opinion
RepaiRing the
damage
Services can’t ignore the
links between childhood
trauma and substance use,
according to Bill Say
LET'S TALK ABOUT ATTACHMENT THEORY. The
correlation between early childhood neglect and abuse
(trauma) and heroin dependency is one of the most
powerful in the field of social research.
This is not to say that all people who experience
childhood trauma will become problematic substance
misusers, nor is it saying that all substance misusers
necessarily have had difficult childhoods. However, there
is certainly a demonstrable link between the two. To
understand substance misuse as more than simply a
choice, bad luck or habit, we must include the important
variable of our early childhood attachment patterns.
‘Most substance misuse
issues can be traced to
pain and trauma, and
the effectiveness of
substance misuse
services hinges upon
finding alternative ways
of managing the
existential crises of
suffering and trauma.’
10 | drinkanddrugsnews | April 2019
So what is an attachment pattern and how
are they formed? Bowlby, a prominent
psychologist, postulated that our relationship with
primary caregivers – particularly during times of
distress – forms the basis of all future relationships,
and this becomes most apparent when those
relationships are fractious or challenging. A crying baby
is essentially saying 'something is wrong, can you come
and help'. We cry when we are in pain and that pain
can be physical or emotional. Being sad, being angry or
being scared, hurts. A nurturing caregiver will, in the
most part, be able to alleviate that pain by feeding,
wiping, burping or simply hugging and reassuring that
child that they are not defenceless and alone.
Every time the pain alleviation occurs we
strengthen a neural pathway in our developing frontal
lobe that eventually will enable us to know that pain
is temporary and can be alleviated – either through
our developed emotional resilience or through turning
to others for support. In Bowlby’s terms, this is a
securely attached child and thus an emotionally
mature and emotionally resilient adult. But, what
happens when a child’s needs are not met?
The child cries and no one comes. If this happens
often, it is neglect. A child’s cry is a distress signal, and
that distress will become louder and louder until
eventually it stops. As we get distressed or are in pain
or scared our bodies automatically go to fight or flight
mode (the autonomic sympathetic nervous system).
We are releasing adrenaline, and when we are soothed
we go back to business as usual and return to normal
human functioning. This includes release of growth
hormones, digestion, blood filtration, emotional and
cognitive learning and, most importantly, the ability to
love, nurture and safely get close to others without
fear of rejection.
So what’s happened to that crying child who has
stopped crying? That child, due to neglect, has simply
given up asking for
their needs to be
met. That child will
have come to a conclusion about their basic human
needs, which can only be ‘my needs are not important,
therefore I am not important, I am worthless’. When
they stop crying they enter the ‘freeze’ condition,
which is the body’s way of saying that you cannot
sustain this flood of adrenalin forever. The child will
disengage, not ask for help, think of themselves as less
than others, and resign themselves to a life where the
world is dangerous. In essence they either get angry
with the world and go to battle with it, or withdraw –
fight or flight. These neural pathways become locked
in, and these become our truths.
How do we exist with pain? We can’t reach out to
others and we don’t have the resources to cope
ourselves. So the first time we try heroin, coke, alcohol,
we get a flood of endorphins. That’s what heroin does
– it’s an endorphin replicant, and it removes all the
pain of loss and fear and anger that we’ve carried our
whole lives, without ever knowing anything else. It
feels magnificent and we feel whole again – do you
think we might use it again?
When the primary caregiver soothes our pain we
develop our pain tolerance and our pain endurance
slowly with nurture – basically we are building our
endorphin system. Most substance misuse issues can
be traced to pain and trauma, and the effectiveness of
substance misuse services hinges upon finding
alternative ways of managing the existential crises of
suffering and trauma, and finding meaning in
belonging and real acceptance and understanding by
others. And, most importantly, real understanding and
acceptance of ourselves. Mental health and substance
misuse must always be considered together.
Bill Say is partner at Just Say Training,
www.justsaytraining.co.uk
www.drinkanddrugsnews.com