Universally speaking, addiction is defined as the continued use of a mood altering substance or behaviour despite adverse dependency consequences. It is an “impaired control over a reward seeking behaviour from which harm ensues”, (West, 2007). Such forms of addiction can include drug abuse and alcohol abuse, which fall under the category of substance addictions. Likewise, there are addictions such as gambling and sexual activity that fall under the category of process addictions. Orford (2001) defines addiction as the development of desires and inclinations, which in itself is basic to life. This quote brings up the question of why addiction occurs in some people and not in all, if it is after all, basic to life. The answer to this may be that addiction is “a complex bio-psycho-social phenomenon”, (Drummond et al, 1995). It is thought that trauma is an aspect of this bio-psycho-social phenomenon that can contribute to the development of addiction problems. Joseph (2012) defines trauma as a deeply distressing or disturbing experience which causes damage to the psyche. For this essay, I will be looking specifically at distal trauma to see if traumatic childhood events contribute to the development of addiction problems. I will be using the disease model, stress model and attachment model of addiction to explain this link, and to examine if there are any practical implications of these models for the treatment of addiction.
According to National survey, trauma such as Childhood Sexual Abuse (CSA) correlates with women from the U.S’s use of alcohol and other drugs. In a longitudinal analysis by Wilsnack, Vogeltanz, Klassen and Harris (1997), results from over 1,099 female participants, indicated that women with histories of CSA were significantly more likely than women without CSA histories to report recent alcohol use, intoxication, drinking- related problems and alcohol dependence symptoms. This is in keeping with previous evidence such as that from Neumann (1996) and Roesler & Dafler (1993), that women with histories of child sexual abuse are more likely than women without child sexual abuse histories to experience substance abuse. These examples however could be quite biased for the evidence in favour of the childhood trauma/addiction link, as other studies have shown that women have much stronger associations between childhood trauma and addiction in later life than do men. This was observed in Hyman, Garcia and Sinha’s 2008 study in which they examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults, both male and female. Emotional abuse in men and women was associated with a younger age of first alcohol use and a greater severity of substance abuse. The associations were much stronger for women, but saying that, the associations for men were still relatively strong. What is surprising about this study was that sexual abuse in women was not directly related to lifetime substance abuse severity, which is in contrast to the Wilsnack et al study’s findings. Furthermore in a different study by Heffernan, Cloitre, Tardiff, Marzuk, Portera and Leon, (2000), which investigated the relationship between childhood abuse and opiate use among 763 consecutively admitted psychiatric inpatients, they found that physical abuse alone or mixed with sexual abuse had a much higher association with opiate use than sexual abuse by itself. Overall, opiate users were 2.7 times more likely to have a history of childhood abuse than non-opiate users. In terms of trauma, it seems that different forms of childhood trauma have varying degrees of effect on addiction and that CSA abuse may not be as big of a predictor as other forms such as emotional abuse and childhood maltreatment, but is still relevant.
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One model that may explain the connection between childhood trauma and addiction is the Disease model. Under this model, addiction is described as a lifelong disease involving biological and environmental sources of origin. Goldman, Oroszi and Ducci (2005) carried out a study with thousands of twin pair participants. They found that the heritability of alcoholism is approximately 50%, and the heritability of cocaine and opiate addiction is approximately 60%-70%. Therefore, genetic and environmental influences on the development of addictive disorders are equally important. Working of Johnson and North’s 1992 framework that the gene GABRA2 might play a role in drug dependence, Enoch, Hodgkinson, Yuan, Shen, Goldman and Roy (2010), hypothesised that early life trauma might interact with GABRA2 variation to predict alcohol and drug dependence in humans. Their succeeding study confirmed that the interaction between GABRA2 and childhood trauma can influence vulnerability to substance dependence. This is a highly prolific finding as it highlights that some people may be more genetically prone to addiction than others, especially when Childhood trauma interacts. Treatment outcomes for the GABRA2 gene are being developed but none thus far have been successful. Poor outcomes following treatment for substance dependence are common, and efforts to improve the efficacy of treatment have become an integral part of treatment design (Dayel and Marlatt, 1997). The GABRA2 gene is just one take on the disease model of addiction, but there are others such as that; Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus and subiculum, which in turn can lead to substance abuse (Teicher, Anderson and Polcari, 2011). What is important to remember though is that just because the trauma/ addiction connection may have a biological basis, does not mean that it will be any easier to treat as evidenced by the GABRA2 gene treatment implications. In-fact, the implications of a person following the disease model of addiction may be negative, as labelling them as an “addict” keeps them from developing self-control, something that is deemed crucial for addiction treatment by Urbanoski and Wild (2012) under their Self Determination Theory.
Another model that may explain the connection between childhood trauma and addiction is the Stress Coping Model. The concept that stress leads to substance abuse in vulnerable individuals and relapse in addicts is not new. Most major theories of addiction postulate that acute and chronic stress play an important role in the motivation to abuse addictive substances (Sinha, 2001). The term “stress” commonly refers to the reactions of the body to specific events or stimuli that the organism perceives as potentially harmful or distressful. Such stress inducing events or stimuli, which are referred to as stressors, can be psychological in nature and can extend to childhood trauma such as family difficulties (Brady and Sonne, 1999). According to the stress coping model, the use of addictive substances serves to reduce negative affect in individuals and increase positive affect, thereby reinforcing drug taking as an effective, albeit maldaptive, coping strategy (Wills and Shiffman, 1985). Sinha, (2001) highlights that a greater understanding of how stress may perpetuate drug abuse will have a significant impact on both prevention and treatment development in the field of addiction. Biologically speaking, it has been observed that the Corticotropin- releasing hormone (CRH) is involved in the release of certain endogenous opiods from specific neurons in the brain, thus resulting in various behavioural and emotional consequences of stress, for example, substance abuse. In a 2010 study by Roberto, Cruz, Gilpin, Sabino, Schweitzer, Bajo, Cottone, Madamba, Stouffer, Zorrilla, Koob, Siggins and Parsons, they found that by suppressing the CRH hormone in rats, then alcoholic rats (the rats in the study were carefully cultivated by the researchers to become addicted to alcohol) drank less and even prevented non-alcoholic rats from developing alcohol dependence. A CRH antagonist was used to suppress CRH. This biological understanding of the stress model could have huge implications for the treatment of individuals with addiction problems. If the results of Roberto et.als study can be replicated in humans, then the treatment implications for the stress model of addiction are vast and can include not only addiction rehabilitation, but addiction prevention. However, it still remains to be seen if this stress model can hold up in the real world of more complicated human addictions. The big issue is that the CRH antagonist (known as antalarmin), is not widely tested or used on humans. Instead a psychological perspective may be used in terms of dealing with stress, which would in theory, effectively deal with the issues that cause addiction in the first place. Stress experts Smith and Pergola (2006), claim that the best way to avoid and deal with stress is to take care of yourself and have a healthy lifestyle. They go on to say that steps such as taking time to relax, talking with a friend, and learning to keep a perspective on things that are important and those that are not, are crucial to preventing stress and therefore addiction.
The last model which will be explained is the Attachment model which is in ways similar to the stress model in that it characterises addiction as trying to fix feeling bad. According to attachment theory, patterns of attachment are encoded and stored as generalized relational patterns in the systems of implicit memory. These are conceptualized as cognitive affective internal working models which are seen as mediating how we think and feel about ourselves, others and the relationships we develop (Renn, 2009). Childhood trauma such as abuse has been found to comprise brain-mediated functions such as attachment, empathy and affect regulation (Perry, Pollard, Blakely, Baker and Vigilante, 1995). If the trauma is left unresolved and is carried into adulthood, it leaves the individual vulnerable to affect dysregulation in interpersonal conflict situations which leads to misguided attempts of self repair, such as through substance abuse, for suppressing dreaded psychobiological states (Renn, 2009). Substance abuse, as a reparative attempt, only exacerbates the condition because of physical dependence and leads to further deterioration of existing physiological and psychological structures (Flores, 2001). Thorberg and Lyvers (2010) conducted a study with substance abuse inpatients in which they found that attachment is associated with and predicts affect regulation abilities and difficulties in interpersonal functioning. This evidence opens up a lot of new windows in terms of treating substance abuse individuals. Treatment programmes consisting of group therapy that integrate the 12 step abstinence based models have been advocated by theorists such as Flores (2001), who maintains that substance abuse addiction spanning from attachment problems can be cured in this way. Unfortunately, not everyone is as optimistic as Flores as even Thorberg and Lyvers have highlighted that “even though the notion that a secure attachment style may help protect against the development of substance abuse, makes obvious psychological sense, but definitive evidence is still lacking until longitudinal investigations are conducted”.
From the studies reviewed, it is clear to see that there is a plethora of evidence linking childhood trauma to later life substance abuse and addiction. This answers Orford’s (2001) quote about why not everyone succumbs to addiction if it is so very basic to life. The disease model claims that some individuals are more genetically predisposed to addiction while the stress and attachment models claim that addiction results from the individual’s need to suppress/cope with stress and to help deal with their attachment imbalance. Although each of these models have their own respective treatment implications, I noticed that the most prominent and empirically proven approach to treatment across the board lies in the individual’s ability of self control. The stress model highlights that the best mechanism to combat stress (therefore addiction) is for the individual to take care of themselves and have a healthy lifestyle, the attachment model emphasizes the need for the individual to indulge in group therapy, and the disease model affirms the risk of falling into the trap of the individual believing that they are helpless to their addiction. For those afflicted with addiction problems spanning from childhood trauma, I believe their best hope for rehabilitation is if they position themselves as an active participant in their struggle, and take the required and advised steps towards the road to recovery, as outlined by the 3 models.
