By David Fawcett PhD, LCSW
HBO recently released a documentary, Leaving Neverland, focusing on the alleged victims of pop star Michael Jackson. In particular, two alleged victims, Wade Robson and Jimmy Safechuck, and their families discuss their experience with Jackson and how it affected them. In light of this documentary, I thought it might be appropriate for a more general discussion of what childhood sexual abuse does to its victims, with a particular focus on the drastically increased risk for addiction.
In nearly thirty years treating addiction I have counseled thousands of clients, nearly all of whom used alcohol, heroin, stimulants, or sex addiction as their primary emotional coping strategy. Through this work, it is clear to me that an addict doesn’t use in an attempt to capture good times or great feelings; instead, an addict uses to numb the overwhelming weight of uncomfortable emotions. Even as a novice therapist, it quickly became evident that the great majority of addicted clients—men and women, black and white, gay and straight, old and young—had experienced childhood abuse, including a significant number who had experienced childhood sexual abuse.
While the association between childhood trauma and later-life addiction seems intuitively correct, the extent of the overwhelming impact of these experiences is increasingly being documented, particularly with data from the ACES Study (the Adverse Childhood Experience Study).[i] From 1995 to 1997, the CDC and Kaiser Permanente conducted two waves of research on more than 17,000 participants who were mostly white, middle-class adults with health insurance. Since that time, the CDC has conducted periodic surveillance on this population, which has resulted in a number of findings that illustrate the dramatic impact of adverse childhood experiences on the health outcomes of adults—from heart disease to addiction and even early death.
Last year I had the privilege of spending the day with Vincent Felitti, MD, the principal investigator of the landmark ACES Study, and now a distinguished elder of the American psychological community. I had known of the study and its importance for many years, but I was stunned at the findings:
- Adverse childhood experiences (ACEs) are common. 28% reported physical abuse and 21% reported sexual abuse.[ii]
- The more ACEs a child experiences, the more problems. Almost 40% reported two or more ACEs and 12.5% reported four or more.[iii]
- ACEs increase the risk of early initiation into illicit drug use by 2 to 4 times.[iv]
- Teens with 3 or more ACEs were 19 times more likely to increase their alcohol and drug use.[v]
- ACEs increase the risk of mental and substance use disorders in older adults (50+ years).[vi]
- For every additional adverse child experience, the rate of prescription drug use increased by 62%.[vii]
- ACEs in any category increased the risk of attempted suicide 2 to 5 times through the lifespan, and those who reported 6 or more ACEs had 25 times increased odds of attempting suicide.[viii]
- A boy with 4 or more ACEs is a staggering 46 times more likely to become an injection drug user later in life than one who has had no severe adverse childhood experiences.[ix]
As ACEs increase, so do the odds of high-risk sexual behavior and HIV risk.[x]
Why Does This Occur?
With a better knowledge of childhood brain development, we are now beginning to understand the mechanism by which these risks occur. The brains of children who have experienced trauma are physiologically different from those who have not, with notable changes deep in the parts of the brain that regulate emotions, self-awareness, and how much or how little attention one pays to sensory information within the body. It is also notable that childhood trauma affects boys and girls differently, although we don’t completely understand how or why.
Exposure to childhood sexual abuse (like other trauma) activates the body’s biological stress response system. This complex set of interrelated reactions drives the child into fight-or-flight or a numbing/fantasy response. This increases levels of the stress hormone cortisol and a number of other chemicals that change heart rate, metabolic rate, blood pressure, and alertness. Over time, these symptoms shift into a semi-permanent state that affects memory, brain development, and the ability to regulate emotions.
Implications for Treatment
While we still have limited understanding of the physiological and psychological mechanism by which childhood sexual abuse affects addiction in later life, the findings we do have shed light on important treatment practices.
- Trauma-informed care: Understanding and integrating the experience of childhood sexual abuse into the overall treatment plan for an addicted client is critical for identifying and addressing lifelong patterns that put an individual at risk for addiction and (if in recovery) relapse. It is vital to remember, however, that newly-sober addicts (including sex and porn addicts) will be overwhelmed by delving into their painful personal history too early in the process. Early on, crisis counseling, support, and skills for self-regulation are the most essential work.
- Compassion: Addicts do not use substances or behaviors to feel good. They use to find a solution to the emotional pain they are experiencing. Shame, stigmatization, and humiliation only make matters worse. Compassion for the addict’s experience is an essential element of healing, as it is for partners of addicts. Dr. Rob Weiss’ new book, Prodependence: Moving Beyond Codependency,[xi] outlines the importance of compassionately recognizing the partner’s behavior as grounded in love and a desire to heal the relationship.
- Resilience: Trauma affects various children differently. One factor explaining this is resilience, which is not a character trait but rather a set of skills that can be learned and strengthened. By helping addicts identify their strengths and skills, allowing them the opportunity to change outdated beliefs about themselves, and encouraging healthy interactions, their own resilience will be strengthened and the quality of their recovery will be greatly improved.
- Connection: The greatest healing force for addiction is social connection. This is especially true when childhood sexual abuse underlies the addiction. Childhood sexual abuse not only traumatizes, it isolates and interferes with the ability to form meaningful and healthy relationships. Good treatment is informed by this understanding, placing high value on a trusting relationship with the clinical team, opportunities to build strong connections among peers, and laying the foundation for an expanding network of support groups.
Childhood sexual abuse, as well as other adverse experiences at an early age, can be devastating, creating lifelong patterns that impact brain development, social relationships, physical and psychological health, and an individual’s risk for counterproductive coping strategies such as addiction. But it is not necessary to live with the destructive consequences of events over which a child was powerless. Healing is possible. Compassionate and informed treatment can do wonders.
For more information on Seeking Integrity treatment programs and free resources visit www.SexandRelationshipHealing.com and www.SeekingIntegrity.com.
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[i] https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html
[ii] https://www.acesconnection.com/g/resource-center/blog/resource-list-ace-studies
[iii] https://www.acesconnection.com/g/resource-center/blog/resource-list-ace-studies
[iv] Dube, S.R., Anda, R. F., Felitti, V. et.al. (2001). Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA 286(24), 3089-3096.
[v] https://www.acesconnection.com/g/resource-center/blog/resource-list-ace-studies
[vi] Choi, N.G., DiNitto, D.M., Mari, C.N., et.al. (2017). Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years. International Psychogeriatrics 29(3), 359-372. Doi:10.1017/S1041610216001800.
[vii] Forster, M., Gower, A.L., Borowski, I.W., et.al. (2017). Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents. Addictive Behaviors 68, 30-34. Doi: 10.1016/j.addbeh.2017.01.004.
[viii] Merrick, M.T., Ports, K.A., Ford, D.C., et.al. (2017). Unpacking the impact of adverse child experiences on adult mental health. Child Abuse & Neglect 69, 10-19. Doi:10.1016/j.chiabu.2017.03.016.
[ix] https://www.acesconnection.com/g/resource-center/blog/resource-list-ace-studies
[x] Campbell, J.A., Walker, R.J., Egede L.E. (2016). Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. American Journal of Preventive Medicine 50(3):344-352.
[xi] Weiss, R. (2018). Prodependence: Living with, loving and caring for an addict. Deerfield Beach, FL: Health Communications.