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Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

In past articles and our most recent article on trauma, we have mentioned the impact that Adverse Childhood Experiences, or ACEs, can have on an individual. While it wasn’t long ago that we figured it out, there is a great deal of research supporting the notion that one of the key contributing factors to substance abuse, mental health and other behavioral disorders is childhood trauma. Adverse Childhood Experiences, known widely as ACEs, are common and seemingly passive experiences that one may have as a child, that, when occurring repeatedly or in combination, have a devastating impact on a person’s development and long-term health.

When an Adverse Life Event takes place during one’s life in later adolescence or as an adult, the connection for the survivor to make between the traumatic experience and their future issues can be clear. Whether it’s a singular “Big T” trauma or a series of less severe “Little T” traumatic events, the link between these experiences and a person’s behaviors can often be made easily. For example, a 58-year-old man who recently went through a divorce, was laid off and then lost his house, might make the connection between these experiences and his increased drinking and isolation.

However, the link between ACEs and mental health or substance abuse issues that develop later in life can be more difficult, for a couple of reasons. For one thing, the mental health or substance abuse issues often don’t surface until years, or even decades, after the Adverse Childhood Experience occurs. What starts as general family dysfunction, divorce, neglect, or abuse may seem relatively normal through childhood and even into adulthood. The early signs and symptoms of a greater issue often manifest themselves as isolation, lack of trust, avoidance and other social and emotional issues before they ever develop into substance abuse or severe mental illness.

What are ACEs?

The notion of Adverse Childhood Experiences, or ACEs, began with the research of the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study. The study was conducted between 1995 and 1997 and studied nearly 17,000 Kaiser patients in a San Diego Health Clinic[1]. Patient health was studied through physical exams and surveys of current health and behaviors, while they also completed surveys about childhood experiences. What this groundbreaking study was looking at was the link – which was not understood at the time – between childhood trauma and physical, mental and emotional health later in life.

The ten childhood experiences they were looking at were:

Childhood abuse

1.     Emotional Abuse

2.     Physical Abuse

3.     Sexual Abuse

Childhood neglect

4.     Physical Neglect

5.     Emotional Neglect

Household challenges

Growing up in a household were there was:

6.     Substance abuse

7.     Mental Illness

8.     Violent Treatment of a mother or step-mother

9.     Parental Separation/divorce

10.  An incarcerated household member

 

Participants in the study were then given an ACE Score between 0 and 10, the total sum based on how many of the 10 types of adverse experiences they reported experiencing.

The Findings of the CDC-Kaiser ACE Study

The ACE Score, from 0 to 10, is used to assess cumulative childhood stress – now sometimes referred to as “Little T” trauma or by association with this study – a person’s “ACEs”. One of the clearest and most widely understood finding of the study was that Adverse Childhood Experiences (ACEs) are more common than one might think, or thought at the time. More than half (52%) of the participants from the original CDC-Kaiser study reported having at least one ACE, and more than 1 in 5 (20%) reported exposure to 3 or more ACEs, while another 6.2% reported 4 or more exposures[2].

The most prevalent of the categories of childhood exposure was substance abuse in the household (25.6%); the least prevalent exposure category was evidence of criminal behavior in the household (3.4%)[3]. Another finding was that the susceptibility of a person’s exposure to multiple ACE categories, as the relationship between single categories of exposure was significant. If someone reported any single category of exposure, the probability of exposure to any additional category ranged from 65%–93%; and then not surprisingly, the probability of more than two additional exposures ranged from 40%–74%[4].

The key finding of the study as it related to health outcomes, and which changed the way we understood childhood trauma, was that as one’s ACE Score increases, so does the risk for serious diseases and conditions, including:

  • Alcoholism and alcohol abuse
  • Illicit drug use
  • Depression and other mental health issues
  • Suicide attempts
  • Health-related quality of life
  • Smoking
  • Chronic disease
  • Heart and liver disease
  • Poor academic achievement
  • Poor work performance and financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • STDs and unintended pregnancies
  • Risk for sexual violence and intimate partner violence

The increased risk for these negative health outcomes and well-being are dramatic. Compared to someone with an ACE Score of 0, a person with an ACE Score of 4 or more is:

  • 18 times as likely to have attempted suicide
  • Twice as likely to have had two or more weeks of depressed mood in the past year
  • Nearly 5 times as likely to have ever used illicit drugs
  • More than 11 times as likely to have ever inject drugs
  • More than 5 times as likely to be an alcoholic

How are ACEs Linked to Health Issues?

There is a large and growing body of research about how childhood stress and trauma affect brain development, brain chemistry and, thus, the regulation of the body’s emotional, stress and fear response systems are impacted. Repeated stress and activation of these systems of the brain dramatically alter the formation of myelinated axons and the amygdala, the part of the brain that activates the autonomic nervous system (ANS) and releases hormones like adrenaline and cortisol into the body. If you’re walking through the woods and see a bear approaching, or you see a kid walking into oncoming traffic, the activation of this system is very effective in increasing your heart rate, opening your airways, and increasing blood flow to your organs and muscles, and away from certain parts of the brain.

However, if the stress response system is activated every night by the sound of your dad coming home, or the sight of your mom reaching for a bottle of alcohol, your body and brain are hit with the same fight-flight-freeze response. The repeated activation of this system take a toll on your vital organs as well as your brain’s ability to regulate emotions and responses to triggers. When the body produces too much of, or stops producing, the natural chemicals to sooth or excite you, it is very common for people to turn to external stimuli to compensate this: depressants like alcohol and benzodiazepines, stimulants like cocaine and methamphetamine, or even behaviors like gambling and sexual intercourse.

Exposure to abuse and neglect also impact the prefrontal cortex, the part of the brain responsible for high level cognition and controlling impulse, and the nucleus accumbens, the brain’s pleasure-reward center which releases the body’s natural dopamine. The nucleus accumbens was first discovered in 1954 by two scientists when rats became addicted to pressing a lever that activated this part of the brain. The role of the nucleus accumbens and its connection to the amygdala and hippocampus[5] have great implications in the study of psychiatric disorders, substance abuse and addiction, obsessive compulsive disorder and Tourette’s Syndrome, and more studies are being conducted.

Dose-Response Relationship

The CDC-Kaiser study also found a “dose-response” relationship between ACEs and negative health and well-being outcomes across a person’s lifetime. A dose-response relationship is one where as the dose or intensity of the trigger increases, so does the intensity of the maladaptive behavior or response. For example, the more a person is exposed to abuse or neglect, the more severe the negative health outcomes will be.

Follow-Up Studies

Dr. Nadine Burke-Harris

One of the most notable cases of these results in action was the work of Dr. Nadine Burke-Harris, a pediatrician in San Francisco who was originally unaware of the CDC-Kaiser ACE Study. She noticed when she began working in a hospital in Bayview-Hunter’s Point, a low-income area of the city riddled with addiction and violence, that there was an abnormal number of children being referred to her for Attention Deficit Hyperactivity Disorder (ADHD). One of her colleagues made her aware of the ACE Study, which led her down a path of studying her patients’ exposure to trauma and how the brain and body were impacting their health. She subsequently started the San Francisco Center for Youth Wellness, where Dr. Burke-Harris made it routine to screen children for their ACE Score to better understand the risk factors of these youth across their lifetime.

See her TED Talk on How Childhood Trauma Affects Health Across a Lifetime:

Behavioral Risk Factor Surveillance System (BRFSS)

In 2009, the CDC began collecting annual ACE data through the Behavioral Risk Factor Surveillance System (BFRSS) from voluntary respondents telephonically. It is now the longest-running phone survey in the world. The BFRSS asks questions modified from the original ACE Study, from people across 32 states, using randomly dialed numbers. The data collected from the BRFSS are:

All ACE questions refer to the respondent’s first 18 years of life.

  • Abuse1
    • Emotional abuse: A parent or other adult in your home ever swore at you, insulted you, or put you down.
    • Physical abuse: A parent or other adult in your home ever hit, beat, kicked or physically hurt you.
    • Sexual abuse: An adult or person at least 5 years older ever touched you in a sexual way, or tried to make you touch their body in a sexual way, or attempted to have sex with you.
  • Household Challenges
    • Intimate partner violence:2 Parents or adults in home ever slapped, hit, kicked, punched or beat each other up.
    • Household substance abuse: A household member was a problem drinker or alcoholic or used street drugs or abused prescription medications.
    • Household mental illness: A household member was depressed or mentally ill or a household member attempted suicide.
    • Parental separation or divorce: Parents were ever separated or divorced.
    • Incarcerated household member: A household member went to prison.

The findings of the BFRSS are similar to that of the original CDC-Kaiser ACE Study:

  • More than two-thirds of the participants reported at least one adverse childhood experience
  • More than 1 in 5 reported exposure to 3 or more ACEs

Similarly, they also found a dose-response relationship with ACE Scores correlated to an increase in the following:

  • Myocardial infarction
  • Asthma
  • Mental distress
  • Depression
  • Smoking
  • Disability
  • Reported income
  • Unemployment
  • Lowered educational attainment
  • Coronary heart disease
  • Stroke
  • Diabetes

Treatment of Childhood Trauma

Understanding the role that adverse childhood experiences (ACEs) play in brain development and prevalence of addiction, mental illness and life-threatening diseases is a pivotal precursor to addressing these issues. Identifying and acknowledging the root of the issues is an important step in the recovery process, and only once a person can work through the lasting effects of exposure to Adverse Childhood Experiences can they truly recover. Because of the way these experiences embed themselves in our brain and body, the process of resolving them can take months or even years, but even the most complex trauma can be resolved with enough time and commitment.

Despite the acceptance of this research in the medical field, behavioral health professionals have been slower to integrate the identification and treatment of trauma into practice. It is important for someone who has been exposed to these adverse childhood experiences to find help at trauma-focused treatment programs like Roots Through Recovery, who utilize evidence-based approaches like Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing (SE), Mindfulness-Based Stress Reduction (MBSR), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and expressive approaches like music and sound therapy, trauma-focused yoga, and art therapy.

EMDR at Roots Through Recovery

Resources:

[1] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[2] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[3] Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[4] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[5] https://www.eurekalert.org/pub_releases/2014-05/cafn-itp052114.php

As “Thay” – Father of Mindfulness – Prepares for the End, We Honor His Gifts

As “Thay” – Father of Mindfulness – Prepares for the End, We Honor His Gifts

As TIME reported this week, in a matter of weeks, days, or possibly even hours, Vietnamese monk Thich Nhat Hanh — known by his disciples as “Thay” — will no longer be among the living. Although his passing could be viewed as a tragedy for some of his followers, the monk’s impending next step in his spiritual journey is also shining a light on the wisdom and lessons he passed down to those who followed him over the course of his eventful life.

Thay, which is Vietnamese for “teacher”, a renowned spiritual leader, is perhaps best known as the “Father of Mindfulness.” His teachings have brought peace and joy to millions over his 92-year life, and they all stem from his early Buddhism beliefs that mindfulness goes hand in hand with living a content and fulfilling existence.

Mindfulness is one of the foundations of a mind-body-spirit, or whole person, approach. The practice of even one minute a day has been found to lower stress, increase focus and joy, and assist in improving mental health, substance use, and other related issues such as chronic pain [1] [2] [3]. For some people — including many of Thay’s pupils — the Buddhist principle provides life-changing results unlike anything they’ve ever tried before.

The process of becoming more aware of oneself and one’s surroundings physically, spiritually, and mentally is Thay’s own spin on a very simplified version of Buddhism. It also provided the basis for evidence based approaches for behavioral health treatment like Mindfulness-Based Stress Reduction and work in tandem with EMDR and other trauma therapies. Although it has enhanced the lives of everyone from Martin Luther King Jr. to Oprah Winfrey, committing to it fully is a lifelong process and should be practiced daily to achieve its full benefits.

Part of what makes Thay’s teachings so effective though, and largely why it works so well for clients at Roots Through Recovery, is that everyone can always become more mindful and no matter your commitment level, the noticeable improvements on your life are immeasurable. Regardless of where a person may stand within the Buddhist doctrine, self-improvement and mindfulness are two aspects that we believe can always help. So even as Thay’s life comes to an end, we will continue to honor his blessings to the world and keep his legacy alive.

References

[1] https://pdfs.semanticscholar.org/1727/db7dbe033fdd89a021baabac0cbff58bab2a.pdf

[2] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.912.4622&rep=rep1&type=pdf

[3] https://pdfs.semanticscholar.org/05c1/4273f0d3d4acdac20ee49c76ba3aa3afe7a5.pdf

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Roots Presents: Nuances in Trauma Treatment with Deborah Sweet, Psy.D.

Roots Presents: Nuances in Trauma Treatment with Deborah Sweet, Psy.D.

Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors National Recovery Month in an effort to increase awareness and understanding of substance use and mental health disorders, and to honor and celebrate the people who recover. The theme for 2017 is “Join the Voices for Recovery: Strengthen Families and Communities”. One of the most prevalent issues individuals and families face in their journey of recovery is trauma, or the way in which they perceive and experience major life events. As we’ve written in the past, trauma is completely subjective and, if untreated, can lead to the use of behaviors and substances to escape the effects of trauma.

This year, Roots Through Recovery is honored to celebrate Recovery Month with a special speaking event with Deborah Sweet, Psy.D.: “The Nuances of Trauma Treatment: What to use, how and when”. Treating trauma is it’s own specialized area of psychotherapy. Specific tools and modalities are needed to help people recover from the effects of trauma. Trauma is held in the subcortical region of the brain therefore traditional therapy, though wonderful, will not move traumatic incidents the way that EMDR, Brainspotting, Somatic or Havening therapies do. In this talk, Dr. Sweet will provide information on types of treatment and when and how to use them.

Title: “Nuances in Trauma Treatment: What to use, how and when”
Date: Wednesday, September 27th
Time: 11:00am to 1:00pm
Location: 3939 Atlantic Avenue, Suite 102, Long Beach, CA 90807

RSVP NOW to save your seat!

Deborah Sweet, Psy.D. is a licensed psychologist, trauma expert and Founder of the Trauma Counseling Center of Los Angeles. Treatment at TCCLA focuses on helping people recover from the overwhelming effects of trauma using modalities that are specifically designed to help people recover from trauma. These cutting-edge modalities include the Somatic therapies of Somatic Experiencing, Sensorimotor Psychotherapy and the Trauma Resiliency Model; EMDR, Brainspotting and the Havening Technique. At the Trauma Counseling Center of Los Angeles, the team helps individuals clear traumas by engaging the subcortical regions of the brain to restore resiliency to the nervous system, enable clearer thinking and an ability to enjoy life more fully.

Lunch will be provided, thanks to our event sponsor WEconnect Recovery. The event is completely FREE, but you must RSVP, and seats are limited.

This is an officially-registered SAMHSA Recovery Month event. Find more Recovery Month events here.

What is EMDR and How Does it Work?

What is EMDR and How Does it Work?

EMDR has received some notable attention recently thanks to its effectiveness in treating trauma. There is a lot of information available online and in academic literature of the therapy, so we put together this article as an overview of EMDR to help you understand what it is and how it works.


So what exactly is EMDR and how does it work? 

EMDR stands for Eye Movement Desensitization and Reprocessing, and it involves 8 phases including the use of eye movement, or bilateral stimulation, which appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. As we wrote about in past blogs, when a person experiences a traumatic event, their brain goes into defense mode and changes its function.

One of these functions includes the hippocampus, which usually works to store memories in a neat filing system that allows us to easily and accurately recall these memories. When faced with a threat, the hippocampus takes on the role of pumping cortisol throughout the body so that we don’t feel pain, and puts the memory storage on the back burner. So it’s no wonder it’s incredibly difficult to recall a traumatic event, or we recall it inaccurately by filling in the blanks later on.

EMDR allows us to go deep into the brain and file these memories with the appropriate meanings and emotions attached to them. According to the EMDR International Association, the goal of EMDR is to:

“Process completely the experiences that are causing problems, and to include new ones that are needed for full health… That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded… The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.”

One of the leading experts on developmental trauma and author of The Body Keeps the Score, Dr. Bessel van der Kolk recalls the experience he had using EMDR on a patient when he realized the power of the therapy. Watch below:


What are the 8 phases of EMDR?

Phase 1:  The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan.  Client and therapist identify possible targets for EMDR processing.

Phase 2:  During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6:  In phases three to six, a target is identified and processed using EMDR therapy procedures.  These involve the client identifying three things:

1.  The vivid visual image related to the memory
2.  A negative belief about self
3.  Related emotions and body sensations.

In addition, the client identifies a positive belief.  The therapist helps the client rate the positive belief as well as the intensity of the negative emotions.  After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation.  These sets may include eye movements, taps, or tones.

Phase 7:  In phase seven, closure, the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8:  The next session begins with phase eight.  Phase eight consists of examining the progress made thus far.  The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

From EMDR.com


Does it actually work?

At least 20 positive controlled outcome studies have been done on EMDR therapy. According to the EMDR Institute, which hosts a comprehensive list of EMDR-related research, some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six, 50-minute sessions.

EMDR International Association reports on the same topic, “Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies. Research has also shown that EMDR can be an efficient and rapid treatment” (www.emdria.org).


Who does EMDR? 

Only Masters-level or Doctoral-level professionals–therapists, nurses and doctors–who have gone through approved EMDR training can provide EMDR to people. Roots Through Recovery is proud to have two clinicians on our team that are trained and certified to provide EMDR. Clients who have undergone EMDR therapy for trauma have seen great improvement in their management of traumatic experiences, and how that plays a role in their addictions and mental health.

For a free assessment or to find out more, call us today at (562) 473-0827 or email us at info@roots-recovery.com


Related Articles from Roots:

The Direct Link Between Trauma and Addiction

How Childhood Trauma affects health across a lifetime

Resources & Further Reading:

EMDR International Association

EMDR Institute, Inc.

Dr. Bessel van der Kolk

Trauma and Addiction: The Direct Link

Trauma and Addiction: The Direct Link

Not why addiction, but why the pain? – Dr. Gabor Maté

What Dr. Maté—a leader in addiction medicine and world-renowned author and speaker—is saying, is something we’ve long known to be true about trauma and addiction, and yet the field of addiction treatment still lags behind the research (links to 6 studies at bottom of page): addiction is usually a symptom of underlying trauma, or mental health issues that are the manifestation of trauma. Dr. Maté uses the word ‘pain’ to refer to trauma and other underlying issues, whether it’s past sexual or physical abuse, the pain of not being able to control one’s thoughts and emotions, loss and grief, physical pain or whatever is causing the unpleasant feelings.

  • In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event (SAMHSA).
  • Ninety percent of clients in public behavioral health care settings have experienced trauma (SAMHSA).
  • Over two-thirds of people seeking treatment for some sort of addiction report one or more traumatic life events (Back et al., 2000).
  • Rates of witnessing serious injury or death of others and experiencing physical assault are two to three times higher in substance-using individuals than in the general population (Cottler et al., 2001; Kessler et al., 1995).

So what is trauma?

Trauma becomes increasingly difficult to define in succinct terms as one further investigates and uncovers the myriad definitions. The reason for this is the subjectivity involved in traumatic experiences, which lends itself to the definition that we think is the clearest, from the Substance Abuse and Mental Health Services Administration (SAMHSA):

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

“Experienced by an individual…” That is the key. Trauma isn’t an event, but how one experiences or perceives an event. This inherent subjectivity is why people can experience the same seemingly traumatic event, such as being in a car accident or growing up in a war-torn country, and come out of the experience with varying degrees of trauma or distress. Trauma can take all forms, from childhood experiences of divorce, abuse and neglect, bullying, and witnessing domestic violence to loss of a parent, loss of employment, a breakup or being involved in a volatile relationship. It can also result from growing up in an alcoholic or addicted home, or any other environment where individuals are taught to bury their feelings.

Roots through Recovery’s Clinical Director, Diana Kang, PsyD. says, “Trauma does not discriminate can can impact anyone. Everyone has a different perception of trauma, and how it is experienced in the body and mind varies greatly from person to person.” Unfortunately, many people experience trauma at some point in their life and don’t understand or acknowledge the trauma, so it goes untreated and manifests itself in fear and hopelessness, depression, anxiety, and in the most severe cases, Post-Traumatic Stress Disorder (PTSD).

The Adverse Childhood Experiences study conducted by Kaiser Permanente and the CDC in the 90s developed a tool for measuring an individual’s exposure to events that could be experienced as traumatic, including abuse or neglect. Some examples of adverse childhood experiences include: physical and emotional abuse or neglect, sexual abuse, witnessing abuse of a parent or another child, substance misuse in the household, divorce of parents and the incarceration of a family member. Although as one reads through the list and these events seem all too common in households we know or our own, ACEs are strongly related to the development and prevalence of a wide range of health problems throughout life, including those associated with substance use and abuse.

ACEs are a good example of the types of complex issues that the prevention workforce often faces. The negative effects of ACEs are felt throughout the nation and can affect people of all backgrounds. Research has demonstrated a strong relationship between ACEs, substance use disorders, and behavioral problems. When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning or ability to cope with negative or disruptive emotions may be impaired.

How does trauma affect my body?

The human body is highly regulated by the stress response systems that have developed over time as a survival mechanism. Experts in the field of stress and trauma, including the brilliant Dr. Nadine Burke Harris, often cite the example of seeing a bear in the forest. In this case, the body instantly responds to the threat by flooding the body with adrenaline, opening up the airways and increasing our heart rate, stifling fear and allowing you to run or fight for survival. This is a great system to have in these situations of life or death. But, what happens when the bear is your dad who comes home drunk at night, or the bully in your school, or an entire block in your neighborhood? Having the body’s fight, flight or freeze response system activated too frequently is damaging to our physiological systems.

Trauma responses act on several systems that affect one’s physiology. According to the Centers for Disease Control and Prevention, what is currently known is that exposure to trauma leads to a cascade of biological changes and stress responses. These biological alterations are highly associated with PTSD, other mental illnesses, and substance use disorders. These include:

  • Changes in limbic system functioning.
  • Hypothalamic–pituitary–adrenal axis activity changes with variable cortisol levels.
  • Neurotransmitter-related dysregulation of arousal and endogenous opioid systems.

“As a clear example, early ACEs such as abuse, neglect, and other traumas affect brain development and increase a person’s vulnerability to encountering interpersonal violence as an adult and to developing chronic diseases and other physical illnesses, mental illnesses, substance-related disorders, and impairment in other life areas” (Centers for Disease Control and Prevention, 2012).

Trauma also affects the brain.

A recent study published by Indian scientists reports new findings on how traumatic experiences affect the brain and how these effects later play out in memories. The study showed heightened electrical activity in the amygdala, located deep within the temporal lobe of the brain. “This region of the brain is known to play key roles in emotional reactions, memory and making decisions. Changes in the amygdala are linked to the development of Post-Traumatic Stress Disorder (PTSD), a mental condition that develops in a delayed fashion after a harrowing experience”. The study also found that a well-known protein involved in learning and memory, NMDA-R, is also involved in the process of creating these unpleasant memories and blocking them during a traumatic event reduced electrical activity at these synapses.

So then how are trauma and substance use connected?

The reasons behind this common co-occurrence of addiction and trauma are complex. For one thing, some people struggling to manage the effects of trauma in their lives may turn to drugs and alcohol to self-medicate. PTSD symptoms like agitation, hypersensitivity to loud noises or sudden movements, depression, social withdrawal and insomnia may seem more manageable through the use of sedating or stimulating drugs depending on the symptom. However, addiction soon becomes another problem in the trauma survivor’s life and before long, their coping mechanism no longer works, and causes far more pain to an already struggling person.

Many people who find themselves in a treatment program aren’t getting the help they need if the program only treats addiction, and does not consider trauma or co-occurring mental health issues (often called “dual diagnosis”) as the root cause of substance use. “Symptoms of someone suffering from trauma include flashbacks, nightmares, feeling like you are reliving the traumatic event, and avoidance of sights, sounds or feelings resembling the traumatic event (i.e. veterans avoiding fireworks during the 4th of July)”, offers Dr. Kang. She goes on to say, “Substance use is often one way to cope and numb out the impact of trauma. Sometimes it may be the only coping method one has. Therefore it is important to treat both the trauma and the addiction. When you address the addiction without looking at the trauma, you are not resolving the root of the addiction.”

With the impact stress responses and trauma have on the body, it’s not surprising that emotional and psychological pain often lead to an endless cycle of self-medicating, which leads to more pain, and inevitably more self-medicating, and so on. Often times, when left undiagnosed and untreated, people will self-medicate with alcohol, illicit drugs or misuse prescription drugs to placate the feelings of depression or anxiety or to numb the pain of the trauma. In these instances, the substances serve a purpose which is why to simply remove the substance, without understanding the individual need for it, is to ignore the cause and is not a long-term solution, much like putting a band aid on a bullet wound. “Over time, and often during adolescence, people with exposure to ACEs may adopt negative coping mechanisms, such as substance use or self-harm, social problems, as well as premature mortality. High ACE scores are associated with substance use disorders in adults:

  • Early initiation of alcohol use. Underage drinking prevention efforts may not be effective unless ACEs are addressed as a contributing factor. Underage drinking prevention programs may not work as intended unless they help youth recognize and cope with stressors of abuse, household dysfunction, and other adverse experiences. Learn more from a 2006 study on initial alcohol use among adolescents.

Video: https://www.samhsa.gov/capt/tools-learning-resources/aces-risk-factors-substance-misuse

Am I at particular risk for trauma and/or addiction?

Other possible reasons addiction and trauma are often found together include the theory that a substance user’s lifestyle puts him/her in harm’s way more often than that of a non-addicted person. Unsavory acquaintances, dangerous neighborhoods, impaired driving, and other aspects commonly associated with drug and alcohol abuse may indeed predispose substance abusers to being traumatized by crime, accidents, violence and abuse. There may also be a genetic component linking people prone toward PTSD and those with addictive tendencies, although no definitive conclusion has been made by research so far.

Often times, clients are not consciously aware that they are using substances to cope with the symptoms of trauma. They may have no memory of a traumatic event or experience, and yet, the trauma surfaces in their body or subconsciously in their brain without them knowing, ands they escape with the use of drugs or alcohol. As Primary Therapist Lauren Emmel said on a recent podcast with Todd Zalkins, “[Trauma] can surface after eight months, four years, ten years. It’s in a part of the brain… that doesn’t know any time. So something that impacted us when we were eight, ten, twelve, can impact us when we’re 20, 30, 40 if left unprocessed.” Self-soothing and distraction are ways people use substances to help get through these challenging times, and in order to develop a lifestyle that does not rely on substances, one must identify new ways to cope with unpleasant feelings.

So what can I do to reduce trauma and its effect on me?

To prevent further harm and prevent relapse, it is up to treatment professionals to recognize the prevalence of trauma among individuals coping with addiction, routinely screen for trauma symptoms, and deliver the integrated, multidisciplinary treatment that has proven effective in treating co-occurring disorders. The Substance Abuse and Mental Health Services Administration offers a helpful manual for practitioners or anyone interested in learning more about trauma informed care in their Treatment Improvement Protocol (TIP) 57, Trauma-Informed Care in Behavioral Health Services.

Treatment for co-occurring disorders, such as Roots through Recovery’s extended care program, offers clients effective ways to work through their trauma and find prosocial and physiologically beneficial ways of addressing the body’s response to trauma. Programs that address trauma from a cognitive, emotional and physiological standpoint allow individuals suffering from trauma and addiction to achieve sustainable life change and support the development of coping skills. Some of the evidence-based practices employed by treatment programs who embrace trauma-informed care are EMDRSomatic Experiencing, Prolonged Exposure Therapy, Cognitive Processing Therapy, meditation and mindfulness, seeking safety and trauma-focused or mindfulness-based cognitive behavioral therapy.

As we learned, unprocessed trauma can affect us dramatically at the core of our physiology and brain development, have a lasting effect on us psychologically, and can surface at any time. Addressing past trauma is a process, that should take place over time, at the right time and with a professional who is equipped to address trauma.

As primary therapist and EMDR specialist, Lauren Emmel, says, “It’s important to look at the different phases of trauma therapy. In the beginning phase of trauma therapy, if you’re working with recovery, is stabilizing, is creating a safe space, resourcing, going to meetings, finding a support group. The mind is all over the place, so if you start going into the trauma work, it’s going to disregulate the system. So first and foremost, it’s stabilizing. It’s finding a safe space that you feel that you can express yourself. And then the middle part is the actual trauma work.

Avoiding trauma, and turning to unhealthy coping mechanisms, only exacerbates trauma and can lead to addiction or other harmful behaviors. Seeking treatment and confronting trauma in a safe place is the best way to address trauma and reprocess it so that one may give traumatic experiences attention and acknowledgement, but not let them negatively impact your life.

To schedule an intake with an addiction and trauma specialist today, call Roots through Recovery at 562.473.0827 or email info@roots-recovery.com.

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