Substance abuse is a devastating and chronic condition that is difficult to overcome. Many people who go through rehabilitation programs relapse, sometimes repeating multiple cycles of treatment and relapse (1).
Often, substance abuse is associated with a wide range of problems occurring on multiple levels. Researchers have suggested related factors in physical, psychological, and emotional realms. The spiritual and social aspects of substance abuse create a whole new set of challenges for people seeking to escape substance abuse. We need to consider the whole picture when developing treatment strategies, enabling healing to occur on multiple levels.
Risk Factors for Substance Abuse and Other Health Problems
The research has been quite clear in determining common risk factors for substance abuse disorders. Experiencing abuse or neglect in childhood is linked to the development of substance abuse problems and a variety of other physical and emotional health problems such as heart disease, cancer, depression, and attempted suicide (2,3).
Given the strong and consistent association between childhood abuse and neglect and a plethora of serious health problems, many argue we should be assessing child abuse and neglect when people access health care or substance abuse treatment centers.
Dysfunctional family life increases association with peers involved in substance abuse
Child abuse and neglect can indirectly lead to a separate but powerful risk factor for substance use in adolescents and youth. In a dysfunctional home, it is more likely the child will make associations with other peers from similar backgrounds and situations.
Forming relationships with peers who are abusing substances is a strong predictor of problematic substance use (4). When our youth reach adulthood, the risk is even higher if they remain exposed to adult peer groups who are using substances. It is easy to see how adolescents or young adults who experience strained or abusive relationships with parents will seek a sense of belonging and security outside of the family unit.
Young people in distress will find support and companionship where they can, often with others who are experiencing similar difficulties. The substance use then provides an opportunity for bonding and management of symptoms of trauma and stress.
Implications for Treatment
If we assess for childhood trauma and neglect when addiction services are accessed, we will know more about the underlying causes of addiction and can anticipate mental health problems that may be fueling the substance abuse.
While mental health problems typically occur before substance abuse, often the problems with mental health are attributed to the substance abuse. When this happens, health care providers are “missing the mark” in treatment. The substance abuse is targeted for treatment while the underlying contributing factor is not even discussed. Failure to address underlying mental health challenges likely increases the danger of relapse after recovery.
Why Should We Screen for Past Child Abuse?
● Breaking the cycle – many adults who are abused and neglected end up mistreating their own children. Even adults who make a concentrated effort to be good parents can inadvertently cause trauma through their own mental health conditions.
Depression and anxiety are impossible to hide from a child. The child feels the sadness and fear and is often not given the tools to cope because the parents themselves do not have coping tools. A mother or father with post-traumatic stress disorder cannot hide symptoms from the child and, unfortunately, are likely to experience difficulty being fully present for the child.
A parent struggling with his or her own trauma is less likely to demonstrate problem-solving skills and less likely to provide comfort to the child during times of stress. The effects of a traumatized childhood do not evaporate when the child grows up! The effects tend to be passed down to the next generation in one way or another.
● Decreasing relapse probability – When we address childhood trauma and work with a therapist to cope with symptoms and heal core issues that follow us from childhood and into adulthood, we are less likely to relapse after recovery from addiction.
Substance abuse that has developed as a result of childhood trauma is often an attempt at self-medication. Substance abuse may numb intense emotions that are difficult to control. If we are able to address underlying causes, the need to self medicate should not contribute to the motivation to use again.
● Working towards healing – In order to reach a high level of functioning, and personal fulfillment, we need to heal our whole selves. Addiction is not just a physical problem. Addiction represents challenges on emotional, psychological, spiritual and social levels. Each of these levels needs to be addressed in order to achieve lasting healing and overall functioning (5).
Address the Underlying Causes of Complex Symptoms
Screening and assessment for child abuse and neglect can empower health care professionals to incorporate a multilevel approach to healing. When we understand the effects of childhood trauma and how the residual emotional and psychological effects can contribute to substance abuse, addiction, and a range of other health issues, we are better able to develop treatment approaches that address the problem on multiple levels.
1. Farley, M., Golding, J. M., Young, G., Mulligan, M., & Minkoff, J. R. (2004). Trauma history and relapse probability among patients seeking substance abuse treatment. Journal of substance abuse treatment, 27(2), 161-167.
2. Schäfer, I., Pawils, S., Driessen, M., Härter, M., Hillemacher, T., Klein, M., … & Schneider, B. (2017). Understanding the role of childhood abuse and neglect as a cause and consequence of substance abuse: the German CANSAS network. European journal of psychotraumatology, 8(1), 1304114.
3. SAMHSA. (2000). Chapter 2. Screening and assessing adults for childhood abuse and neglect. Treatment Improvement Protocols. (TIP) Series, No. 36. Center for Substance Abuse Treatment. Rockville (MD)
4. Van Ryzin, M. J., Fosco, G. M., & Dishion, T. J. (2012). Family and peer predictors of substance use from early adolescence to early adulthood: An 11-year prospective analysis. Addictive behaviors, 37(12), 1314-1324.
5. SAMHSA. (2000)
Fabiana Franco, Ph.D is a clinical professor of psychology at the George Washington University and sees clients in New York and Washington D.C.