childhood trauma and sud's (paper)

Running head: CHILDHOOD TRAUMA ON ADULT SUBSTANCE USE DISORDERS 1

The Effects of Early Childhood Trauma on Adult Substance Use Disorders

Kathleen J. Reeves

Temple University

Author Note

This scientific review paper was prepared for Capstone: Nature V. Nurture, Section 004; taught

by Professor Dr. Sheree Logue

CHILDHOOD TRAUMA ON ADULT SUBSTANCE USE DISORDERS 2

The Effects of Early Childhood Trauma on

Adult Substance Use Disorders

Stress caused by everyday life events are normal and daily occurrences for most people.

Being stuck in traffic for hours, feeling like you’re being followed, or hearing a baby cry will

often elicit a physiological response; such as sweaty palms, foot tapping, dilated pupils, or

quickened shallow breaths. These responses are your body’s way of preparing to react to the

stimulus, also known as fight or flight. (McLeod, 2010). But when a stressor, however

seemingly small, is experienced by someone who has experienced trauma in their life, that

response is often exacerbated and intensified. Where someone who has not been the victim of

any trauma may still exhibit a small response, a trauma victim may experience symptoms such as

an exaggerated startle response, hypervigilance, and extreme irritability (Heffernan, Cliotre,

Tardiff, Marzuk, Portera, & Leon, 2000).

Trauma can be described as any mentally, emotionally, or physically distressing event

that does not usually occur within the range of normal human experience. Specifically, a trauma

that occurs in very early childhood will almost always lead to low self-esteem, inadequate

feelings of self-worth, as well as never developing the necessary and appropriate coping

mechanisms. Depending on the child’s age at the time of the trauma, there is a high probability

they will be ill-equipped to handling the ordeal (Cornbluth, 2014).

During the preschool years, birth to age 5, the brain is undergoing rapid change and

growth. Children are developing their language skills, learning to problem solve, and reason.

During these early years, children show centration of thought, meaning their focus is limited to

one aspect of a situation or object. Therefore, when trauma occurs during this stage of life the

child’s mind may become fastened on a specific part of the traumatic experience. They may


become withdrawn and fearful of people or situations related to the trauma. School age children

and youth that experience trauma will show symptoms such as irritability, avoidance, withdrawal

from age appropriate activities, and focus and attention issues (Cornbluth, 2014). The brains of

young children as well as school-aged children are not fully developed, and are therefore unable

to sort out a traumatic event. Their systems become overloaded by the daunting experience, and

they are rendered helpless and unable to endure. The younger the child is when the trauma

occurs, the more profoundly affected they are as they grow into adolescence and adulthood. Most

importantly, the ability of the individual child to cope is pivotal to any potential treatment.

However, any treatment given will be a challenging and prolonged experience (Cornbluth,

2014).

Childhood Physical and Sexual Abuse

A specific type of trauma is physical and sexual abuse brought upon a child. There are

many warning signs a child who has experienced this type of trauma will exhibit. Many children

show signs of intense distress: such as disturbed sleep, problems with eating and toileting,

difficulty paying attention and concentrating, anger and irritability, withdrawal, repeated and

intrusive thoughts, and show extreme distress when confronted by anything that reminds them of

their abuser or traumatic experience (Cornbluth, 2014). In the 2010 Child Maltreatment report

conducted by the U.S. Department of Health and Human Services, 1 in 5 girls and 1 in 20 boys

under the age of 13 years have been victims of sexual abuse. By the age of 14 years, while still

under 17 years, 28% of adolescents in the United States had been sexually victimized. The

reported statistics of childhood sexual abuse are usually thought to be far less than the actual

number. Physical abuse, as it relates to childhood trauma, can be defined as any purposeful

physical harm caused to a child in any manner other than accidental. Physical abuse is difficult to


measure and report on due to the subjective definition of parental corporal punishment

(Grossman, 1997).

There have been strong associations made between sexual, mental, and physical abuse on

children, and later substance use disorders in adults. Reports indicate the nearly two-thirds of

people in a substance abuse treatment facility claim to have been physically or sexually abused

as children. After controlling for a family history of substance abuse, Bennett & Kemper

concluded that women who suffered abuse as children were also at a two- to three- fold increased

risk for substance use disorders (1994). In another study done on patients receiving outpatient

treatment for substance use disorders, 104 out of 105 female patients reported having

experienced trauma in the form of physical and/or sexual abuse. The female subjects also

reported weak social connections, constant familial strife, and a generally poor quality of life

(Heffernan et al., 2000). According to an article published in the Addictive Behaviors Journal, it

was found that of the patients having a history of past sexual violence, there was a higher rate of

need for substance abuse treatment among the female patients. The most reasonable and probable

explanation for this disparity is due to the harsher nature of sexual violence inflicted upon

females (Schäfer, Gromus, Atabaki, Pawils, Verthein, Reimer, Schulte, & Martens, 2014).

In a dissertation titled, Effects of Childhood Trauma and Dissociation with Substance

Abusing Adolescents, the author Gary A. Grossman, conducted a study to examine the

relationship that early childhood abuse had on a sample of 207 adolescents, ages 11 to 18 years.

137 of the 207 adolescents were living in a juvenile youth detention center, and 70 were

currently admitted to a state psychiatric hospital. Grossman administered the Substance Abuse

Subtle Screening Inventory, the Multidimensional Addicts and Personality Profile, the Child


Abuse and Trauma Scale, and Adolescent Dissociative Experience Scale to all patients in the

sample. A significant positive relationship between early childhood trauma and substance use

disorders in the adolescents was found. He also concluded that among the participants who were

chemically dependent, there was a positive correlation to those who exhibited dissociative

symptoms, therefore a correlation also existed between trauma and dissociation in adolescents

(Grossman, 1997).

The combined effects of all abuse can affect a child cognitively, emotionally,

behaviorally, socially, and physically; leading to an especially high risk of engaging in riskier

behavior (Cornbluth, 2014). The severity of a substance use disorder was also found to be highly

correlated with the severity of childhood sexual, physical, and/or emotional maltreatment

(Grossman, 1997). Occasionally though, with intense therapy, a good support network and the

formation of a healthy bonded attachment to a safe adult, a child is able to recover and resolve

from a past trauma. However, where post-traumatic stress disorder (PTSD), depression, anxiety,

or panic attacks exist in conjunction with an already established substance use disorder, the rate

of successful rehabilitation is even rarer. Furthermore, of the children who go on to have

substance use disorders, the ones who have experienced high rates of abuse and trauma almost

always experiment with chemical substances at an earlier age, as opposed to those addicted

persons who did not experience trauma as a child (Banducci, 2014).

Addiction and Drugs of Abuse

There is overwhelming evidence that addiction is a disease, affecting the brain as well as

the physical body. But, despite the amounts of research in the field of addiction, there are still

those that believe addiction is a choice, or a resolvable mental health issue (Glantz, 2010).

Despite the controversy, substance abuse has become a pandemic. It is without question affecting


humans on a global level; without any bias to race, religion, sexual orientation, or social

economic status. Consequently, the treatment of all substance use disorders within the United

States is an industry that is growing every day. In this country alone, the annual cost of treating

substance use disorders is approximately 600 billion dollars (Fletcher, Nutton, & Brend, 2014).

A Brief History of Drugs

In America during the late 1800s, Civil War soldiers suffered from a number of physical

and mental traumas due to their experiences at war. Morphine, which was created in 1806 by a

German scientist, was given to the soldiers on and off the battlefields (Plummer, 2010). Due to

its highly intoxicating and addictive powers society and the federal government soon took notice.

In 1914, the first federal law The Harrison Act was enacted, regulating and controlling the

production, sale, and distribution of opiates. As American culture and its drug use began to

change in the 1960s and 1970s, it became necessary for the government and its laws to change

with it. In 1965 the Drug Abuse Control Amendments which espoused strict control over most

illicit drugs was enacted (notes from addiction class). Today America’s “War on Drugs” is

almost always in the forefront of the media.

Substance Use Disorders

According to The Diagnostic and Statistical Manual of Mental Disorders, (5th ed.; DSM-

5; American Psychiatric Association [APA], 2013), a diagnosis of substance use disorders cover

a variety of criteria. For example: taking a drug in increasingly larger amounts, continuing to

take a substance regardless of its negative effects on relationships, cravings and urges for the

substance, gaining a tolerance to the drug (needing to use more of the drug to gain the same

effect), spending large amounts of time obtaining the drug, and withdrawing from once enjoyed

activities (APA, 2013).


Although there has been academic advancement in the field of addiction, there is a

limited amount of literature examining the appeal to certain and specific chemical substances. Of

all addictive drugs, opiates are said to be the most addictive of all. Despite the consequences of

long-term use, addicts have proven that once addicted, the ability to find and use the drug begins

to outweigh any previous priorities. Reality television shows, such as A&E’s Intervention, depict

the length in which an addict will go in obtaining their drug of choice; specifically intravenous

(IV) heroin users. There are an estimated 1.5 million IV users in the country at any given time. In

addition to the mental health concerns that arise from IV drug use, there are a multitude of health

issues that are raised as well. In 2006 intravenous drug users accounted for 12% of all new

infectious disease contribution in the United States, as well as making up 60% of all new

Hepatitis C cases in the United States (Plummer, 2010).

Heroin addicts that began using before adulthood, associate the early use with severe

childhood trauma. The common reasoning behind this was the desire to seek comfort, rather than

the pleasure most assume. Trauma is not only limited to childhood. In the 1970s soldiers that

fought in the Vietnam War began returning home, many with undiagnosed cases of post-

traumatic stress disorder. While fighting the war in Asia, high potency, low-cost heroin was

readily available. Unfortunately, the drug became a way to cope and deal with the everyday high

stress environment the soldiers were living in. Vietnam Veterans are a specific group that have

been shown to suffer from considerable rates of heroin abuse (Plummer, 2000). As previously

discussed, our bodies have a natural physiological response to stressors (McLeod, 2010). But,

when enduring high amounts of stress, such as fearing for your life, your body will respond

accordingly. Heffernan et al., (2000) found that, “Those with a trauma history may preferentially

use opiates for their analgesic properties and capacity to attenuate hyperarousal symptoms


associated with trauma exposure” (p. 798). Analgesic means that the substance has a numbing

effect. When ingested into the body, the normal emotional responses to pain are altered.

Therefore, the use of opiates is considered to be the users attempt at gaining relief from intense

emotions that can be crippling when their capacity for self-regulating is impaired. Researchers

have long believed that the use of opiates by trauma victims is an attempt at self-medication

(Heffernan et al, 2000).

Genetics and Environment

There are multiple factors that go into addiction, such as environment, as well as the

genetic heritability of the disease. Familial factors can have a great affect, both negatively and

positively on addiction. A variety of aspects of family functioning correlate with risk of

substance use and abuse. Those individuals who have experienced dysfunction such as parental

divorce or death, a family history of addiction, criminal behavior amongst family members, and

having come from a lower socioeconomic situation are all correlates to an increased risk of later

substance use disorders (Kendler, Sundquist, Ohlsson, Palmer, Maes, Winkleby, & Sundquist,

2012).

When examining this paradigm it is necessary to consider both genetic background as

well as environmental factors. At the very earliest stage of development the parent-offspring

relationship is absolutely critical. The environment and social experiences in which a child is

exposed also greatly influences the expression of that child’s genes, and therefore their behavior

and personality. Several studies have shown that genetic factors account for 30%-60% of the risk

for chemical dependence (Li, Du, Yu, Jiang, Fu, Wang, Sun, Chen, & Zhao, 2012). Specifically

the Monoamine Oxidase-A (MAO-A) and serotonin transporter genes have exemplified the

relevance of these interactions. In recent genetic work it was found that males who were exposed


to abuse as children possessed a lower activity form of the MAO-A gene. They presented with a

much higher rate of violence and conduct disorders as opposed to males who also lacked a high

level of the gene, but were not mistreated. These males were also at a higher risk of developing a

mental health disorder such as depression if they are exposed to at least three stressful life events

during childhood and adolescence (Champagne, 2005). It can be determined from these findings

that having a higher proclivity towards violence and conduct disorders also increases the

propensity to engage in riskier behaviors as well as putting oneself in more dangerous situations

and environments. While already being genetically predisposed to addiction, these behaviors

open the doors to substance use and abuse, leading to the inevitable substance use disorder.

Adoption

Adoption is another path to understanding addiction due to its interacting factors of

genetics and environment. A child who is adopted experiences a great trauma, sometimes as

early as birth. In a study entitled, Behavioral Outcomes for Substance-Exposed Adopted

Children: Fourteen Years Postadoption, it was found that adopted children that were born to

addicted birth mothers, predicted elevated behavioral problems (2008). The psychologists that

conducted the study mailed questionnaires to 956 adoptive parents, receiving 469 completed.

Their primary source of interest was to find out if substance-exposed adopted children had an

increased frequency of behavioral issues. The researchers found that indeed the children that had

been exposed to illicit drugs, specifically heroin, crack cocaine, and cocaine, and marijuana, did

show an increased incidence of behavioral issues (Crea et al., 2008). It is important to note

though, that the non-exposed adopted children also began to display increased behavioral

problems, but not as early as the substance-exposed children did (Crea et al., 2008).


Adopted children are twice as likely to abuse drugs if their biological parents did too.

This suggests that genetics play a crucial role in the eventual development of substance use

disorders. Based on a study in Sweden surveying over 18,000 adopted children, addiction within

the adoptive family also plays a large role in contributing to later substance use. Of the 18,000

ethnically Swedish and non-Swedish participants, the adopted children had about twice the risk

of developing a substance use disorder if their biological sibling had similar issues. But the risk

was about the same if their adoptive siblings, those who had no biological connection to them,

had a substance use disorder. In the national Swedish adoption study, children born to biological

parents diagnosed with a substance use disorder, were more than two times as likely to also

become later diagnosed with a substance use disorder (Kendler et al., 2012). The children who

had been adopted were also at a higher risk for succumbing to the adverse effects of dysfunction

in their adopted home, as opposed to those adopted children who were not genetically

predisposed to addiction (Kendler et al., 2012). In an article written by Amanda Gardner (2012),

Kendler et al. also notes that for an individual who experiences a troubling environment yet

possesses a low genetic risk of addiction, they are only slightly more susceptible to an increased

risk of drug abuse. But, those with a high genetic risk are much more likely to become addicted

to a substance (2012). These findings strongly correlate with the genetic influences of drug

abuse; but there is also a strong argument for nurture and its effects on adopted children and their

risk of addiction. Those who experienced the trauma of adoption, as well as possessing a genetic

predisposition to drug addiction, yet were not exposed to high-risk environmental factors, were

less likely to become addicted later in life (Kendler et al., 2012).

Forming Attachments


When a newborn comes into the world, the need for a secure attachment to a parent or

primary caregiver is extremely important to the infant’s well-being. For example, when a

newborn cries and their needs are consistently met the infant learns to trust. This early

attachment between a child and parent is the ultimate key to the child’s future success. The

profound nature of this bond is made clear if a child were to experiences a traumatic event, but

experienced the trauma after a trusting and loving attachment with a caretaker had already been

forged. That initial healthy bond has the potential to act as armor for the child, making their

recovery that much easier and possible. (Cornbluth, 2014). According to a recently conducted

study published by Fletcher et al. (2014), the emotional and physical propinquity to an infant and

caretaker is biologically imperative. Being tangibly or emotionally separated can cause anxiety,

loneliness, and sadness in the newborn.

As an infant is cared for, that attachment and bond will naturally progress, but the quality

of the attachment can vary. For example, a secure attachment guarantees that the child will feel

understood and therefore secure. All of their needs, both physical and emotional, will be met so

their brain is able to develop appropriately providing the infant with their best chance at life

(Cornbluth, 2014). This healthy cognitive development results in the child’s ability to regulate

themselves and have high self-esteem which directly correlates with making better decisions

later in life (Khantzian, 2011). An insecure attachment can also be formed. This type of

attachment results in a failure of a parent or caretaker to meet their child’s needs. This lack of a

healthy attachment prevents a young child’s brain from organizing itself properly which can

even lead to physiological disorders such as failure to thrive (Cornbluth, 2014).

Separation Trauma Leading to Addiction


An attachment disorder stemming from abandonment is a trauma that will remain ever

present throughout the child’s life and into adulthood. Insecure attachments have detrimental

effects on an individual’s ability to create and maintain lasting healthy relationships, as well as

their ability to adjust and adapt to new environments (Fletcher et al., 2014). An insecurely

attached child that has experienced abandonment or neglect will react ambivalently towards their

mother or father. As the child grows into adolescence they may become fearful of any close

relationship as a way of protecting themselves. This occurs when the traumatized child has been

taught that their parent or parental figure is unsafe or inconsistent (Fletcher et al., 2014).

In 1997, Edward Khantzian was one of the first to examine and publish research based on

the correlation that exists between attachment and substance abuse. Khantzian’s theories on

addiction went against what most experts believed. He hypothesized that substance use and

abuse was not about seeking out pleasure, but instead about seeking out comfort and contact

(Khantzian, 1997). In later years, Khantzian elaborated on his research, stating that addiction is a

disorder of self-regulation and self-medication (2011). Due to the experiences of extreme trauma

in early childhood, the child is void of any ability to regulate their emotions and relations to

others. They become even more detached and disengaged, bringing into existence unbearable

amounts of stress, which then creates an even further reliance on addictive substances.

(Khantzian, 2011). In some instances, in which the addict is suffering from severe separation

anxiety, the drug actually replaces their need for any human connection at all.

Comorbidity

Substance use disorders, oftentimes caused by the experience of a trauma, are generally

present with some form of a psychiatric disorder. In fact, more than 25% of all adolescents in a

substance abuse treatment program are dually diagnosed. To make the case of dual diagnosis;


substance use disorder and mental health disorder, over 70% of all suicides within the age group

of 11 years-old to 18 years-old, occur amongst substance abusing adolescents (Schäfer et al.,

2009).

In a study relating to this period of adolescence, dissociation, or dissociative identity

disorder, was the most common psychiatric disorder among the representative age group;

although dissociation is not limited to this age group. Dissociation is well documented to be

linked with trauma, often due to past traumatic events in the adult’s early childhood. Dissociative

identity disorder, which is the most common of the severe co-occurring mental health disorders

among all age groups of substance abusers, is distinguishable from other mental disorders.

Patients exhibit symptoms of memory disruption, amnesia, or both, and/or autobiographic

memory amnesia. It almost invariably emerges as a result of overwhelming childhood

experiences. In order for dissociation to occur, the childhood abuse must be of an extreme nature,

and is usually associated with the child failing to receive any type of nurturing essential to

healthy development (Kluft, 1996). The child’s mind goes into self-preservation mode and will

actually disassociate from its physical form in order to deal with the horror of extreme abuse and

neglect in order to protect themselves.

As previously discussed, drug use and eventual addiction can very often become a coping

mechanism as a result of trauma. Acquiring dissociative symptoms is also a coping mechanism,

and is a way to detach oneself from the reality of their situation. Dissociation in childhood and

other psychiatric disorders caused by trauma and abuse will severely impair the cognitive

development of a child, thus providing a link between early childhood trauma and mental health

diagnoses.


If the trauma veritably results in dissociative behaviors and the adolescent or adult is not

properly medicated and/or treated, then the use of illicit drugs and the eventual dependency to

those drugs will reduce the symptoms of dissociation. But this is a temporary fix, and will only

last until the effects of the drug abate. Once the side effects of the chemical desist, the

dissociation returns, only to continue the cycle (Grossman, 1997). The process of attempting to

reduce these symptoms by way of a substance is known as self-medication. Self-medication is

when an individual turns to a behavior or substance to soothe an undiagnosed and untreated

mental health condition. The complexity of this is that the shame and anguish that goes along

with using drugs can also be very traumatic itself (Dayton, 2000). The emotional pain that results

from this only reaffirms and nurtures the already existing psychological disorders, again causing

the self-medication to continue.

Impulsivity

Impulsivity can be loosely defined as action and response without competent and

sufficient foresight; it is often associated with a variety of mental health disorders. Common

features of impulsivity can be observed as a decreased inhibitory control of one’s behavior, being

incapable of delayed gratification, and anxious decision making without consideration

(Winstanley, 2007). The characteristic of impulsivity has shown to have a pronounced difference

between substance abusers and those who do not have any addictive disorders. Impulsivity in

early childhood is also found to be a high-risk factor for drug use during the time of adolescence.

Interestingly, there is some evidence that high impulsivity scores are positively correlated with

the total number of illicit drugs used over the period of a lifetime. Impulsivity is known to be

rooted in biological and psychosocial processes. But, psychological literature also says that

impulsive personality is positively linked to early childhood trauma and abuse (Li et al., 2012).


In a study that analyzed the psychological features of a prison subgroup, it was found that

the subgroup, which consisted of prisoners having been diagnosed with substance use disorders,

were more likely to be habitual offenders, as well as displaying higher rates of violence and

suicide attempts while incarcerated. The offenders also scored higher on subscales for childhood

trauma. These results positively correlate with higher scores for impulsivity as compared with

the rest of the sample group; this was assessed using the Barratt Impulsivity Scale (BIS). It was

also found that the consequences of childhood trauma greatly affected the prisoner’s abilities to

exhibit resilience during incidences of highly stressful situations; as measured by the Connor-

Davidson Resilience Scale (CD-RISC). (Cuomo, Sarchiapone, DiGiannantonio, Mancini, & Roy,

2008).

Research regarding the biological aspects of impulse control has also been conducted.

The findings indicate that some of the same brain structures and neurotransmitter systems are

implicated in both addiction and impulsivity. In particular, the orbitofrontal cortex and nucleus

accumbens have been identified as important loci of impulse control. These parts of the brain as

they relate to addiction, have been strongly established in that drug-induced changes in dopamine

within the nucleus accumbens signal the rewarding properties of addictive substances

(Winstanley, 2007).

Trauma and the Brain

The connection between maladaptive behaviors during early childhood trauma is a well-

studied area in psychology. Until recently though, the direct link between trauma and

neurological changes had been difficult to find. Research now shows that children exposed to

any form of traumatic event, both physical and emotional, not only suffer psychological

repercussions, but certain parts of the brain are actually being altered (Ecole Polytechnique


Fédérale de Lausanne, 2013). The experiences of a young child, both healthy and traumatic, are

also extremely significant to their cognitive development. The amazing human brain is designed

to change in response to patterns of repetitive stimuli, and if the neurologic growth is ingrained

by trauma, devastating and lasting effects can result. Specific neurochemical systems in the brain

called the catecholamine systems which include the dopaminergic and noradrenergic systems

become sensitized by repetitive stressful experiences brought upon by abuse and trauma. The

results are inattention, poor impulse control, and overall emotional and cognitive dysregulation.

The traumatized child may therefore exhibit many maladaptive behaviors that when left

untreated, are associated with behaviors seen in adults having substance use disorders (Perry,

2000).

In a recent study, scientists exposed a sample of male rats to repeated stressful stimuli

within the first few days of life. The researchers observed that the traumatized rats became

noticeably more aggressive as they got older. The rats were then neurologically examined to find

out if the experiences had left a lasting mark. While examining the brains of the experimental

group of rats, the researchers observed there was only minimal activation of the orbitofrontal

cortex, therefore reducing the rats’ abilities to regulate their impulses. The study also measured

certain gene expression in the rats, specifically the Monoamine Oxidase-A (MAO-A) gene. The

scientists were curious to see if exposing the rats to trauma would elicit the same neurologic

changes in the brain of a young child that was exposed to trauma and abuse. The research team

was interested in finding out if there was a modification in the expression of this gene. To qualify

this, the psychological stress experienced by the rats was observed. The scientists found that the

expression of the MAO-A gene increased within the prefrontal cortex of the rats’ brains,


determining an epigenetic change. The trauma inflicted upon the group of male rats did in fact

cause a long-term alteration of the brain (Ecole Polytechnique Fédérale de Lausanne, 2013).

Finally, the researchers tested the efficacy of an MAO-A gene inhibitor, in this case an

anti-depressant, to see if it could possibly reverse the upsurge of aggression in the rats, which it

did. In the future, the team of scientists will explore treatments for reversing such physical

changes in the brain. Most interestingly, the researchers will attempt to understand whether

certain people are more vulnerable to being effected by trauma based on their genetic makeup

(Ecole Polytechnique Fédérale de Lausanne, 2013). This is extremely important to the field of

trauma and substance use disorders because of the link between such changes in the brain and

addictive diseases. Keeping in mind the well-founded connection that already exists between

trauma and addiction, this research could also provide many answers to the investigation of

heritability of substance use disorders; and with knowledge comes the power to help others.

Conclusion

Strong associations between childhood sexual, physical, and emotional abuse and adult

substance use disorders have been consistently demonstrated across a range of studies and

published literature. It is also known that when having experienced these debilitating traumatic

events, the child’s chances of developing depression, anxiety, dissociation, and other mental

health disorders is much higher (Grossman, 1997). Children who undergo trauma in any form

almost always suffer from low self-esteem, low self-worth, insecure attachments, and more.

As the traumatized child physically grows as well as cognitively develops into the stage of

adolescence they are ill-equipped at handling normal stressors life will throw their way. These

crucial and formidable years are when it is most necessary for a teenager to have the ability to

self-regulate and to possess the confidence in themselves to make good decisions. If that child


had formed a secure attachment with a parent or caretaker at birth, their chances of being able to

do this and to better withstand trauma is much higher (Cornbluth, 2014).

When examining the relationship between the environment a child experiences, it is

equally important to consider the genetics they were born with. Several studies show that the

genetically heritable risk for developing a substance use disorder is around 30%-60% (Li et al.,

2012). Changes in the brain also occur in response to severe stress, resulting in lack of impulse

control and motor behavioral dysregulation (Perry, 2000). Specifically the expression of the

MAO-A gene which increased within the prefrontal cortex of the brain causing a long-term

neurologic alteration (Ecole Polytechnique Fédérale de Lausanne, 2013).

Children born to an addicted mother, who were also adopted or put into foster care are of

the most likely susceptible group to developing a substance use disorder (Kendler et al., 2012).

This is most likely due to the already existing genetic predisposition, as well as the inability to

have formed the profoundly necessary bond with their mother. The importance of a child

forming a secure attachment is proven if that child were to experience a trauma later in life. That

trusting and bonded attachment acts a protection to any negative after effects which can lead to

low self-esteem, risky behaviors, and potential substance abuse (Cornbluth, 2014).

Comorbidity, as it relates, is having a substance use disorder while also being diagnosed

with a mental health disorder (Schäfer et al., 2009). The most common dually diagnosed

psychiatric disorder is dissociative identity disorder. When a young child is suffering through

unthinkable patterned abuses, they go into self-preservation mode in order to survive the ordeal;

they completely detach themselves from the situation and the people around them (Kluft, 1996).

If dissociation does occur in response to the trauma and the child does not receive help, as they


become adults the symptoms may become so unbearable that self-medicating with drugs may

ensue (Grossman, 1997).

Social experiences and genetics offer cues both behaviorally and cognitively to one’s

overall future well-being. When healthy attachments are forged and there is stability in

environmental settings, over time a child is able to withstand future life stressors that will

inevitably come their way. However, when a child suffers through extreme forms of abuse and

trauma, cognitive growth and development are hindered. These impediments almost always

correlate with a decreased inhibitory control of one’s behavior, leading to self-medication with

drugs and substance abuse and addiction.

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