# Motivation and emotion/Book/2022/Childhood trauma and subsequent drug use

* Multimedia presentation (3 min)

## Overview

The use of drugs has jumped from the romanticisation of the “love drug” known by the name of methylenedioxymetamfetamine (MDMA) and hallucinogenic drugs in the 1980s, to the rumination of them and their lethal and detrimental nature across time. When it comes to drug consumption, we see those individuals who search for a deeper meaning, those who try to find an escape and those who conform to social norms. Yet, humans are aware of the detrimental consequences of drug consumption. From a young age we are taught about drugs and their lethal consequences due to the detrimental impact drugs can cause to an individuals health (see Figure 1) Why do individuals partake in drug consumption when they are aware of what might happen?
Imagine an individual who has consistently used drugs for years, developed an addiction and is therefore unemployed. This behaviour has caused family members and friends to detach themselves, leaving this individual lonely. Family members constantly asking why they have done this to themselves and the blame being pointed at the individual for ruining their life. Although it is not out of the picture, we tend to believe that people are responsible for their actions and therefore blame them for using drugs. Why do we tend to believe this? Is it truly the individuals fault or can drug use be influenced by previous traumatic experiences?
This chapter focuses on how childhood trauma can influence subsequent drug use.
* Focus questions:
* What is childhood trauma?
* What are theoretical underpinnings of childhood trauma induced drug use?
* How does childhood trauma influence drug use?
* What are the strategies for treating trauma-induced drug use?
* Suggestions for this section:
* What is the problem? Why is it important?
* How can specific motivation and/or emotion theories and research help?
* Provide an example or case study.
* Conclude with Focus questions to guide the chapter.

## What is childhood trauma?

The American Psychological Association (APA) defines a traumatic life event as:
   "One that threatens, injury, death, or the physical integrity of self or others and also causes horror, terror, or helplessness at the time it occurs. Traumatic events include sexual abuse, physical abuse, domestic violence, community and school violence, medical trauma, motor vehicle accidents, acts of terrorism, war experiences, natural and human-made disasters, suicides, and other traumatic losses (American Psychological Association, 2008)."
* When these events are experienced in a developing child, this constitutes as childhood trauma.
* Due to children's vulnerability and lack of understanding, depending on their age, trauma can be especially harmful and result in many consequences throughout adolescence and adulthood.

### Types of childhood trauma

Childhood trauma refers to negative events that threaten or cause harm to a child's emotional and/or physical wellbeing (see Figure 2). Childhood trauma is most commonly the result of a child perceiving themselves to be in a life-threatening situation.
Terr (1991) introduced two types of childhood trauma:
* Type I - results from a single event such as an accident, witnessing a crime or rape.
** Individuals affected by Type I trauma especially if the incident occurred after the age of 3, are thought to remember the incident and experience perceptual symptoms such as visual hallucinations as a consequence of the trauma.
* Type II - results from repeated exposure of extreme traumatising events such as re-occurring abuse
** Individuals affected by Type II trauma, are proposed to repress the event using denial and dissociation methods to avoid the trauma exposure.

### Consequences of childhood trauma

* Emerging literature puts a strong focus on the effects of childhood trauma on brain development. Adverse events experienced in childhood, exposes children to become insecurely attached and develop poor self-regulation skills (Ford, 2009). Emotional dysregulation as a consequence of childhood trauma, has been highly linked to substance use with heavy consumption in adulthood (Dass-Breilsford & Myrick, 2010).
* Longer term reactions include unpredictable emotions, sleep disturbances, separation anxiety, the development of new fears, anger irritability, and even physical symptoms like headaches to nausea (American Psychological Association, 2008).
* Since children are still developing, childhood trauma can have long-lasting effects on a child's physical, mental and emotional well-being which carries onto adulthood. Moreover, common consequences of childhood trauma includes co-occuring psychiatric problems and substance abuse (Dye, 2018).

## What constitutes drug use?

* Drugs have been been used medically and recreationally throughout history with early civilisations using them for religious rituals.
* Drug misuse is defined as the recreational use of alcohol, illicit drugs and pain medications which can lead to emotional, physical and social harm (Ghuran & Nolan, 2000).
* Repeated drug use often leads to substance use disorder (SUD) which commonly constitutes addiction and the inability to discontinue drug use.
* According to the 5th edition of the Diagnostic Manual of Mental Disorders (DSM-5) substance induced disorders occur when the substance use leads to intoxication, addiction, withdrawal and induced psychological disorders such as psychosis and and depressive disorders (American Psychiatric Association, 2013).

### Alcohol

* The World Health Organisation (WHO) has identified alcohol as a psychoactive type of drug which is highly addictive and the cause of around 3 million deaths per year (World Health Organization, 2022).
* Repeated alcohol use can result in alcohol use disorder which can impact an individual's psychological, physical and social well-being

### Pain medication

* Pain medication such as opioids are crucial in the medical world and have a purpose of delivering an analgesic effect for those individuals experiencing agonising pain. Acute pain patients benefit from these drugs immensely.
* The use of pain medication is common among those who suffer from chronic pain conditions and is commonly not addictive or harmful when used in moderation. Nonetheless, the addictive properties in opioids paired with repeated use can quickly lead to drug addiction (Schnoll & Weaver, 2003)

### Illicit drugs

* What makes a drug illicit? An illicit drug is one which has not been medically approved and is prohibited and illegal to be consumed, possess and sold. Illicit drugs are illegal due to the risk of addiction and the psychological and physiological risks attached to them. The international illegality of these drugs extends from plant-based drugs (e.g. cannabis, cocaine heroin) to pharmaceutical drugs (e.g. benzodiazepines) and synthetic drugs (e.g. MDMA, amphetamines) (Degenhardt & Hall, 2012).
* The use of illicit drugs is commonly looked down upon and seen as the self-endangerment of an individual's well-being and sanity. So why do individuals partake in illicit drug use?
Quiz Time!
What makes a drug illicit?
When it has been medically approved for consumption
When it has not been medically approved and is prohibited and illegal
When it is a plant-based drug :

## What are the theoretical underpinnings of trauma-induced drug use?

* Using drugs is a dangerous behaviour that is commonly performed recreationally with large negative consequences. Although drug use is often initiated by peer pressure within social situations, psychological trauma can be a precursor for drug use throughout the lifespan. Trauma-exposed individuals are likely engaging in drug use as a maladaptive coping strategy to experience an emotional relief which may be compounding distress (Sheerin et al., 2016).
* This part of the chapter will discuss the theoretical concepts surrounding the motivation behind trauma induced drug use.

### Protection motivation theory

* Protection motivation theory proposed by Rogers (1997) considers how individuals cope in distressing situations in order to protect oneself from perceived threat. This theory operates on three aspects:
** The magnitude of the threat within a specific event
** the probability that this event will re-occur
** The efficacy of a protective response

### Extrinsic motivation

* Extrinsic motivation describes a situation whereby, an individual follows the pursuit of an instrumental goal. Operant condtioning falls under extrinsic motivation since we see motivation of certain behaviours occur due to rewards and punishment. One theoretical underpinning that may explain why individuals who have experienced childhood trauma reach out to drugs can be explained by negative reinforcement.
* When considering the negative reinforcement model and its influence in drug use, we can suggest that childhood trauma and the subsequent emotional damage, can motivate drug use. This can be considered whereby trauma may place an individual in an uncomfortable and distressing emotional state which can be relieved through an immediate short-term reward illicit by the consumption of drugs (May et al., 2020)

## How does psychological trauma motivate drug use?

* It comes as no surprise that individuals turn to drug misuse to self-medicate against the unbearable pain and distress caused by unresolved and unprocessed traumatic experiences (Marcenko et al., 2000). The sad reality is that a lot of children who experience trauma in the early years are unaware of the extent to which this event may have impacted them later in life. A common coping mechanism of childhood trauma is repressing the event especially in younger children who do not understand the concept of right and wrong yet.
* What trauma types are most relevant to drug use? Is there a specific type of event that is more likely to lead to drug use later in life? What does it mean to self-medicate?

### Childhood trauma types most relevant to drug use

* It comes as no surprise that adverse childhood experiences play a role in maladaptive coping mechanisms. Nonetheless, it is important to address the types of trauma that affect this behaviour in order to successfully treat it.
* A study conducted by Dube et al. (2003) demonstrated that childhood neglect was a predictor for illicit drug use. How does this occur?
* Household dysfunction consisting of domestic violence, violence towards parent, divorce, mentally family member etc. presents another predictor for potential drug use.
* Another type of childhood trauma that heavily influences drug use is childhood sexual abuse with the most common mean age at 11 - 13 years of age. Childhood sexual abuse is more commonly related to later substance use in comparison to an adulthood sexual abuse life event (Liebschutz, 2002).

### Self-medication following childhood trauma

* Early childhood sexual trauma has been theorised to result in drug use due to the desire to numb the painful affect caused by the trauma (Marcenko et al., 2000) .
* Moreover, the psychological impact that childhood trauma has on a developing child plays a large role in how the child learns to adapt and cope. For example, a child with severe attachment issues due to a physically abusive parents, may turn to drugs to counteract the insecure relationships they experience throughout adulthood - avoidance of loneliness.

## What are the strategies for treating trauma induced drug use?

* From a physiological perspective, the neurobiological pathways that are impacted by trauma (causing PTSD) and substance use have some similarities whereby, certain drugs have a depressing or arousal effect causing hyper-vigilance.
* When considering treatment strategies for childhood trauma induced drug use, it is important to consider that both potential disorders need to be addressed simultaneously. The childhood trauma may have developed into PTSD and the symptoms may have induced a dependence on drugs causing substance use disorder (SUD).
* Types of treatment for treating trauma induced drug use may include cognitive behavioural therapy (CBT), eye-movement desensitisation reprocessing (EMDR), medication and behavioural counselling (Note: I may turn these into sub-headings but unsure at this point).

## Conclusion

* In conclusion, the motivation to use drugs can stem from a number of factors, however, childhood trauma can be at play too.
* The protection motivation model describes how individuals who experienced childhood trauma, may strive to protect themselves after a perceived life-threatening stressful life event. If we consider frug use as a coping mechanism, individuals have found a coping strategy that effectively numbs from the adverse emotions felt due to the experience.
* Moreover, extrinsic motivation may have an impact on childhood trauma induced drug use. This can be considered whereby trauma may place an individual in an uncomfortable and distressing emotional state which can be relieved through an immediate short-term reward illicit by the consumption of drugs.
* Additionally, the types of trauma experienced have been shown to play a role in later drug use with the most prominent being, child neglect, household dysfunction and sexual abuse.
* It comes as no surprise that individuals may feel the need to self-medicate to cope with an adverse memory which is unprocessed and/ or repressed.
* Luckily there are treatment methods available although, it may be difficult to treat both drug use (which has turned into addiction) and psychological trauma simultaneously, it is not impossible.
* Suggestions for this section:
* What is the answer to the question in the sub-title (based on psychological theory and research)?
* What are the answers to the focus questions?
* What are the practical, take-home messages?