Why Childhood Abuse So Often Leads to Drug Use

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Published in Addictive Behaviors, a recent study by Schimmenti and collaborators explores the association between childhood abuse and substance use disorder, suggesting that childhood neglect or abuse may have a “central role in predicting the use of most substances.” Furthermore, dissociation appears to mediate the relationship between drug consumption and childhood maltreatment.

Childhood Abuse and Dissociation

According to DSM-5, dissociation refers to the “splitting off of clusters of mental contents from conscious awareness.” An everyday example is daydreaming, or the experience of being so absorbed in a movie that one loses awareness of the surroundings.

Though dissociation is not inherently pathological (as the above examples illustrate), severe and chronic dissociation is common in certain psychiatric disorders. For instance, in panic disorder, dissociation may include uncomfortable sensations of unreality and detachment from oneself, which are called derealization and depersonalization, respectively.

Depersonalization and derealization are also common in patients with drug use problems, certain neurological conditions (e.g., migraine headache), and some mental health illnesses—borderline personality disorder, complex posttraumatic stress disorder (cPTSD), dissociative subtypes of PTSD, etc.

One group of people prone to experiencing pathological dissociation is those with a history of childhood neglect and abuse.

Childhood Abuse and Self-Medication

The trauma model of substance use suggests people with a history of trauma tend to self-medicate, meaning they use psychoactive substances in order to self-soothe and prevent awareness of distressing emotions.

Like drugs, dissociation, too, can reduce awareness of trauma-related emotions, and, hence, decrease distress. However, both dissociation and self-medication can also inhibit the integration of adverse emotional and bodily experiences (e.g., uncomfortable feelings, painful sensations, overwhelming memories of trauma), with the result being greater trauma symptoms.

In summary, there are direct and indirect pathways from childhood trauma to substance abuse:

• Direct pathway: Childhood trauma leads to self-medication with the goal of soothing painful emotions related to trauma.
• Indirect pathway: Childhood trauma leads to drug use via psychological dissociation, as a way to keep distressing emotions and sensations out of awareness.

These pathways were investigated in the study by Schimmenti et al., as described below.

Investigating the Link Between Childhood Abuse, Dissociation, and Drug Use

Sample: 1,040 Italian adults living in the community; 67 percent women; average age of 30 years old (age range of 18 to 78 years); 22 percent married.

Measures

• The Childhood Trauma Questionnaire—Short Form. 28 items; includes scales assessing emotional neglect, physical neglect, physical abuse, emotional abuse, and sexual abuse. Example: “Someone tried to touch me in a sexual way, or tried to make me touch them.”
• The Dissociative Experiences Scale-Taxon. Eight items. Example: “Some people have the experience of feeling that their body does not seem to belong to them.”
• The Level 2—Substance Use—Adult. 10 items; measures the use of legal and illegal drugs without a prescription (e.g., painkillers, marijuana, ecstasy, heroin), or the use of drugs in larger amounts or over a longer period than prescribed.

The Consequences of Emotional, Physical, and Sexual Abuse

An analysis of data showed found trauma survivors who had experienced greater childhood maltreatment were more likely to dissociate and engage in drug use.

Those “who were maltreated in childhood tended to use different types of substances,” and “dissociation acted as a partial mediator between child maltreatment and substance use,” according to the researchers.

Furthermore, the interaction between dissociation and childhood physical/emotional abuse “predicted use of substances with calming effects on the nervous system, such as sedatives and heroin.”

The interaction between dissociation and sexual abuse predicted the “use of substances with predominantly perturbative (e.g., LSD) and excitatory (e.g., methamphetamine), but also potentially calming (e.g., some types of inhalants) effects.”

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This suggests that compared to those with a history of physical and emotional abuse, sexual abuse survivors cope by relying on alterations in consciousness and perceptions that go beyond just sedation.

What About Treatment for Childhood Trauma?

As for treatment for people who experienced childhood trauma, the primary goal is to help these individuals process trauma more effectively and integrate different mental states better. This may require focusing on the following skills:

• Mentalizing abilities. To develop a greater understanding of one’s own and other people’s mental states (e.g., beliefs, emotions, desires) that motivate behavior.
• Metacognitive skills. To become more aware of and to have greater control over one’s thinking processes—attention, memory, cognitive flexibility, etc.
• Emotion-regulation strategies. To learn how to influence the experience and expression of emotions using powerful techniques including self-compassion, reappraisal, and problem-solving.

Effective emotion-regulation strategies, in particular, have been found helpful in the treatment of emotional disorders, including anxiety and mood disorders, obsessive-compulsive disorder, PTSD, and dissociative disorders.

Takeaway

Previous research shows that having a history of childhood maltreatment is associated with substance abuse (e.g., alcohol, cannabis, heroin) and other compulsive or addictive behaviors.

The investigation discussed here empirically tested a trauma model of drug use, finding support for the view that substance use may stem from a “psychological vulnerability based on a difficulty processing and integrating childhood experiences of neglect and abuse.”

Though trauma is not the only cause of substance abuse, the trauma model can help us understand why childhood abuse survivors who struggle to soothe themselves and make sense of their distressing experiences tend to self-medicate and use drugs.

In terms of treatment for victims of abuse and neglect, it is important to address trauma early and help trauma survivors learn greater emotion-regulation techniques and self-regulation strategies. Doing so facilitates coping with distressing trauma-related emotions, reducing the likelihood of dissociation or self-medication.

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