ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY
"If you think what happened to you as a child doesn't affect you as an adult, think again"
The ACE study’s initial surveys were completed between 1995 and 1997 by the Centers for Disease Control (CDC) and Kaiser Permanente. 17, 421 participants were followed for more than 15 years. Adult participants were asked about their childhood experiences that occurred when they were younger than 18 years of age. Results showed the strong link between childhood trauma and adult health problems, both physical and mental. The areas they asked the participants about included 5 personal areas: physical, sexual. and emotional abuse, and physical and emotional neglect. The other 5 areas related to other family members. The infographic below illustrates the 10 areas of trauma measured. Each type of trauma counted as a score of 1.
ACE's that occurred during childhood correlated highly with an increased risk for adults developing major illnesses such as diabetes, heart disease, cancer, and chronic lung disease. ACE's also correlated with high risk behaviors such as smoking, exposure to sexually transmitted diseases, and substance abuse. Even more dramatic correlations were found between ACE's experienced and the risk of depression and suicide. The higher the ACE score, the higher the correlation of developing physical or mental illnesses. For example, participants who experienced 4 or more adverse childhood experiences were 260% more likely to have chronic obstructive pulmonary disease, and 5 times more likely to abuse drugs compared with participants who had not experienced childhood adversity. The infographic below demonstrates the scores and results.
The ACE study's dramatic results show once again the relationship between trauma experienced as a child and severe difficulties and illnesses as an adult. It is no surprise that when looking back into the history of addicted women adverse childhood experiences are revealed, and have played a major role in their addiction and often mental health issues as well. It is these same adverse experiences that the children of addicted women experience, such as loss of a parent, neglect, domestic violence and other traumas that are experienced just as the mother had experienced during her childhood. When women have children and are abusing substances already gives their child or children a positive ACE score. By preventing another pregnancy until the woman can receive treatment and maintain her sobriety will prevent the same pattern of adverse childhood experiences from occurring again.
Attachment
"Attachment is a deep and enduring emotional bond that connects one person to another across time and space" (Ainsworth, 1973; Bowlby 1969)
Specifically, attachment theory looks at the trust that develops between an infant and child and the primary caregiver as the basis for a child's emotional and social development.
When a child experiences trauma in the form of physical and emotional neglect, and/or physical and/or sexual abuse, a disruption in secure attachment occurs. As a result, an insecure attachment pattern occurs that results in unhealthy thoughts and perceptions of the self and others, and an inability to regulate emotions in a healthy way. These, in turn, result in self-destructive behaviors such as substance abuse and other addictions, and insecure attachment and relationship problems as adults. The cycle continues with maladaptive parenting as adults based on their own mistreatment as children.
This is a simplified explanation of a complex problem. An extensive amount of research has been produced on the attachment theory and childhood trauma. (See my Resources section)
When a woman enters a recovery program after recently giving birth, she frequently is separated from her baby. Her baby is temporarily placed with family members or foster caregivers. This is a result of having tested positive for drugs at the time of delivery. The baby may be placed with the mother later because she has agreed to enter a treatment program. Other women in recovery have also lost custody of a child or children and are attempting to regain custody by entering a treatment program. Often, women have other older children already out of their care either temporarily or permanently. A disruption of attachment is evident when a child is caught in the revolving door of foster care, different family members, interspersed with visits with the mother. It is confusing, chaotic, and results in childhood trauma. This results in the cycle of substance abuse and maladaptive parenting continuing.
However, if the mother can stay in recovery, learn parenting techniques, get help with understanding and coping with her own trauma and addiction, there is hope for her and her children. But if she leaves treatment prematurely, and does not have custody of her children, there is a good chance she will become pregnant again and then return to treatment hoping this time the results will be different.
If women can obtain an effective contraceptive while in treatment, as a essential part of also obtaining needed health care services, she has a chance to have a different outcome and be successful as a mother to her existing children.
Trauma and the Connection to Addiction
When one thinks of trauma, the common reaction may be to think of an act of violence. But trauma comes in many forms. Violence, abuse, posttraumatic stress disorder (PTSD) are often terms used instead of trauma. Child abuse, both physical and emotional, sexual abuse, neglect and abandonment are common histories in the lives of addicted women. Violence is often pervasive in their lives, starting in childhood either experiencing or witnessing violence in the home, to the violence observed and experienced as a result of living in poverty and growing up with addiction as a normal part of everyday life, to partner violence later. Many times the addicted woman is introduced to substances by a family member, even a parent, never knowing an environment where drugs or alcohol weren’t the norm.
I am again going to recommend reading the important work of Stephanie S. Covington, Ph.D., LCSW in this area of trauma and addiction. It is her 2012 presentation from a symposium that is available online. It can be accessed by doing the google search Trauma Matters: The Connection Between Addiction, Mental Health, and Trauma. It is excellent in addressing what trauma is and its results, what trauma informed services entail, and the process of trauma recovery.
Trauma recovery doesn’t happen overnight or even after spending months in a treatment program. For many women, trauma work may take years of recovery. But this is where it starts – with trauma informed care. Recognizing and understanding their trauma history and working through it with support is essential in order for addicted women to provide adequate, consistent, loving, and appropriate parenting. Postponing pregnancy allows women to gain the necessary skills, insight, and trauma informed care that will enable them to provide for children in their care, and to focus on reuniting with existing children if they have been removed from their care. Effective, safe, long acting birth control methods offer women the chance to succeed in parenting their children. Family planning must be incorporated into every recovery program and setting in order to accomplish this.
ADDICTION TREATMENT THAT SERVES THE SPECIAL NEEDS OF WOMEN
“A woman is the full circle. Within her is the power to create, nurture, and transform.”
-- Diane Mariechild --
After working with women for many years and hearing their stories, common topics would recur when women talked about their past experiences and what led to using substance and continued them to keep using substances. For some women, they had already been through several treatment programs. This created shame and distress that they couldn’t maintain sobriety. Physical and sexual abuse, domestic violence, losing their children or the fear of losing them, concerns about maintaining a relationship with partners that often were also using or incarcerated, and lack of resources – no money, no housing, no sober support system in place, lack of education and job skills all were recurrent themes.
Stephanie S. Covingtom, PH.D, L.C.S.W, is the Codirector of the Center For Peace and Justice, http://centerforgenderandjustice.org. In her article Women and Addiction: A Trauma Informed Approach, she defines gender-responsive/women-centered service as “the creation of an environment – through site selection, staff selection, program development, and program content and materials – that reflects an understanding of the realities of women’s and girl’s challenges and strengths”.
In the same article listed above, Dr. Covington also cites Gender Responsive Principles applicable to any setting that serves women. These principles are:
“Gender: Acknowledge that gender makes a difference.
Environment: Create an environment based on safety, respect, and dignity.
Relationships: Develop policies, practices, and programs that are relational and promote healthy connections to children, family, significant others, and the community.
Services: Address substance abuse, trauma, and mental health issues through comprehensive, integrated, and culturally relevant services.
Socioeconomic status: Provide women with opportunities to improve their socioeconomic conditions.
Community: Establish a system of comprehensive and collaborative community services."
It is the care provided through gender-responsive services that provides women with the insight and information that they need in order to incorporate family planning and health maintenance into their recovery plans. In gender-responsive treatment the site must be conducive to treating women, the staff must be sensitive to and trained in the special needs of women, and non judgmental in areas relating to reproductive health and addiction in general. The curriculum must include not just parenting skills, but information about birth control methods. Transportation must be available to access these services. The program must offer insight to the women as to the advantage of postponing pregnancy until sobriety is maintained, and they are stable in a sober lifestyle for an extended period of time.
This is how empowerment occurs for women – moving forward with support through the hard work of recovery, and gaining control over all aspects of their lives which includes successful parenting and the possibility of reuniting with their children.
Breaking The Cycle
Whenever I waver even slightly in my determination to help women break the cycle of losing their children, I hear yet another woman’s story that convinces me (and still astonishes me after all the years of providing care for addicted women), and hopefully will convince you too, that this is a problem that effects us all and needs solutions.
“Cynthia” is a 29 y/o with a history of cocaine abuse and is now in treatment again. She has had 11 pregnancies and 7 children. They range in ages from 14 years old to 6 months old, with 1 set of twins that are 6 years old. Two of her children are 10 years old because they were born 9 months apart. None of the 5-6 fathers are involved. Her mother has custody of her children, and she is planning on possibly letting her sister-in-law adopt her 6-month old baby. She doesn’t want another pregnancy “right now”.
Fortunately, she now has Nexplanon, the hormonal implant that provides effective birth control for 3 years, inserted after her last baby was born. There are many, many stories just like “Cynthia’s, and many mothers grieving the loss of their children, and many children attempting to cope and understand, and suffering the consequences of inconsistent attachment. I can’t help but look back at “Cynthia’s” history, and think, if only 10 years ago, or even 5 years, she had chosen to obtain a long acting contraceptive, she may have been able to provide care for at least some of her children, and spaced them so that her failure to be able to parent them wasn’t inevitable. Even in the best situation, without addiction involved, parenting is challenging with that many children.
