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Compassion for Survivors of Trauma – a New View of Substance Use Disorder/Addiction!

I remember being assigned to read the book by Dr. Gabor Maté, In the Realm of Hungry Ghosts, while in graduate school and simply feeling gratitude, compassion and validation afterwards.  I never believed in the medical model of addiction that describes the symptom of addiction as a chronic disease of the brain, even suggesting a genetic component to the disease, implying that if my parent(s) had addictions, most likely I would too.  Now, don’t get me wrong, the brains of people who struggle with addiction are different, yet those changes are created as a response to the adverse childhood experiences (AKA TRAUMA) these people survived.  And if your parents suffered from addictions when you were growing up, that experience is traumatic to a child!

I’ve written before about the impact of adverse childhood experiences, especially on physical health later in life as well as addiction; however, I felt compelled to revisit it again when I learned of research that found over 96% of the study participants suffering from substance use disorders, including prescription opioids, nicotine, and cocaine, had trauma histories.  When comparing the groups based upon their drug of choice, the prescription opiate group reported more traumatic childhood experiences than the other groups and a younger age of their first adverse childhood event.  So, when you learn about the underlying dynamics associated with substance use, the thought of “Just Say No” to drugs seems crazy!

Trauma comes in many packages and I’m grateful that the new California Surgeon General (Dr. Nadine Burke Harris) is focusing on early childhood, health equity and Adverse Childhood Experiences and toxic stress as her key priorities. (For more information on the ACEs Aware initiative, visit www.ACEsAware.org.)  It is time to stop blaming the victims and participate in bringing this information forward in order to educate.  What we don’t know, we don’t know.  However, once we know better, we can do better.  With this knowledge, we can bring more empathy and compassion in our interactions with people that struggle with substances.  We can take extra steps to explain this new research to them, validating their experiences and bringing them hope that they can heal from these past traumatic experiences and release their attachment to something that is harmful to them.  We can empower them to explore various healing modalities, such as psychotherapy, neurofeedback, meditation, hypnosis, guided imagery, and expressive arts, such as yoga, writing and drawing, all of which have been shown to support post-traumatic growth.

To read more about this research, click on the box below:

Can Stimulating the Prefrontal Cortex Calm the Default Human Survival Flight/Fight Response?

When humans encounter situations that they perceive as threatening, the parts of the brain responsible for our survival (i.e., amygdala, hippocampus) kick in to determine if running away from the threat is possible, to fight if not, and if neither is possible to stand still, hold our breath to be quiet and ultimately faint.  This flight/fight/freeze/faint response is not only the default position of our brains, it can be so activated over time from trauma and stress that it stays turned on even when we are not in harm’s way.

As someone that grew up in a home that would now be described as chaotic, I found myself in a series of situations that I either ran away from or fought, with a few where I found myself frozen in fear.  As a young child we don’t understand how these experiences are effecting our development, we just do what we have to – anything to survive.  As a young adult, I began to sense the amount of pressure I held in my body and used that energy to drive myself forward, sometimes to the point of exhaustion.

Through several years of psychotherapy, I discovered that the survival response in my brain, when activated (which happened to be most of the time), reduced my access to the parts of my brain that helped me to focus and communicate.  I subsequently learned that this is referred to as ‘amygdala hijacking’ and I describe it as the amygdala literally turning off the light switch leaving it in the dark to fend for itself without being able to see that there is access to support, specifically the prefrontal cortex.  And when you can’t access this part of the brain on a consistent basis, it loses its ability to offer a more balanced perspective of life.  Remember that saying “If you don’t use it, you lose it”, well it applies here too.

When I discovered yoga, I found a way to keep these two parts of my brain connected and when I did, it reduced the level of anxiety in the moment and began to strengthen the bridge that allows space to response, instead of react.  One of the most powerful tools that I learned from my time on the yoga mat was deep belly breathing, which was the first tool that I took off of the mat and into my everyday experiences.

Research has shown that practicing such breath techniques has neurophysiological impacts through respiratory vagus nerve stimulation.  The vagus nerve is the main part of our parasympathetic autonomic nervous system that is responsible for rest and digest processes and when stimulated is closely associated with emotional balance, mental flexibility, empathy and attachment.  It does this through decreasing hippocampal activity among other things, reducing the reactivity in the fear center of our brain, making access to the prefrontal cortex easier.  Now, what I have to admit is that I practiced such breath techniques for years until I began to consistently experience the emotional balance I so craved.  So, from personal experience I know it works, yet it can take time.

So how excited was I when I read the recent research in the Journal of the American Medical Association (JAMA) Psychiatry that looked at this bridge from a different perspective – stimulating the prefrontal cortex in order to allow it to stay online and calm the fear center of the brain when experiencing threatening circumstances, reducing anxiety.  This research looked at the effects of transcranial direct current stimulation, such as used in direct neurofeedback, of the prefrontal cortex on amygdala threat activity in people who experience chronic anxiety.  Neuroimaging was used to assess the impact and the results reveal a direct connection between the ability of the prefrontal cortex to regulate the fear response in the amygdala.  These findings offer more support to the neurocognitive mechanism contributing to the positive effects of direct neurofeedback and offer much hope to more directly and quickly reduce anxiety through such a non-pharmaceutical treatment option.

The Legacy of Childhood Trauma – Transgenerational Impact!

I had a dear colleague once say to me “We didn’t know what we didn’t know.  When we know, we do better”.  I hear myself repeating this phrase often, because blame and shame are not healthy, period.  Yet, if we don’t look back to reflect on the need for change and growth, then we are doomed to repeat the mistakes of the past.  I have written reflections in the past on the research around the impact of adverse childhood events (ACEs) on the individual and today I want to share the research that shows the impact of such events doesn’t stop with the individual!

Both of my own parents experienced childhood trauma and stressors, which thwarted their emotional growth trajectories, yet they didn’t know that about themselves and neither did society.  However, I definitely sensed that something was off and, as little ones will naturally do, I attempted to fill in the gaps.  Impossible, I know now, but I didn’t know then.  How ironic.

With this new research from UCLA reflecting a strong association between children’s behavioral health problems and their parents’ adversity histories, we now know better.  When our awareness grows around our past, it brings a deeper understanding of our experiences and our normal, natural adaptive responses.  With that deeper understanding, our hearts can begin to heal from events that our conscious minds were not even present to directly witness, yet stuck in our bodies instead.  We can create opportunities for ourselves to challenge those strongly guarded, unspeakable beliefs that there must be something wrong with us or that we are not worthy of acceptance and love, which keep us from a meaningful connection with ourselves and to others.

So, if you currently suffer from symptoms of trauma, such as anxiety and/or depression, and are not aware of experiencing any adverse childhood events yourself, perhaps consider exploring any that your parents might have been subjected to as they grew up.  Please remember that this exploration and what it might uncover is not meant to blame your parents.  It is meant to shine a light on the blame and shame that you might be carrying and that is feeding the self-judgment that is holding you back from a life full of connection, meaning and health.

To read more on this research, click on the button below:

What will it really take to reduce drug abuse in the world?

No, not more law enforcement efforts to reduce the production and transportation of illegal drugs.  This question has a basic economic component – as long as the demand is greater than the supply, the war on drugs will be lost.  So, how do we reduce the demand for drugs?  We must learn why people turn to drugs in the first place and we must stop buying into the belief that drug addiction is a disease and one that affects only the weak!

I have always felt that more compassion and understanding were needed for people who found themselves addicted to drugs or alcohol, not punishment, and yet, I wasn’t aware of the research that might support my feelings.  Then I read Dr. Gabor Maté’s book In the Realm of Hungry Ghosts: Close Encounters With Addiction, and I felt so validated in my view of this deeply concerning human experience.  This book opened my eyes and my heart to the underlying reasons that someone might turn to substances to soothe a painful internal landscape.  What Dr. Maté highlights is that addiction is a normal, natural response to emotional loss which is traumatizing to the human spirit. In other words, addiction soothes the pain of trauma.  So, drugs work – even if only to temporarily separate, or dissociate from the internal emotional pain of our traumatizing experiences.  And sometimes drugs may be the only reliable source of comfort that is available.  Sad, but true and I know many people find this fact hard to believe, especially when they have not walked in the shoes of the people they judge.  Then, when it happens in our own families, it becomes even harder to accept because we must take some accountability and responsibility for the depth of the pain that our loved ones feel.

Now, not all individuals that experience early childhood trauma will turn to drugs, so further research is needed to better understand the relationship between adverse childhood events and dissociation through addiction to manage overwhelming, painful emotions.  What some more recent research has shown is that there is another factor to consider in the equation, alexithymia.  A normal part of our development as children is learning how to understand and express emotions in order to regulate our emotional environment and we learn this by observing and exchanging emotions with our caregivers.  However, when children experience developmental trauma this lesson is impossible to learn, impairing our ability to deal with our emotional experiences and alexithymia develops, which is simply the difficulty to identify, describe, and feel our emotional states.

Early research suggested that men may experience alexithymia more than women, possibly due to the underlying beliefs found in a patriarchal societal culture that values logic and reason over intuition and emotion.  However, with the emerging research that is looking at the association between trauma, alexithymia and dissociation in the role of addiction, it appears that trauma disrupts the ability to process emotions in both genders equally.  Patriarchy only adds another layer of complexity, as this culture informs men – and thus women trying to succeed in a man’s world – that emotions are not valued and reflect some weakness in character.

These research findings bring much awareness to how the human spirit needs emotional connection with others who can nurture both our rational and intuitive intelligence, both our ability to feel and to understand our emotions, and ultimately express our emotions so that our actions can be guided, and not driven by them.  I found this research quite calming to my own spirit, not only because it validated my personal experience but because it validates a new approach to healing addiction, one that comes from a place of compassion and great appreciation for the resiliency of the human spirit instead of through further traumatization supported by the current, failing war on drugs.  This new approach is growing from a broader and deeper understanding of what is considered developmental trauma, which I will write more about in my next Talk Therapy reflection, and the need to help people put words to their powerful, sometimes overwhelming, emotional experiences of the past in order to face the pain and fear head on, because if you can’t feel it, you can’t heal it.

We all can make a difference in reducing the demand for drugs and decrease the incidence of addiction.  My recommendation in doing so is to look into the research that supports that addiction is a symptom, not a disease.  From this deeper understanding, embrace the idea that we are all born with emotions and emotions are a significant part of our intelligence.  Once there, commit to being a better role model to the people in your life by openly expressing your emotions and not just the “positive” ones – all of them, including disappointment, rage, guilt, shame – as all emotions are vital parts of our wholeness and well-being.

If you want to take the first step on the path of deeper understanding of addiction, click on the link below to read a recent study that explores the relationship between developmental trauma, dissociation, and alexithymia: