The Origins of Addiction - from Dr. Vincent Felitti and the Adverse Childhood Study

In this film,  Dr Vincent Felitti, from Kaiser Permanente presents information from the ongoing 17,000 person Adverse Childhood Experiences (ACE) Study to challenge the conventional view that certain chemicals are intrinsically addicting.  He presents the evidence gathered in the ACE study to show that “addiction is not a disease, but is an unconsciously attempted response to minimize the effects of abnormal life experiences. Addiction can be seen as the unconscious, compulsive use of psychoactive materials in response to the stress of life experiences, typically dating back to childhood.”

Dr. Felitti discusses patients, including the woman who was the first person to draw his attention to the issue of using substances (in her case food), who are engaging in behaviors normally considered harmful in order to alleviate and protect from the pain of childhood experiences.  He primarily addresses food, alcohol, nicotine, methamphetamines and heroin addiction.  They are a few of the things that may be seen as public health problems but may often be “personal solutions to long-concealed adverse childhood experiences.  Describing bad habits as self-destructive behaviors hides their functionality in the life of a trauma survivor.”

As I think about how we try to address substance abuse, the heroin crisis, and human trafficking, I am drawn to the conclusion that we will fail in our attempts to resolve the crises until we begin to talk about the long held private conditions that lead to the public problems.  “These life experiences are very likely to be lost in time, and protected by shame, by secrecy, and by social taboos against exploring certain aspects of human experience.”  So many of us were raised in families and cultures where we did not discuss shameful family secrets.  As we grew up we were seen as the problem when the legacy of adverse childhood experiences presented as addictions and mental illness.

At this point in time treatment options are few and far between and minimally address the origins of the addiction.  By failing to address the adversity experience in childhood by so many people, we fail in our attempts to treat.  When treatment fails, we blame the person instead of recognizing that by “treating someone’s attempted solution, we may be threatening and causing flight from treatment” or forcing them to find another, possibly life-threatening, solution.

When these childhood experiences are named and validated as the source of long term difficulties in adolescence and adulthood we are removing the stigma and helping persons understand that it is not about having something wrong with them, but that something was done to them.  The next steps are to assist in finding healthier solutions and recognizing the strength and resiliency that helped them find solutions in the first place and survive in the midst of extremely adverse experiences. 

http://www.albertafamilywellness.org/resources/video/origins-addiction

Basic Assumptions for Working with Traumatized Family Members with Attachment Problems

Last week I attended the New Hampshire Infant Mental Health Conference.  The primary focus of the conference was evaluating for and treating trauma in children.  Cassie Yackley, Psy.D. of the Dartmouth Trauma Intervention Research Center adapted and presented the following from Dan Hughes’ Basic Assumptions for Parenting and Treating Traumatized, Attachment-Resistant Children.  I thought it would be valuable to post here.

Whenever you are working with a parent or child who has suffered trauma remember:

1.      They are doing the best they can.

2.      They want to improve.

3.      Their life, as it is not, is “a living hell.”

4.      They try to be safe by controlling everything in their environment.

5.      They try to be safe by avoiding everything that is stressful and painful.

6.      Their “attacks” reflect a fear of your motives for the nurturing and support you provide.

7.      Poor affect regulation, fragment thinking, a pervasive sense of shame, inability to trust, and lack of behavioral controls inhibit them from being able to have the relationships they desire.

8.      For them to change, they will need you to accept, comfort, and teach them.

9.      You will need to validate their sense of self (and family) while teaching them important developmental skills.

10.  You will need to understand their developmental stage and adjust your expectations to match so that they will have success, not failure.  Your physical and psychological presence are the foundation of your comforting and teaching them.

11.  Under stressful emotional conditions, they will regress and revert to basic, solitary defenses that they have used to survive.

12.  They will have to work hard to learn how to live well.  You cannot do the work for them, nor can you save them. You can comfort and teach them.

13.  You will need support and consultation from trusted others if you are to be able to successfully comfort and teach them.  You will make mistakes and will need to face these, learn from them, and continue.

“You Should Be Over It by Now”

These seven words can extend the experience of grief, guilt and shame of many survivors of sexual assault and other types of trauma.  Unfortunately, these words are often said by someone that the survivor looks to for support such as a family member or mental health professional.  Childhood sexual assault survivors have told me of instances when they were expected to engage in family activities that include the perpetrator of their abuse because the family feels “it is all in the past and you should forgive and forget.”

This refusal to accept the ongoing impact of the abuse in a person’s life can increase the shame, guilt, and sense of loneliness and isolation that a survivor feels. 

According to researchers Koss and Harvey (1991), “victims of sexual assault show very high distress levels within the first week that peak in severity by approximately 3 weeks postassault.  The distress then continues at a high level for the next month but begins to improve by 2 to 3 months.  After 3 months, rape victims do not differ from nonvictims on most symptom{s}” (p. 57).  However, even though these levels of distress will gradually diminish there are long term effects that can impact the life of the victim.  Women who have been sexually assaulted are more likely than others to experience a lifetime prevalence of clinical depression, addiction to drugs or alcohol, anxiety disorders, and post traumatic stress disorder.  (Koss & Harvey 1991 as quoted by End Violence Against Women International).

Trauma survivors may be also be experiencing long term effects of grief.  A trauma survivor is no longer the same person that he/she was before the assault took place.  The world no longer feels safe and the impact of the assault changes the persons physically, emotionally, and spiritually.  Experiencing grief at the loss of the pre-trauma person is a normal response to the horrific event.

Many victims have fewer episodes of reliving the assault as time goes by.  However, there comes a point in the recovery process where they realize they are not able to simply “get over” the trauma as easily as they originally thought.  This may be due to a crisis that floods the person with memories or (as noted above) contact with the perpetrator or someone who looks like the perpetrator. 

Many of the women that I have worked with find that their recovery from the trauma is impacted by the validation or lack of validation by important people in their life.  If a family member denies that sexual assault occurred against a young child or teen, that victim often feels as if the family has colluded with the perpetrator and/or blames the victim for any disruption to the family.  The victim then learns to suppress their emotions often leading to drug or alcohol abuse, depression, and anxiety.

When a trauma survivor asks me how long it will take to “get over” what has happened, I respond by letting them know it will take as long as it takes.  Some days will be better than others and eventually the good days will number more than the bad days.  However, the event or series of events will always be with them.  I encourage survivors to find ways to be in contact with other survivors so they know they are not alone, but I still want them to feel validated in their uniqueness.  No one likes to be told (as one woman recently related to me) that the rest of the world has problems, too.  Yes, the rest of the world has problems, too, but this woman just wanted her family member to acknowledge her pain. 

Being able to move on does not mean getting over.  The impact of the abuse will always be there.  Eventually the person does become stronger at the broken places and can transform the pain.  However, no one can predict how or when that happens.

Citations are from Victim Impact: How Do Sexual Assault Victims Respond? And How Can Law Enforcement and Other Community Professional Respond Successfully? By  Kimberly A. Lonsway, PhD and Sergeant Joanne Archambault (Ret.), May 2007, www.evawintl.org

Book Review: Enhancing Resilience in Survivors of Family Violence

 Anderson, Kim M. Enhancing Resilience in Survivors of Family Violence. New York: Springer, 2010.


Kim Anderson Ph.D., LCSW of the School of Social Work at the University of Missouri has written a book that provides advocates and mental health professionals a common language in meeting the needs of survivors of family violence. She states that“resilience research, posttraumatic growth literature, and strengths-based social work practice contribute to a helping framework that optimizes human potential while counterbalancing a more traditional vulnerability/deficit model in mental health practice” (pg. 17).

Advocates have been doing strength-based work under the empowerment model for years and this has often led to a mistrust of the mental health community in which a victim is often pathologized rather than commended for having the skills she needed to survive the abuse. “A pathology model of trauma leads practitioners, who lack the ability to understand the full meaning of victimization and its consequences, to interpret the pain and hurt expressed by survivors as evidence of psychopathology. To label as pathology rather than acts of resistance and signs of creative survival obscures and denigrates courageous efforts in the face of immense adversity. Therefore, mental health assessment tools that highlight survivors’ capacity for agency, resistance and resilience are necessary (Gilfus, 1999)” (pg. 82).

This book is not just for mental health professionals. It is an excellent guide for advocates in assisting trauma survivors in recognizing how their actions (or even inactions) were a sign of strength and resilience in the face of extreme adversity. Through the use of case studies and transcripts of sessions with survivors, Dr. Anderson provides examples of how survivors can be guided to recognize their own strengths. She also includes a number of assessment tools that could be used and discussed in the context of support groups.

Dr. Anderson also recommends ways in which to lead the survivor in creating a self narrative of “strength, purpose, and possibility” using Photo Story 3 (a free download from Microsoft) to create a self narrated story board. See http://www.silencespeaks.org/ (The DVD from this website will soon be in the NHCADSC library.

Exploration of a person’s spiritual connections also is discussed as a means for a person to find meaning in their suffering which not only leads to an experience of psychological relief but also a greater life purpose. Many survivors who are trying to understand their experiences blame themselves for their actions or inability to leave or change their circumstances. Self forgiveness and compassion towards self helps the survivor move forward and begin to “embrace the ‘broken places.’” Dr. Anderson also discusses the some faiths’ desire for the survivor to forgive the abuser. “In the author’s experience, forgiveness of one’s perpetrator does not necessarily provide wholeness and resolution in the same vain as self-forgiving. It is helpful to shift self-blame to its appropriate owner, the abuser, and hold him accountable particularly as family and legal systems often fail to do so” (pg. 123).

I also found the chapters “Recommendations from Survivors to Other Survivors” and “Recommendations of Survivors of Violence to Helping Professionals to be enlightening and validating of the work that domestic violence and sexual assault advocates do. There is also a chapter on vicarious trauma and compassion fatigue to assist the worker in managing their own reactions to the stories that they hear everyday.

I highly recommend this book to anyone working with survivors of violence.