where it is seen as a lack of self control, hedonistic or pursuing pleasure. Once a person is in the throes of addiction initially it feels good and that may be part of it, but it is not the whole picture.
However, there are several factors that combine, and all of them have important roles to play. These factors include psychological, religion, family, community, economic, spiritual, lack of control, genetic, biological, pharmaceutical, environmental, self medical hypothesis, disorder attachment, OCD and not feeling that you belong, as well as many more.
There is no one single reason why someone does something. Instead, we must look at the complexity of these factors and how they work with each other.
2. The Addiction Tree
The addiction tree expands our understanding of what addiction is. We tend to focus on alcohol and substance abuse, the tree opens up our understanding and consists of a range of addictions we are all vulnerable to.
The addiction tree forms a range of addictions:
- Activity Addictions – Gambling, crime and exercise.
- Thought Addictions – Obsessional thinking, perfectionism and fantasy.
- Substance Addictions – Alcohol, drugs and food.
- Feelings Addictions – Anger, worrying and guilt.
- People Addictions – Relationships, sex and love.
What could we not live without?
3. The Pursuit of Pleasure
Using drugs and alcohol can feel good, and we tend to focus on the negatives. Why does a person do it? To put it simply because it feels so good. From being on the receiving end of enjoyment, a sense of calmness or the euphoric joy that it brings. It just feels good and alters the way a person acts and feels.
“I do feel invincible… like nothing’s gonna touch me… like I could do this forever. And sometimes I wish that I could have that sexual pleasure feeling forever. I don’t want it to end.” (Lorvick, 2012).
In Christiane’s research with the charity One in Four, her findings show that people are attracted to a particular type of drug depending on what it induces. Understanding the drug of choice and it’s effects can help us understand how a person may be using it to manage their internal state. This can be to either feel alive or to numb the pain:
- Highly hyper-aroused state (hyper alert or vigilant) because they were in a state of fear – their go to drug may be heroin, ketamine or cannabis that helped to bring them down.
- Hypo-aroused (in a dissociative state) where a person feels numb and things are suppressed – their drug of choice may be cocaine or MDMA, substances that induce a sense of euphoria.
The addiction is used to solve the problem. The Self Medication Hypothesis looks at how a person finds a way of medicating unbearable internal states or trauma. These compulsive behaviours are used to self-soothe. It’s important that as therapists we explore what’s running underneath the surface!
4. What runs underneath and how does this link to abuse and trauma?
A client might describe how there is a huge empty space that is unfillable and that there is a yearning to fill this void. Gabor Maté talks about how part of the addiction “is the pursuit of wanting more and more”, so that void can be filled.
Therefore sometimes it may be the anticipated pleasure that provides the adrenaline, rather than the actual subject of the addiction.
We may well discover that at the root of their addiction and empty space is pain. The substance is inducing a state to take the pain away.
“It originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, or loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain.” Gabor Maté
People who have been exposed to high doses of adversity are more likely to engage in high-risk behaviour. Having an understanding about how exposure to early adversarial situations effects the developing brains and bodies of children can tell us as much.
5. The Adverse Childhood Experiences Study
Originally conducted in the USA, a research study called the Adverse Childhood Experiences Study (ACEs Study) ran between 1995 – 1997. They asked 17,337 adults about their history of exposure to what they called ‘Adverse Childhood Experiences’ or ACEs. Those who participated in the research then had a long-term follow up study.
The ACE’s include:
- physical abuse
- sexual abuse
- emotional abuse
- physical neglect
- witnessing violence in the home or within the community
- having a family member attempt or die by suicide
- one parent addicted to substance misuse
- one parent with mental health problems
- parental separation or divorce
- one parent in prison
These traumatic childhood events are linked to chronic health problems such as struggling with obesity, mental illness, and substance misuse in adulthood.
In 2015, the Welsh ACE Study examined 2000 participants between 18-69 from across Wales. Their findings showed that 47% of adults suffered at least 1 ACE as a child and 14% suffered 4 or more.
Compared to individuals reporting no ACEs, individuals who had experienced four or more ACEs were:
- 7 times more likely to be alcoholic
- 10 times more likely to have injected street drugs
- 12 – 14 times more likely to have attempted suicide.
6. The science of trauma and addiction
People that have been exposed to high doses of adversity are more likely to engage in high-risk behaviour. Trauma affects areas like the nucleus accumbens – the pleasure and reward centre of the brain that is implicated in substance dependence.
Recreational drugs mimic what our own bodies produce. They alter how we act and feel but how does this link to our body? Our bodies are addicts to the natural chemicals in the brain that help us to feel good.
Our brain naturally releases a quartet of happy chemicals – dopamine, serotonin, oxytocin and endorphin – to make us feel great. These substances act as mood enhancers and trick our brain into releasing happy chemicals:
- Euphoria and intense sexual feelings (Dopamine) – similar effects are found in caffeine, weed, and alcohol.
- Confidence and feelings of satisfaction and accomplishment (Serotonin) are found in cocaine.
- Love this love hormone plays a role in social bonding, sexual reproduction similar feelings (Oxytocin) found in MDMA
- Happiness reduces our perception of pain (Endorphin) and are found in heroin, codeine and morphine.
These mood enhancers work for a short time to take away the pain as they alter how we act or feel. Or they make us feel alive, and numb the pain. The drug of choice becomes the way of coping with the trauma.
7. At the root of all addiction is pain
Addictions almost always originate in pain, whether felt openly or hidden in the unconscious. Not all addictions are rooted in abuse or trauma, but they can nearly all be traced to a painful experience(s) in a person’s life. They are emotional anaesthetics that can be used in different ways to fill a void, as a stress reliever, to help one feel alive, as an adrenaline rush, or to provide a feeling of belonging.
A client might be referred because of a recent loss in their life which may then manifest as a powerful predictor for the reactivation of childhood trauma. A person may come to you because they are scared of forming relationships and it feels safer to get a release from pornography or sex workers. They may find that hostility has become a barrier as they feel terrified of being close to someone. Issues of wanting to be close but then scared of being close arise.
Many computer games are about creating self esteem, and if you get good at the games you go up in the ranks and reap the rewards. For some, this may be the only source of self esteem that they receive.
There may have been a lack of attachment in childhood which leads a person to become dependent on an external source for soothing.This could be where a person seeks external sources of self soothing in love, sex, alcohol or drugs. Heroin has been described as experiencing a loving safe hug which we can link to attachment in that moment.
It’s important that we explore what’s happened and what has brought them to therapy. A person may tell you that they want to reduce, quit and find these substances hard to let go and then shame shows itself.
8. The role of shame that drove the addiction in the first place
When a client has an addiction we tend to find that there will be shame. And it’s really important not to re-shame the client. Look at the reasons behind what led them to need to soothe pain or distract from it, or why there is a constant yearning to escape from the discomfort.
How might your client suppress shame? The more shame a person has, the more they might be likely to want to medicate it. When you come down from a high then the shame kicks in. This becomes a cycle, as you might feel ashamed and then you repeat. Explore the link between early childhood experiences.
9. ‘Them vs Us’?
It’s important to be mindful, it should not be the case that they are addicts and some how we are not.
Who doesn’t love an addictively good box set that you just HAVE to watch? Or enjoying a well earned G&T or a glass of wine as a reward for getting yourself through the day or for finally getting the kids go to bed? From the high that you receive from the likes on your social media, to the boost of self-esteem that rises as you go through the ranks of a video game? We all do things to feel better about ourselves.
Addiction is neither a choice or disease. As therapists it is so important for us to explore the original source of a person;s background and their lived experience – how they felt when taking the substance rather than focusing on what the actual substance is can offer us so much more information.
Here are some of the future questions we can be thinking of as therapists:
- Can we form more partnerships with alcohol and drug services and form a multidisciplinary treatment team?
- Encouraging these services to ask the right questions in order to record the link with survivors’ experiences to alcohol and drug abuse to works towards reducing the dose of adversity.
- What is the experience like and how does it affect them?
- What did the short term effect offer you?
Always remember Maté’s mantra: ‘The first question is not’ “Why the addiction?” but “Why the pain?”
Brighton Therapy Partnership offers numerous training courses throughout the year, as well as online video training through our groundbreaking Therapy Education Online platform.
We’re currently offering 20% off our Trauma Masterclass, with over 4 hours of video content from expert speakers. Enter THEO2020 at checkout by 31 May 2020 to receive your discount.
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