How We Learn to Self-Medicate

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It is said that in any AA or NA meeting 60% of its group members will have experienced some form of abuse (physical, emotional or sexual) as a child. Childhood abuse is a good indicator of later substance abuse and addiction. 

Recently I posted about ACE (Adverse Childhood Experiences) Study which showed that early adverse experiences, or traumas, predict adult physical and mental health problems that ultimately lead to early death. Adult substance abuse is one such consequence, in addition to smoking and obesity.

In this context, I've been thinking a lot of about validation. To validate simply means recognizing another person's experience of an emotion and their reaction.

If a friend is crying because his dog recently died, I would validate by saying something like "I see that you are really sad" or "You are really missing Buster." In my wanting to help, I might instinctively want to problem solve or advise him so he feels less hurt. I will get there, but first and foremost I acknowledge that his sadness is real and valid.

Imagine a little girl falls and scrapes her knee, and she cries. Her mother or caretaker hopefully will say something like "Oh, no, you fell. Come and let me look at it" or "Let me see. I think it's going to be okay." Both statements indirectly validate that an accident has happened and that the little girl's reaction is valid. But, another parent might simply order the child to stop crying, or say something like "I told you not to run" or "This is what happens when you misbehave by running." 

In a dysfunctional or abusive family, a child's feelings and reactions are invalidated, as the latter examples illustrate. It doesn't seem so bad when looking at just one example, but when it is long-established pattern, parental invalidation teaches the child that her feelings, especially negative ones, can't and shouldn't be felt or expressed. 

The same girl might grow to ignore, disregard, deny or avoid her feelings, especially uncomfortable ones like sadness, anger, shame, guilt, boredom, loneliness, even though they are part of every person's experience.

Enter alcohol and drugs, which in the short-term help her avoid unpleasant feelings. Repeat this way of coping and a dependence and addiction develops. And a cycle of self-medication begins: Immediate relief from unpleasant feelings followed by intensification of those feelings, and so on...

Child Adverse Experices (ACE) and Adult Health

Federal law defines child abuse as the following:

• "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or
  
• "An act or failure to act which presents an imminent risk of serious harm."

Number of reported cases of child abuse is about 3 million annually. Every ten seconds another case of child abuse is reported to child protective services. 

I can't help wonder the actual number of children affected by child abuse and neglect. In my private practice and my work at a community mental health clinic, vast majority of clients experienced some form of abuse and neglect as children, but most of these cases did not get reported.

So, why do my clients come to therapy? Main complaints are: depression, anxiety, problems with drug and alcohol, addiction to food or sex, relational problems, sleep issues, low self confidence, general dissatisfaction in life. 

The relationship between childhood trauma and its effect on adult physical and mental health has been measured and documented in a study with over 17,000 people: ACE Study (Adverse Child Experiences). You can measure your score here. 

I will definitely revisit this subject in future posts.

FYI: April Is the Cruelst Month and Child Abuse Prevention Month

I. THE BURIAL OF THE DEAD

APRIL is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.

excerpt from T.S. Eliot's The Waste Land

Yes, in case you didn't hear, April is child abuse prevention month. The connection between the poem and government-sponsored, PSA-worthy month which goes unnoticed is beyond tenuous. But child abuse is cruel as it makes lasting negative impact for the rest of that child's life, I make no apologies for quoting T.S. Eliot.

As a social worker I am a mandated reporter, which means by state law I have to report to ACS (Administration for Children's Services) suspected cases of child physical, neglect or sexual abuse. Teachers, doctors, psychologists, nurses, police, EMS are also mandated reporters. I am sure I am forgetting a few professions.

Physical and sexual abuse is easy to define and comprehensible by non-professionals. Neglect, however, is a bit more difficult to define. It can mean abandonment — leaving children under the age of 12 unattended, using drugs around minors (cannabis excluded), not having food in the home, children missing school and providing inadequate medical care. Since I am listing them from memory I am sure it's incomplete. Child neglect/emotional abuse is difficult to assess, but it can damage just as much as other forms of abuse.

Working with children can be one of the most rewarding/heart-breaking experiences. Most children end up in therapy due to "benign neglect; their parents (in my case single mothers) simply lack the energy (depression, poverty) or their attention have been compromised by their own needs (boyfriend, job) to be fully emotionally present with their kids (or to provide good-enough parenting). But children are amazingly resilient, and like the way plants forgotten in the corner become revitalized with regular watering and sunlight, children respond to undivided attention and adult presence.

On a couple of occasions, children who were actively being abused were put under my watch. And making that report was heart wrenching knowing what I know about the overburdened system. It felt like I was handing a child over to a barely functioning bureaucracy with my fingers crossed, hoping their welfare didn't deteriorate.

For a brief overview on the lasting impact of childhood trauma, go here.

NCA PSA 2013 "Stand Up, Step Forward" from Ian Buchanan on Vimeo.