Made up of over 86 billion neurons, the brain remains one of the most puzzling and amazing organs in our bodies. You need it to do pretty much everything, so it’s safe to say it runs the show. When adverse experiences take place in childhood, these can leave profound and often perplexing effects on the brain. Some of these experiences fall under different forms of maltreatment such as physical, sexual, and emotional abuse. All forms of child maltreatment have consistently been associated with an abundance of mental health problems and substance use and disorders. Since the brain is still in development until around the age of 25, childhood experiences are especially significant in affecting healthy development and future behaviors.
Where Addiction Takes Root
There are a considerable number of reasons as to why someone may turn to drugs or substances. Creating a dialogue on these reasons necessitates looking beyond the surface—beyond the “face” of addiction, as not many people know (let alone, are willing to talk about) how complex its development can be. Not everyone who has an addiction has one or more identifiable reasons. However, certain risk factors have been connected to the emergence of substance use and disorders. These factors have been proven to increase vulnerability of drug misuse by examining individual and surrounding elements.
A 2017 publication by Transactions of the American Clinical and Climatological Association outlined some of these risk factors. The risk factors for addiction can be broken up into two sub-groups: environmental and personal risks. Easy access to drugs and substances, prominent advertising of substances, high levels of familial conflict, and low parental monitoring are all environmental risk factors because they pertain to an individual’s surroundings. Personal risk factors are things such as a family history of substance use, mental health struggles or illnesses, low involvement in school, domestic dysfunction and violence, and a history of abuse and neglect (Mclellan, 2017).
With a clearer understanding of where substance misuse and addictions derive from, we can start to explore further into how everything is interrelated. Some of the most prominent risk factors we’ll be giving our attention to are abuse histories, and mental illnesses and disorders. Each of these has an established connection to the use of substances or developing a substance use disorder. While being a topic that is both extensive and heavy, detangling addiction is essential for societal development and more individualized treatment plans.
Childhood Maltreatment and Trauma
While traumatic events in childhood can provoke powerful emotional and physical reactions in the moment, they can also carry on long after the incident is over. The National Child Traumatic Stress Network explains that a traumatic event can ignite responses in children that directly affect their nervous systems and physical functioning. In cases where a particular traumatic event doesn’t occur, multiple instances of exposure to traumatic circumstances still have equally detrimental repercussions. This is known as developmental trauma, and it’s sustained after repeated distressing experiences (Gregorowski and Soraya Seedat, 2013). According to the CDC, traumas and adversities such as these have proven to sabotage the healthy development of the brain and increase risks of mental health and emotional disorders, suicide, heart disease, chronic health conditions, and drug and substance use.
The Journal of Child and Adolescent Mental Health published an epidemiological study meant to evaluate the risks associated with trauma exposure and PTSD in young people. This kind of study is designed to follow up with participants throughout their lives to find links between risk factors and health status as they approach adulthood. A sample of 2,066 children born in England and Wales between 1994-1995 were assessed for risk factors of PTSD between the ages of 5 and 12. At 18 years old they were interviewed for exposure to trauma and differing forms of psychopathology.
Of those that reported trauma or had risk factors for PTSD, it was found that mental illnesses and disorders were frequently seen in survivors of childhood adversity. People who were exposed to trauma and did not develop PTSD as a result also had severely higher rates for depression and alcohol use disorders. Moreover, a reasonably high 29.2% of people exposed to trauma showed clinical features of major depressive disorder (MDD), while 11.5% showed features of generalized anxiety disorder (GAD). Additionally, 22.9% of the sample showed symptoms of conduct disorder, with 15.9% reporting alcohol dependence. In comparison, an astounding majority of 54.7% of people who were exposed to trauma and did develop PTSD showed features of MDD, 23.8% displayed symptoms of GAD, 27% exhibited clinical features of conduct disorder, and 25.6% reported a dependence on alcohol (Lewis and Arseneault et al, 2013).
Mental Health, Trauma, and Substance Use
Mental illness and substance use have a seemingly comfortable relationship. Did you know that The National Institute on Drug abuse states that 6 in 10 people with an illicit substance use disorder also suffer from a mental illness? It’s even mentioned that over 60% of adolescents in community treatment programs for their use meet criteria for another mental illness. Since we already covered trauma being a catalyst for mental illness in the last section, it’s only fair to start exploring trauma’s direct relationship with substance use.
In 2016 the Journal of Traumatic Stress published a study on trauma exposure, emotional dysregulation, and substance abuse. The purpose of this research was to examine how preeminent drug and substance use was in individuals that experienced a form of trauma or emotional distress. The sample consisted of 2,014 men and women between the ages of 18-65 from diversified sections of the Grady Memorial Hospital in Atlanta, Georgia.
Participants were evaluated using four different means of screening. The first being the Childhood Trauma Questionnaire (CTQ) which is a self-report screen that measures different forms of child maltreatment (physical, sexual, and emotional abuse), the Traumatic Events Inventory (TEI) which assess 17 categories of traumatic events over the lifetime, the Emotional Dysregulation Scale (EDS) which is a 12-item report that reviews different domains of emotional experiencing, the Alcohol Use Disorder Identification Test (AUDIT) which includes 18 items that scale past-year and lifetime use of alcohol, and the Drug Abuse Screening Test (DAST) which contains 20 questions that assess illicit drug use.
There was a lot to unpack from this study, but we’ll be focusing purely on the basics. The sample was analyzed using SPSS-22 software—the world’s leading statistical software for data analysis. After the data was generated, it was found that 95% of the sample reported at least one traumatic event in their lives, and 43.3% of participants reported exposure to at least one form of child abuse. Emotional and sexual abuse were both found to be significant predictors for alcohol usage, with physical abuse leaning towards significance. Apart from that, all forms of maltreatment were associated with emotional dysregulation, which has also been tied to a greater use of drugs and substances in general (Mandavia and Robinson et al, 2016).
Putting Things Into Perspective
Hopefully by now, you can see how this is all coming together. At this point we’ve touched on how addiction gets its start, the connection between trauma and mental health, and mental health’s relationship to substance use. If you’ve made it this far, congratulate yourself. You just came one step closer to dismantling the stereotypes that surround drug addiction. Gaining knowledge in these key areas of mental health is valuable for becoming more empathetic and compassionate, as well as promoting treatments that follow these values. Now what’s left is to zero in on the complicated subject of child maltreatment’s common coupling with addiction.
In 2019, the Candian Journal of Psychiatry ran a study on varying forms of child maltreatment (CM) and lifetime substance use disorders (SUDs). Three forms of maltreatment that were included were physical, emotional, and sexual abuse. A multitude of substances were assessed in this research but these were a few of them: alcohol, opioids, cocaine, amphetamines, nicotine, sedatives, and heroin. Responses were taken from the second wave of the NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), which surveyed 34,653 men and women aged 20 and older. Participants were given questions covering different areas of CM and substance use.
The outcome of the study undeniably carried significance. First, the substances most pervasive across the board for physical, sexual, and emotional abuse were alcohol, opioids, cannabis, cocaine and nicotine. Second, it was instantly apparent that those who experienced any form of CM had increased risks for developing all lifetime SUDs across the board. After adjusting for preexisting mental disorders for physical abuse, the odds for dependence was still significant with emotional abuse following a similar trend. In addition, even though both genders that experienced sexual abuse had higher odds for dependency on substances, women seemed to be the most associated with developing SUDs (Afifi and Henriksen et al, 2012).
To truly illuminate the prevalence of child maltreatment’s connection with substance use, it’s necessary to have a look at some numbers. In a joint effort between the CDC and Kaiser Permanente (a healthcare company based in California), one of the largest investigations on the effects of adverse childhood experiences was carried out from 1995-1997. Ten different categories ranging from all forms of CM to domestic dysfunction, were evaluated in relevance to health risk factors. 13,494 eligible Kaiser Health Plan members were given standardized medical evaluations and the adverse childhood experiences (ACE) questionnaire. Of those same people, 9,508 successfully completed the survey. Considering the heaps of data this study led to, we’ll be going over some of the most relevant findings.
The rates were staggering with 51% of people psychologically abused, 45% of people physically abused, and 39% of people sexually abused exposed to some form of substance abuse. Going forward, people who fell into at least one category of CM or domestic dysfunction were twice as likely to consider themselves alcoholics, while people who fell into two or more categories were 4 times as likely or higher. As for illicit drug use, those who fell into one category were 1.7 times more likely to use, and those who fell into two or more were 2.9 times more likely and higher (Felitti and Anda et al, 1998).
The Truth Behind Addiction
Drug and substance use disorders (SUDs) aren’t uncommon. Addictive disorders are dangerous, and can insert themselves into normal lives with more ease than most would like to believe. Being so prominent in society, addiction has positioned itself as worthy of being considered a public health crisis. As stated by The American Addiction Centers in 2017, 38% of adults suffered with an illicit substance use disorder. During the same year 1 in 8 adults reported struggling with drugs and alcohol. In 2019, over 70,600 people died of drug overdoses in the United States alone. With uncomfortably high rates and tragic outcomes from drug abuse happening everyday, learning more about addiction now is a must.
The relationship between maltreatment, mental illness, trauma, and addiction is understandably very tricky. It can be challenging to gain insight into these subjects, especially if you don’t know where to start. That’s why resources like this exist, so that more individuals have open access to educational content on SUDs. Having this kind of information out there opens doors for survivors and their loved ones to seek treatment options that are more catered to personal life experiences. Not everyone living with a SUD has the same starting point. Approaching addiction strategically and with consideration of prior mental health history leaves room for survivors to begin healing while beginning at the core.
A strong will power or a genuine desire for change isn’t always enough. Moving on from an addictive disorder—whether that be for drugs, substances, or anything else—can be grueling, discouraging, and isolating. A stigmatized idea of who or what a drug user is has made finding the right treatment incredibly more difficult than it needs to be. Addiction is heavy, hard to understand, scary, and truthfully a rabbit hole (if you couldn’t tell). With harsh stereotypes that surround substance abuse, unraveling the roots of addictive disorders can move everyone forward.
Resources
Afifi, T. O., Henriksen, C. A., Asmundson, G. J., & Sareen, J. (2012). Childhood Maltreatment and Substance Use Disorders among Men and Women in a Nationally Representative Sample. The Canadian Journal of Psychiatry, 57(11), 677-686. doi:10.1177/070674371205701105
Alcohol and Drug Abuse Statistics. (2021, June 28). Retrieved from https://americanaddictioncenters.org/rehab-guide/addiction-statistics
CDC Washington Testimony July 11, 2019. (2019, July 12). Retrieved from https://www.cdc.gov/washington/testimony/2019/t20190711.htm
Drug Overdose Deaths. (2021, March 03). Retrieved from https://www.cdc.gov/drugoverdose/deaths/index.html
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258. doi:10.1016/s0749-3797(98)00017-8
Gregorowski, C., & Seedat, S. (2013). Addressing childhood trauma in a developmental context. Journal of child and adolescent mental health, 25(2), 105–118. doi:10.2989/17280583.2013.795154
Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., & Moffitt, T. E. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet Psychiatry, 6(3), 247-256. doi:10.1016/S2215-0366(19)30031-8
Mandavia, A., Robinson, G. G., Bradley, B., Ressler, K. J., & Powers, A. (2016). Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma. Journal of Traumatic Stress, 29(5), 422-429. doi:10.1002/jts.22131
Mclaughlin, K. A., Colich, N. L., Rodman, A. M., & Weissman, D. G. (2020). Mechanisms linking childhood trauma exposure and psychopathology: A transdiagnostic model of risk and resilience. BMC Medicine, 18(1). doi:10.1186/s12916-020-01561-6
McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130.
National Institute on Drug Abuse. (2021, April 13). Part 1: The Connection Between Substance Use Disorders and Mental Illness. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
Peterson, S. (2018, November 05). About Child Trauma. Retrieved from https://www.nctsn.org/what-is-child-trauma/about-child-trauma
URLS
https://journals.sagepub.com/doi/10.1177/070674371205701105
https://americanaddictioncenters.org/rehab-guide/addiction-statistics
https://www.cdc.gov/washington/testimony/2019/t20190711.htm
https://www.cdc.gov/drugoverdose/deaths/index.html
https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104825/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384243/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064859/
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01561-6
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