Drug treatment needs to focus more on underlying trauma and life difficulties, says Scottish Drugs Forum research
27 November 2013
DRUG services in Scotland need to be more trauma-minded, focusing less on drugs and more on underlying traumas and life difficulties, according to major research launched officially today by Scottish Drugs Forum, the national drugs policy and information charity.
The Big Lottery Fund Scotland-funded study – which examined the life histories of 55 former injecting drug users now in recovery – says trauma is “clearly a significant factor in helping fuel the size of Scotland’s drug problem.
“Failure to respond to trauma effectively stores up significant future problems for which the individuals, their families and wider society pay a huge price.”
The research – launched to coincide with SDF’s conference in Glasgow today Frontline Response to Trauma – a Key to Recovery - was undertaken by SDF in partnership with Professor Richard Hammersley of the University of Hull and Dr Phil Dalgarno, of Glasgow Caledonian University.
It identified that progression to heroin use and injecting is a sign that an individual is ‘troubled’ and unable to cope with their life experiences appropriately.
The study also calls for:
- High quality and effective psychological therapies to be more widely and easily available
- Trauma and related services to be reviewed to ensure they have sufficient reach to intervene as early as possible in troubled lives.
Learning/being equipped to cope with negative thoughts, events and feelings without drugs was an important part of recovery. So was the support of other people, including children and parents,” said the research.
“Most participants also felt that using drugs was their biggest regret about their lives.
“Interestingly, people’s visions of recovery did not include plans or hopes to become wealthy or successful…In short, participants wanted to have ‘normal’ lives and to be happy.”
Key findings of the research include:
- Most of the 55 participants were aged 30 - 50 years old, came from or ended up in relatively deprived and stigmatised neighbourhoods – and were stigmatised within their own community for being drug users.
- Drug injecting was principally a dysfunctional coping response to serious traumas or life difficulties as an adult and/or child, serving to obliterate distressing thoughts and worries related to these issues
- Trauma often had not been recognised at the time, by professionals, or by the people involved, who had taken it as a fact of life
- Problem drug use brings further trauma, including violence, overdose, bereavements and serious health problems, escalating (drug) use further
- Participants described recovery as being able face up to the “horrors” experienced without the need to block and deaden thoughts and feelings with heroin and other drugs.
The research said that during some periods of some stories, heavy substance use was the “least negative aspect” of the person’s life. usually before they became dependent on heroin.
“...One function of problem drug use is to block out highly distressing thoughts and feelings and avoid having to deal emotionally or practically with horrific events.
“That people can eventually move beyond such events, with or without drugs, is testament to their resilience.”
Traumas in childhood and early adolescence included:
- repeated sexual abuse by relatives
- repeated physical and emotional abuse by parents (including biological parents, step- parents and foster parents)
- multiple bereavements, or complex circumstances involving chaos and instability due to:
- mothers fleeing violent fathers
- parental mental health problems
- having criminal or drug-dealing fathers.
Researchers found that:
- none of the participants remembered a problem-free childhood; severe childhood trauma was common; almost half remembered sexual or physical abuse
- over a third of participants mentioned growing up with at least one parent with an alcohol or drug problem, often with associated domestic violence
- several people with highly problematic lives at that time said that as a young teenager their substance use had been the best thing in life. Participants who had used substances like this tended to have had highly traumatic childhoods.
However, the participants who described childhoods lacking any memorable problems tended also to report signs of major psychological difficulties from an early age.
“These included signs remembered as commencing aged less than 10 suggestive of anxiety, ADHD and conduct disorder, all of which are known to be more prevalent amongst people with drug and alcohol problems.”
A recurrent theme for childhood was to normalise behaviour that would have been judged by others to be abnormally violent, abusive and dysfunctional, according to the research.
Various participants took it as normal that parents were ‘strict’ and that fathers sometimes beat up their wives. Some also took it for granted that being highly disruptive at school was normal, that being involved young in substance abuse and crime was normal, and that fighting with other young people, including in gang fights, was normal.
“When such events were not too common, or too extreme, participants could view their childhoods as happy, despite events that would greatly have concerned health and social care professionals should they have been aware of them at the time.
“Violent childhoods could lead to participants normalising awful events,” said the researchers.
The stories in the research supported the idea that children who are acting out or misbehaving at school or elsewhere are often exhibiting signs of serious difficulties such as abuse, parental alcohol problems, bereavement or other serious difficulties in the family.
The report said that understanding of the underlying issues affecting troubled children and the need for sensitive intervention require to be continually reinforced within relevant agencies.
“Although there are major resource implications of taking difficult children seriously, the consequences of failing to do so were terrible in this cohort.”
In adulthood all participants had experienced traumatic events related to drug use and drug dealing.
Most people reported multiple serious events, including serious health problems, overdose, the deaths of family or friends by overdose or murder, and experiences of serious violence.
In terms of non-drug related trauma, more men than women reported that the loss of a significant relationship, most commonly a partner or a parent, had been traumatic for them and had significantly worsened their drug use.
In contrast, many women reported needing to break up from partners because of their drug use, or less commonly, their physical and mental abuse.
David Liddell, Director of Scottish Drugs Forum, said: “The findings of this research have important and wide-ranging implications for the approach to the prevention and treatment of problematic drug use in Scotland, which has among the highest recorded rates of people with drug problems in Europe.
“We hope that the findings of this research will help challenge the all-too-common perception that a person’s drug problem is a lifestyle choice or ‘self inflicted’ and recognise instead that, in many cases, drug or alcohol use is a way of coping with trauma.
“We also have to look at the wider social and environmental stresses, such as unemployment, poverty and poor mental health and wellbeing, which disproportionately affect our most disadvantaged families and can lead to severe trauma and breakdown, with the consequences detailed in this research.
“Tomorrow (Thurs 28 November) the Scottish Parliament will debate the Scottish Government’s response to the recent Review of Opiate Replacement Therapies (ORT) as part of Scotland’s national drug strategy.
“We need to recognise and take action on the wider factors underpinning substance use dependency which have blighted generations of disadvantaged families across Scotland -and so minimise what people have to recover from, while maximising what people can recover to.”
There were an estimated 59,600 individuals with problem drug use in Scotland in 2009-10, corresponding to a rate of 1.71% of the population aged 15 to 64.
This represents an increase in estimated numbers of over 4,000 since the last available estimates, which estimated that in 2006, there were around 55,300 individuals with problem drug use. (Source: Estimating the National and Local Prevalence of Problem Drug Use in Scotland (2000, 2003, 2006 and 2009-10 estimates).
Links between poverty, long-term drug use, poor underlying health and the impact of drug deaths on families have been highlighted in the National Drug-related Deaths Database (Scotland) Report 2011 published on 30 April 2013.
It said that over two fifths (44.5 percent) of the cohort, where known, were a parent or parental figure. A total of 331 children lost a parent or parental figure to a drug-related death.
The report said the consequences of a parent dying may be an area for further consideration.
Trauma and recovery amongst people who have injected drugs within the past five years: Executive Summary (1098 KB).
Trauma and recovery amongst people who have injected drugs within the past five years: Full Report (1650 KB).