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Adolescents who have experienced abuse, neglect and abuse have a clearly increased risk of developing substance abuse problems in adulthood.

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Different models are presented here for how to understand the high risk of substance abuse problems in people who have had a difficult childhood, and what may be relevant approaches to prevent people with this type of stress in childhood from developing substance abuse problems.

 

Abuse and neglect are widespread

Research has been done on how widespread it is for children to experience abuse, neglect and abuse. In a study in England among 18-24 year olds (1), the following findings emerged through self-report from the young people:





 

  1. 16% had experienced abuse either in the family or outside
  2. 7% had experienced physical abuse
  3. 6% had been subjected to psychological abuse
  4. 6% had been exposed to neglect / neglect
  5. 11% had experienced sexual abuse

It is emphasized that the real numbers are probably higher, as it is assumed that many of the young people have underreported about what they have experienced. In Norway, it has been estimated that between 10% and 20% of the female population, and between 5% and 10% of the male, have been sexually abused before the age of 18 (2), 1 in 10 children have witnessed to violence against mother or father, and between 3 and 9 per cent have been exposed to more serious physical violence from their parents (3).

 

Common with substance abuse problems in adolescents who have experienced abuse and mistreatment 

Adolescents who have experienced abuse, neglect and abuse earlier in life have a clearly increased risk of developing substance abuse problems (4). Three models have been proposed that may explain why these young people are at particular risk of developing substance abuse problems (5):





 

  1. PTSD models

    Abuse, neglect and abuse of children and young people will in many contexts create traumatic experiences for those who are exposed to it. It is pointed out that chronic forms of trauma create extensive forms of dysregulation in the person's stress system, and that post-traumatic stress disorder (PTSD) in such children can be considered an environmentally complex developmental disorder. Such children are at particular risk of developing mental disorders such as anxiety and depression, and where these disorders in turn increase the chance that they will have substance abuse problems (6).

    Research has shown that children with traumatic experiences have less post-traumatic symptoms when they have good, supportive relationships with their parents, which indicates that good relationships with parents have a protective effect on traumatized children.

    Overall, this type of model tries to explain an increased risk of substance abuse problems by becoming a way to try to control the post-traumatic symptoms, to reduce negative emotions and to (artificially) increase positive emotions. 

  2. Self-dysfunction models

    Abuse, neglect and abuse of children and young people will in various ways make the child vulnerable to having negative attitudes towards themselves, problems with self-regulation and a fragile self-esteem. Studies have been done that link low self-esteem (eg statements such as "sometimes I think I'm not good at anything") to a greater risk of substance abuse problems. For example, it has been shown that having derogatory attitudes towards oneself is closely related to depression, and that both present a clearly higher risk of substance abuse problems (7). 

    For children who have experienced abuse, neglect and abuse, struggling with emotional regulation will be common (8). In addition, it turns out that emotional regulation causes more behavioral problems, which in turn gives a greater chance of being rejected by peers. Thus, vicious circles can arise which reinforce the young person's negative self-image with further anger and disappointment over themselves, and which may help to explain an increased risk of problematic drug use. 

    Taken together, these models suggest that patterns of low self-esteem, self-destructive attitudes, and emotional regulation difficulties can also create vulnerability for the development of mental disorders and substance abuse problems.

  3. Relational difficulty models

    In the last group of models, reference is made to attachment theory, interaction in the family, and to relationships between young people to explain possible development in the direction of substance abuse problems. Attachment style is theoretically considered a lasting pattern of how to relate to other people, and when this pattern is characterized by insecurity and confusion, this can in various ways create dysfunctional behaviors as the person grows.

    It is pointed out that a high proportion of people with substance abuse problems have an insecure attachment style (9). Problematic use of drugs can in such a context be regarded as a form of unfortunate coping strategy in people who have an inherent insecurity in relation to other people.

    Other theories support how difficult relationships both within and outside the family can help explain why some people develop substance abuse problems (10). When parents themselves have antisocial attitudes, and when a young person develops close relationships with other young people who have antisocial attitudes, this can - especially in combination with other psychological and family-related vulnerability - be another way into substance abuse problems.

 

Relevant measures to prevent drug problems in the risk group

Based on the mentioned models that try to explain why abuse, neglect and abuse give greater risk of substance abuse problems, the following target areas can be mentioned for the work of preventing the development of substance abuse problems in the vulnerable people:

 

  1. Reduce symptoms of post-traumatic stress, anxiety and depression in people with such symptoms
  2. Improve daily care conditions, with emphasis on parent-child relationships that support the capacity for emotional self-regulation 
  3. Attachment support measures at home and in kindergarten / school, with a view to increasing the child's / young person's opportunity to develop a secure attachment style
  4. Promote relationships with other children / adolescents with prosocial attitudes in the vulnerable children / adolescents. Good framework and meaningful activities

 

Sources:

  1. May-Chahal & Cawson, 2005: Measuring child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. Child Abuse and Neglect, 29,969-984.
  2. The incidence of sexual abuse in a representative population sample in Norway. Journal of the Norwegian Psychological Association: 
  3. Incidence of sexual abuse of children in the Nordic countries. Uni Research Health
  4. Tonmyr et al., 2010. A review of childhood maltreatment and adolescent substance abuse relationship. Current Psychiatry Review, 6,223-234.
  5. Hovdestad et al., 2011. Why is childhood maltreatment associated with adolescent substance abuse? A critical review of explanatory models. Int J Ment Health Addiction ,, 9,525-542.
  6. deBillis, 2002. Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. Psychoneuroendochrinology, 27,155-170.
  7. Harlow et al., 1986. Depression, self-derogation, substance use, and suicide ideation: lack of purpose in life as a mediational factor. Journal of Clinical Psychology, 42,5-21.
  8. Kim & Cicchetti, 2010. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Psychology and Psychiatry, 51,706-716.
  9. Flores 2004. Addiction as an attachment disorder. Lanham: Jason Aronson.
  10. Brook et al., 2009. Pathways from adolescent parent-child conflict to substance use disorders in the fourth decade of life. The American Journal of Addiction, 18,235-242.

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