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.

Peaches Geldof: Eating Disorders and Body Dysmorphic Disorder

Peaches Honeyblossom Geldof March 13, 1989-April 7, 2014

Peaches Geldof died the other day. Autopsy results are still pending, but given her family history, many, including myself, are guessing that it's related to drugs and/or eating disorder. She was just 25. Horrifyingly, next to her body was her 11-month old son. When PG's mother died, her half sister, a baby at the time, was also found next to their mother who had overdosed from heroin.

PG had gone off radar, at least for me, for a few years, during which she seemed to have grown up —she had gotten married and became a young mother two young boys. Before this she was primarily known for being an English party girl famous for her druggy antics and her father.

I couldn't help knowing who she was just as I know Paris, Lindsay and Brittney. I've given up being resentful about celebrity culture and accepted that this is the pop culture we deserve; we celebrate the famous for just being famous.

In PG's case she was the daughter of Sir. Geldof. For anyone who came of age in the 80's, his name is difficult not to remember. Her mother, Paula Yates, died from a heroin overdose three years after the "suicide" of Michael Hutchence, the INXS singer, another difficult name to ignore from the same era. And as mentioned earlier, Yates' body was found in bed with her youngest daughter.

I am not interested in focusing on celebrities, but these occasional tragedies provide access points to discuss finer points about the nature of addiction and different forms it can take. Her mother was also diagnosed with an eating disorder (anorexia, bulimia, or dependence on stimulants to lower appetite or misuse of laxatives?), so the issue of "heritability" of addiction can be discussed, not just addiction to alcohol and drugs, but behavioral addictions. And is there a positive correlation between early trauma and addiction later on? (My answer? Duh.) Here is an ominous last interview she gave to The Independent, an English newspaper.

In my work, mostly I deal with addictions to drugs and alcohol. But over the years, I've encountered a few clients with eating disorders and body dysmorphic disorder (BDD). Always, these food-related, self-image centered issues were just one part of a larger cluster of addictive behaviors to drugs, alcohol, sex and self-defeating relationships (both romantic and social), in addition to poor self-esteem and a history of early loss of a parent, divorce, parental neglect, emotional abuse, and sometimes sexual abuse. Working with these clients (I am not an expert in eating disorders, btw) it felt as if one's body was the easiest, most readily controllable target onto which to transfer unprocessed negative feelings and memories, all of which take time and lots difficult work. Rather than looking inward to dig at the source of pain, eating disorders and BDD forces the body, and ultimately the self, to take all the blame.

History of substance addiction in the Geldof clan is well known, and the experience of losing one's mother at a young age to addiction without the privacy that is afforded to ordinary people, would have made any young woman susceptible and fragile to becoming self-conscious.

Ultimately, I feel PG's addiction to drugs and alcohol was replaced with pathological obsession/addiction to her weight and appearance, and partly at fault is the celebrity industrial complex, whatever that is exactly.

My heart goes out to the two young children who've just lost their mother, as well as rest of Peaches' family and friends.