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Second-hand Trauma May Double the Risk of Later Substance Abuse Disorders: How to Protect Children

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A study  published in the August issue of the journal Addiction and summarized on PsychCentral by Richard Taite looked at the impact of second-hand trauma on later substance abuse.  Researchers looked for  traumatic medical events in the families of  1.4 million children born in Sweden between 1984 and 1995 by examining hospital discharge records. They were able to identify  children who  had  a parent or  a sibling who had been diagnosed with cancer or an immediate family member who suffered an injury which resulted in permanent disability or who had  been a victim of assault or who had died. They then assigned each child a score of 0-4 depending on the amount of secondhand trauma s/he experienced. Then the  researchers turned to medical, legal and pharmacy records to see which of these children  were  diagnosed with substance abuse problems when they reached their 20’s.

The researchers took care to control for other factors that might promote  substance use, such as socioeconomic status, drug use by family members, psychological wellbeing and parents’ educational level. What they found was striking: Children who experienced even one of the four secondhand traumas under study had twice the risk of later drug abuse.  Children who experienced the death of a parent were at greatest risk.  Having a parent or sibling who was the  victim of violent assault was the second most powerful factor. The PsychCentral report points out that “substance abuse was even higher in children whose siblings had experienced trauma than it was in children whose parents had been traumatized”.  The authors of the study had high confidence in their findings since they were able to conduct annual sampling of a national population over a period 16 years and because they had access to multiple data sources in order to identify cases of substance use disorders.

Of course, previous studies have noted the  impact of adverse childhood events (ACEs) on childrens’ emotional development.  As I explained in another post  researchers have found that  people who endure a great deal of toxic stress spend much of their lives in fight, flight or fright.  As the ACEs Too High Newsletter explained in October 2012:

“(These children) respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work and over-achievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame. (http://goo.gl/VEl0ez)  (Please continue reading)

However, the Swedish study suggests that we should be extremely thoughtful about the needs of children in families who are coping with even a single traumatic event.  I think that a child who appears to be coping quite well in the face of a  family tragedy may be at particular risk.  If the child continues to achieve at a high level  in school and doesn’t present obvious behavioral problems, it may be tempting for overwhelmed  parents or  busy teachers to imagine that she is  relatively unscathed by a catastrophic event.   However, recovering alcoholics and addicts  often tell me that, as children, they acted to protect parents who were struggling with disastrous family events by stifling their own feelings and trying at all costs, not to add to their parents’ burden. Suppressing  natural reactions to huge family events can take a huge toll on a child’s mood, even if the entire cost of the effort doesn’t appear until later in life.  I often think of the observation made by author and grief counselor Dr. Alan Wofelt that anyone old enough to love is old enough to grieve“.  He notes that adults commonly avoid discussing death with children because they fear they will exacerbate the child’s grief by taking note of it.  But, as Dr. Wofelt points out, children will grieve anyway, and worse, they will feel all alone with their pain if adults do not address loss and help them to process it.  Dr. Wofelt has suggested guidelines for helping children to cope with grief.  While he is talking about what to do when a child loses a loved one, it is my experience that these guidelines are useful and pertain to any catastrophic family (or community) event.  Here is Dr. Wofelt’s guidance:

“Be a good observer. See how each child is behaving. Don’t rush in with explanations. Usually, it’s more helpful to ask exploring questions than to give quick answers.

When someone loved dies, don’t expect children’s reactions to be obvious and immediate. Be patient and b e available.

Children are part of the family, too. And reassurance comes from the presence of loving people. Children feel secure in the care of gentle arms and tenderness.

When describing the death of someone loved to a child, use simple and direct language.

Be honest. Express your own feelings regarding the death. By doing so, children have a model for expressing their own feelings. It’s all right to cry, too.

Allow children to express a full range of feelings. Anger, guilt, despair and protest are natural reactions to the death of someone loved.

Listen to children, don’t just talk to them.

No one procedure or formula will fit all children, either at the time of death or during the months that follow. Be patient, flexible and adjust to individual needs.

Adults must recognize their own personal feelings about death. Until they consciously explore their own concerns, doubts, and fears about death, it will be difficult to support children when someone loved dies.”

How have you handled difficult family events with your children?  Do you have your own suggestions?

You can read more about the Swedish study here:

Kids Who Experience Family Trauma at 2x Risk of Addiction | The Science of Addiction.

Read more about addiction and the family in Dr. Wood’s books: Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life and Raising Healthy Children in an Alcoholic Home

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Barbara Wood is a licensed psychologist who practices in Bethesda, Maryland and specializes in the treatment of addictions and trauma. She is the author of two books that explain the impact of alcoholism on families and describe a path toward recovery for family members. Her first book, Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life wa an alternate selection of the Psychotherapy and Social Sciences Review in 1987, and is identified in the current New York Review of Books Reader’s Catalog as one of the best books in print. The Journal of Contemporary Psychology described it as "compelling from intellectual and emotional standpoints" and said that it was "highly recommended to a general clinical readership.” Dr. Wood's second book, Raising Healthy Children in an Alcoholic Home" is a book written for parents in recovery from alcoholism, co-dependence, and other addictive problems. It helps them to become “therapeutic ” parents—active and compassionate listeners and sensitive guides to children in crisis. A reviewer from the Harvard Medical School described it as" an impressive contribution for everyone who grapples with this issue in their own lives as well as for practitioners helping their clients to become therapeutic parents.”

Dr. Wood also performs forensic evaluations and provides expert testimony in cases where plaintiffs or defendants have been affected by traumatic events and/or substance abuse disorders. Washingtonian Magazine has identified her as one of the top 123 psychotherapists in the Washington D.C. Metropolitan area. She lectures widely on her work.


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