IMPACT OF TRAUMA ON ADULT CHILDREN:
MENTAL HEALTH AND ADDICTION
Mary F. Hardy, LPC, LADC
LIFE Senior Services
Objectives:
• Understand how Adverse Childhood Experiences (ACE) and
ACE Scores (ACEs) related to childhood trauma and living
with addiction in the home prior to the age of 18 can
ultimately impact health, mental health and addiction over
the persons lifespan
• Understand how cumulative childhood trauma and addiction
in the family creates imbalance or dysfunction in the family
system.
• Understand the need to provide early identification,
intervention and treatment for persons who are affected by
cumulative childhood trauma.
Adverse Childhood Experiences (ACE) Research
• The Relationship of Adverse Childhood Experiences to Adult
Health: Turning Gold Into Lead, Felitti, Kaiser Permanente 2002
• The Origins of Addiction: evidence from the Adverse Childhood
Experiences Study Felitti, Kaiser Permanente 2003
• Childhood Abuse, Neglect, and Household Dysfunction and the
Risk of Illicit Drug Use, Dube and Others, Pediatrics 2003; 111;564
• Impact of Adverse Childhood Experiences on Health Problems:
Evidence from Four Birth Cohorts Dating Back to 1900, Dube and
Others, Preventive Medicine 37, 2003.
3
Research Continued
• The Health and Social Impact of Growing Up with Alcohol
Abuse and Related Adverse Childhood Experiences: The
Human and Economic Costs of The Status Quo, Anda, Board
of Scientific Advisors, National Association for Children of
Alcoholics and Co-Principal Investigator, Adverse Childhood
Experiences Study, online at http://www.nacoa.org
• A Non ACE Study: Relationship Dynamics Within the
Addicted/Traumatized Family System, Tian Dayton,
Huffington Post, Posted 9/25/10 02:45 PM ET
Adverse Childhood Experiences Study
• Decade-long study examine childhood origins of
leading health and social problems
• Collaboration between Centers for Disease
Control and Prevention (CDC) and Kaiser Health
Plan’s Department of Preventive Medicine
• Key concept of Study suggests stressful or
traumatic childhood experiences are a common
pathway to social, emotional, and cognitive
impairments that lead to increased risk of
unhealthy behaviors, violence, re-victimization,
disease, disability and premature mortality.
Adverse Childhood Experiences Or ACEs Refer
to Growing Up With Any Of The Following:
Abuse:
1. Emotional Abuse
2. Physical Abuse
3. Sexual Abuse
Neglect:
4. Lack of Support
5. Poverty
Household Dysfunction:
6. Witnessing domestic
violence
7. Alcohol/Substance
Abuse
8. Mental Illness
9. Parental Discord
10.Crime
Conceptual Framework Of The
ACE Study
ACEs Are Common
Prevalence of Adverse Childhood Experiences (ACE) Original Study
CDC Website: http://cdc/gov/needphp/ace
ACE Category
1.
2.
3.
Abuse
Emotional Abuse (#1)
Physical Abuse (#2)
Sexual Abuse (#3)
Neglect
Lack of Support (#4)
Poverty (#5)
Household Dysfunction
Witnessing Domestic Violence (#6)
Household Alcohol/Substance Abuse (#7)
Household Mental Illness (#8)
Parental Separation or Divorce (#9)
Crime or Person in Household
Incarcerated (#10)
Women Men
N=9,367 N=7,970
Total
N=17,337
13.1
7.6
10.6
27.0
29.9
28.3
24.7
16.0
20.7
16.7
12.4
14.8
9.2
10.7
9.9
13.7
11.5
12.7
29.5
23.8
26.9
23.3
14.8
19.4
24.5
21.8
23.3
5.2
4.1
4.7
8
Prevalence of the ACE Score by Gender:
Number of Adverse
Childhood Experiences (ACE
Score)
Women
Men
Total
34.5
38.0
36.1
1
24.5
27.9
26.0
2
15.5
16.4
15.9
3
10.3
8.6
9.5
4 or More
15.2
9.2
12.5
0
9
ACE Score - General Findings
• Cumulative impact of multiple exposures can be
captured in an “ACE Score”
• ACE score has strong, graded relationship to
numerous health, social, and behavioral problems
throughout a person’s lifespan
• Adverse childhood experiences (ACEs) are common
– 1 in 4 grew up with substance abuse
– More than 10% had 5 or more ACEs
– ACE- related problems tend to be co-morbid or cooccurring
ACES Have A Strong Influence On:
–
–
–
–
–
–
–
–
–
–
Adolescent Health
Teen Pregnancy
Smoking
Alcohol Abuse
Illicit Drug Abuse
Sexual Behavior
Mental Health
Risk of Re-Victimization
Stability of Relationships
Performance in the Work Place
ACEs Increase The Risk Of:
– Heart Disease
– Chronic Lung Disease
– Liver Disease
– Suicide
– Injuries
– HIV and STDs
– And Other Risks For The Leading Causes Of Death
The Origins of Addiction: Evidence from the Adverse
Childhood Experiences Study, Felitti, Kaiser
Permanente 2003
• Same ACE data from original study
• Added look at ACE Score vs. Adult Alcoholism
• Looked at Vietnam Veteran Data
– Many Veterans used heroin regularly in Vietnam
– Only 5% of those considered addicted were still using 10
months after their return – Why?
• ACEs Suggests Smoking, Alcoholism And Injected
Drug Use As Coping Mechanisms To Get Relief
13
ACE Score vs. Smoking
14
Ace Score vs. COPD
15
Prevalence of ACE Continued
• ACEs of 4 or Higher Result in Increase Prevalence of
Intravenous Drug Abuse and Depression
• ACEs of 4 or Higher Result in Increased Suicide
Attempts; 2/3rd of Attempts May Be Attributable to
ACEs
• ACEs of 6 or More Has a 4,600% Increase in
Likelihood of Later Becoming an IV Drug User When
Compared to an ACE Score of 0
16
ACE Score vs. Intravenous Drug Use
17
ACE Score vs. Attempted Suicide
18
ACE Score vs. Adult Alcoholism
19
Childhood Abuse, Neglect, and Household
Dysfunction and the Risk of Illicit Drug Use
2003 Retrospective Study – N=8,613 found ACEs Correlates
With Early Adolescent Drug Initiation
1. Initiation by Age 14 increases the Adulthood Risk of Illicit
Drug Use 2-4 Fold
2. Risk Appears Stratified by Birth Cohort For Lifetime Use –
5 or More ACEs
–
–
–
–
1900-1932 – 4.3%
1933-1947 – 20.8%
1948-1962 – 56.8%
1963-1978 – 57.7%
20
A Descriptive Epidemiology of Lifetime Trauma
and the Physical Health Status of Older Adults
(Not An ACE Study)
• Research Evaluated Exposure to 22 Trauma
Events Over the Life Course by Age Cohort
• Research Included Exposure Over Age 18,
Versus the ACEs (Under 18).
• Findings Indicated Older Adults Experience
Cumulative Exposure to Trauma Over Their
Lifetime
21
Lifetime Exposure To Trauma
Examples - Ages 65-85+ (N=1,518)
• TRAUMATIC EVENT
• Spouse died
• Child died
– At or near birth
• Major fire, flood, earthquake,
natural disaster
• Fired a weapon in combat
• Sexual abuse or assault
• Physical abuse or assault
• Addiction in the family
• Parent dies or divorces before
you are age 18
% of 65-74
75-84
Sample %
%
37.4 23.2
46.4
19.9 16
23.1
6.8
6.7
7.0
16.2 15.7
17.2
85+
%
69.1
26.8
7.3
17.9
9.9
2.1
3.8
10.6
6.8
6.5
0.8
2.1
6.5
3.1
6.1
2.7
5.2
12.8
8.5
17.1
1.7
2.1
8.4
5.6
22
SAMHSA, Treatment Episode Data Set (TEDS)
(From 1992-2008 – Age 50+), www.samhsa.gov
• SA Treatment Admissions more than doubled from 6.6% in
1992 to 12.2% in 2008
• Age 50+ Alcohol Admissions Decreased from 84.6% to 59.9%,
while primary heroin abuse more than doubled (from 7.2%
to 16.0%)
• Age 50 + Admissions of multiple substance abuse tippled
from 13.7% to 39.7%
• Age 50 + Those who initiated use of their primary substance
of abuse within the past 5 years were more likely that those
in 1992 to have reported prescription pain relievers as their
primary substance (25.8% vs. 5.4%)
23
ACE As Indicator of Effects of Cumulative Stress
on (Neuro) Development
• Link of childhood maltreatment to long-term
changes in brain structure and function
involving several interconnected brain
regions
– Prefrontal Cortex
– Hippocampus
– Amygdala
– Corpus Callosum
– Cerebellum
Early Stress Associated With Lasting Alterations
in Stress-Responsive Neurobiological Systems
• Hypothalamic-pituitary-adrenal axis
• Monoamine neurotransmitter systems
Lasting effects on the developing brain would
be expected to affect numerous human
functions into adulthood, i.e. emotional
regulation, somatic signal processing,
substance abuse, sexuality, memory, arousal
and aggression
ACE Captures A Graded “DoseResponse”
• ACE appears to capture cumulative exposure
to the developing brain to activate stress
response
• This appears to be the pathway by which
ACEs exert their neurobiological impact
• As “dose-response” goes up, risk of problems
from adolescence to adulthood also go up
A Closer Look at
Relationship
Dynamics Within
the Addicted Traumatized Family
System
Source: Tian
Dayton, Huffington
Post, Posted
9/25/10 02:45 PM
ET
Family Dynamics
Dynamics In The Family System
• “No Talk” Rule
• Trauma Extremes: High
Intensity vs. Shutting
Down
• Impulsivity versus
Rigidity
• Despair vs. Denial
• Enmeshment vs.
Disengagement
• Over Functioning vs.
Under Functioning
• Caretaking vs. Neglect
• Abuse vs Victimization
The Cost of “No Talk” Rules
• Defenses such as denial and minimization
• Resist talking about resulting fear and anxiety
• Emotions explode into the container of the
family (get acted out rather than talked out)
• Acting out results in temporary relief – nothing
gets fixed
• Walls go up – may blame others
• Avoid discussion – may not be able to take
action
Trauma Extremes: High Intensity vs.
Shutting Down
• Emotions of fear and high states of stress
– Often accompanied by living with addiction
• Ignite fight or flight trauma response
• Feeling trapped (can not fight or flee to safety)
• May shut down or freeze to avoid negative emotions
– Recurrence of fleeing flooded with feelings to
shutting down reoccur affect how you p0rocess
emotions
– Emotional see sawing affects thinking, feeling, and
behavior of the family
Impulsivity vs. Rigidity
• Impulsive behavior – may be manifested by
blame, anger, rage, emotional, physical or sexual
abuse, over or under spending and sexually
acting out
• Rigidity - may be manifested by rigid rules or
routines or becoming both controlled and
controlling
• Recovery Option – Self regulation of thoughts,
feelings and behavior so they fall within
appropriate range for the situation
Despair vs. Denial
• Denial – is a dysfunctional attempt to ward
off every growing feelings of Despair.
• Reality is “rewritten” in an attempt to make it
less threatening
– Cover up anxiety, guilt, resentment and fear
– Denial replaces honest self-disclosure
– Despair deepens
Enmeshment vs. Disengagement
• Enmeshment is a relational style that lacks boundaries
and often discourages differences or disagreement or
a way of coping with the fear the family is “falling
apart”
• Disengagement is when family members see the
solution to keep pain from their inner worlds from
erupting and avoid subjects, people, places and
situations that might trigger it – isolation.
• Recovery Option: Balanced relationships (allowing
yourself to move in and out of close connection with
others in a natural fashion)
Over Functioning vs. Under
Functioning
• Over Functioning – may wear many hats to
maintain order (while the addict goes in and
out of “normal” functioning)
• Under Functioning – may be associated with
learned helplessness is part of the trauma
response.
• Recovery Option: Balanced functioning is the
obvious in between over and underfunctioning.
Caretaking vs. Neglect
• Caretaking – can be an attempt to attend to, in
another person, what needs to be attended to within
the self. We cant see the real need within another
person because we can’t identify the real need within
ourselves.
• Neglect – Thinking they have too many needs to meet
and mistrustful of deep connection – may push away
others that might help – mainly relationships
• Recovery Option: Balanced care of self and others is a
part of healthy life
Abuse vs. Victimization
• When individuals can’t process personal pain,
they are at risk of acting it out instead.
• Sometimes roles become stratified and
obvious abuser and obvious victim
• Abuse and Victimization are roles that often
get passed down inter-generationally.
• Recovery Option: Learn or relearn the skill of
emotional regulation
What Adult Children Have in
Common With The Identified Addict
1.
2.
3.
4.
5.
Self-Delusion or Denial
Compulsive Behavior
Frozen Feelings
Low Self-Esteem
Medical Complications
Common Stratified Family
Roles
1.
2.
3.
4.
5.
6.
Dependent
Enabler
Hero
Scapegoat
Lost Child
Mascot
Can play multiple roles
Can play different roles over their lifespan
Dependent
•
•
•
•
•
Motivating Feeling
Identifying Symptoms
Payoff for Individual
Payoff for Family
Possible Price
INSIDE: Pain & Shame
OUTSIDE: Blaming,
withdrawal &
perfectionism
•
•
•
•
•
Shame
Chemical Use
Relief of Pain
None
Addiction
Enabler
 Motivating Feeling
 Identifying Symptoms
 Payoff for Individual
 Payoff for Family
 Possible Price
INSIDE: Pain, Anger
OUTSIDE: over responsible,
low self-esteem,
powerlessness
• Anger
• Powerlessness
• Importance; selfrighteousness
• Responsibility
• Illness; “martyrdom”
Hero





Motivating Feeling
Identifying Symptoms
Payoff for Individual
Payoff for Family
Possible Price
INSIDE: inadequacy, guilt
OUTSIDE: overachiever,
performance driven,
works for approval
•
•
•
•
•
Inadequacy; guilt
Overachievement
Attention (positive)
Self-worth
Compulsive drive
Scapegoat





Motivating Feeling
Identifying Symptoms
Payoff for Individual
Payoff for Family
Possible Price
INSIDE: Hurt
OUTSIDE: Delinquency, peer
acceptance, low achiever,
defiant
•
•
•
•
Hurt
Delinquency
Attention (negative)
Focus away from
Dependent
Lost Child





Motivating Feeling
Identifying Symptoms
Payoff for Individual
Payoff for Family
Possible Price
INSIDE: Loneliness
OUTSIDE: Shy, loner,
physical illness,
treasures pets & things
•
•
•
•
•
Loneliness
Solitariness; shyness
Escape
Relief
Social isolation
Mascot
•
•
•
•
•
Motivating Feeling
Identifying Symptoms
Payoff for Individual
Payoff for Family
Possible Price
INSIDE: Fear, confused
OUTSIDE: Humor,
attention seeking, slow
learner
•
•
•
•
•
Fear
Clowning; hyperactivity
Attention (amused)
Fun
Immaturity; emotional
illness
Families and Recovery
• Family members may continue their dysfunctional behavior in
order to try to cope and/or feel safe OR
• They may get into treatment and recovery themselves
• Family members can and do recover. They need to be involved
in primary treatment and get counseling for their own health,
mental health and substance abuse issues, including past
trauma. Important aspects of recovery that help especially
where there is a history of trauma include 12 step programs,
therapy, meditation, yoga, massage, deep breathing and
exercise: activities that quiet and soothe the emotional system
and teach skills of mind/body regulation.
• Family members in recovery can begin to reconnect and move
toward balance and harmony in their lives.
There is HOPE for the family
ACEs Calls For Integrated Perspective of Health
and Social Problems Throughout The Lifespan
The results of the ACE study call for an
integrated approach to intervene early on
children growing up with alcohol abuse in the
home and the abuse, violence, neglect that
frequently co-occur in these homes.
Prevention and treatment of one ACE
frequently can mean that similar efforts are
needed to prevent and treat multiple persons
in affected families.
Our Job as Professionals
• Identify the impact of family dysfunction and
trauma across the life span
• Recognize the far reaching effects of childhood
stress and trauma in the family system
• Provide primary prevention, intervention and
treatment to impacted family members across
the life span
• Don’t allow family members to become a “lost
child” in the recovery process
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QUESTIONS &
DISCUSSION