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iCAAD London 2019 - Clarinda Cuppage and Lou Lebentz - NUMBING THE PAIN: CHILDHOOD SEXUAL ABUSE AND ADDICTION

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Childhood sexual abuse (CSA) has seemed at the forefront of many news items recently and increasingly out there in the public domain. The statistics quoted in the UK are 1 in 4 women and 1 in 6 men are survivors, higher in other countries such as the USA. Indeed, most of our addiction clients tend to present with underlying trauma, many as a result of CSA. So as clinicians and treatment providers how do we deal with this epidemic in terms of numbers and the resultant increased disclosures and presentations?

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iCAAD London 2019 - Clarinda Cuppage and Lou Lebentz - NUMBING THE PAIN: CHILDHOOD SEXUAL ABUSE AND ADDICTION

  1. 1. Numbing the Pain Childhood Sexual Abuse and Addiction #CSANumbingThePain ICAAD, Wednesday 8 May 2019
  2. 2. Disclosure statement ● Lou Lebentz and Clarinda Cuppage are presenting independent of any financial compensation ● Permission has been granted from the Charity One in Four for inclusion of material from the Survivors’ Voices awareness project, freely available in the public domain.
  3. 3. What’s our outcome for you today? • Increase awareness and recognition of the scale of childhood sexual abuse (CSA) • Understand CSA in the context of Adverse Childhood Experience (ACE) studies & increased risk to vulnerability • Improve understanding of the neurobiology of trauma and greater awareness of symptoms of CSA • Greater insight into supporting disclosure and when to work with survivors during recovery • Information about referral and support for survivors and professionals working with them.
  4. 4. CSA statistics • 1 in 4 young people experience a form of CSA by 18 (Finkelhor et al, 2013) • Minimum 15-20% of girls & 7-8% of boys experience CSA (Centre of Excellence of CSA, 2017) • Only 1:8 come to the attention of the authorities in childhood (Children’s Commission, 2015) • There are an estimated 11 million adult survivors of contact and non contact abuse in the UK (Radford et al, 2011) • 53% of women & 27% of men in prison report experiencing emotional, physical or sexual abuse in childhood. (Ministry of Justice, 2012)
  5. 5. CSA in the news
  6. 6. Current state of CSA in addiction • CSA prevalence within addiction not routinely recorded in the UK • 268,390 people were in contact with drugs and alcohol services 2017 to 18 (Public Health England, 2018) • Anecdotal estimates vary considerably: • 80-90% of women, 60% of men in rehab for addiction experienced childhood sexual abuse • CSA in recovery - opportunity to stabilise, signpost and to work.
  7. 7. Clarinda Cuppage Survivors’ Voices Project Coordinator, Counsellor
  8. 8. Why did we do this? • Approximately 25% of clients tell us about substance use issues • Many people with addictions are unaware their trauma is connected to their using • Many people in the 12 step fellowships are survivors, but not necessarily seeking support for CSA • To give survivors of CSA their voice and for their voice and their experiences to educate and inform others.
  9. 9. What did these survivors tell us? • “I walked around continually ensuring that no one really saw or knew the ‘pervert’ that lived within me….Drugs, alcohol and separation from normal society seemed a natural hiding place and for many years worked.” Piers • “From an early age I was abused by my father……The child is suppressed and manipulated and becomes an object of shame, a feeling which possesses them all their lives” Martin • “My story is difficult to hear. I don’t want to hear it myself. I don’t want it to be about me. I don’t want it to be true. Better to have no story than to have mine.” Thomas
  10. 10. Lou Lebentz Psychotherapist, EMDR Clinician Founder @ The Voyage
  11. 11. Adverse Childhood Experiences (ACE) study (1998) • Research demonstrates adverse events in childhood contribute to long-term health • 28% of study participants reported physical and 21% reported sexual abuse • 40% of original sample experienced two or more ACEs, 12.5% four or more • Cumulative ACE score is correlated to health, social, behavioural problems, including substance abuse across lifetime. Physical Abuse Sexual abuse Emotional abuse Physical neglect Emotional neglect Mother treated violently Household substance abuse Household mental illness Incarcerated household member Parent separated or divorced
  12. 12. ACEs - How did you score? https://www.rwjf.org/en/library/infographics/the-truth-about-aces.html
  13. 13. Adverse childhood experiences and addiction The 1998 study found people experiencing more than four adverse childhood experiences (ACEs) are: • seven times more likely to become addicted to alcohol • 10 times more likely to be at risk of intravenous drug addiction • 12 times more likely to have attempted suicide.
  14. 14. The neurobiology of trauma
  15. 15. Left and right hemisphere
  16. 16. Hippo and amy
  17. 17. Trauma and CSA reactions • Fight – Flight – Freeze - Flop (submit) - Friend (attach)
  18. 18. Window of tolerance With thanks to Christiane Sanderson and One in Four
  19. 19. Trauma Effects Trauma Reaction/Triggers Trauma Abstinence Trauma Arousal or Pleasure Trauma Shame Trauma Blocking Trauma Repetition Trauma Splitting Trauma Bonding Betrayal Bonds by Patrick Carnes
  20. 20. Trauma and CSA reactions • Central Nervous System – on high alert, states of fear, panic, anxiety, dissociative rage, sensory overload, inability to filter stimuli • Hypo-arousal, shutting down unable to feel anything or Hyper-arousal, overloaded, constantly activated • Dissociation (mental flight) from day dreaming, going blank, numbing or zoning out to severe memory loss and disconnection from body. Range of dissociative disorders
  21. 21. Trauma reactions (cont) • Survival system activated - outside of conscious awareness and control • Internal cascade of chemicals, amygdala high alert (preparing for emergency), hippocampus • Sympathetic Nervous System – preparing for flight or fight, ‘quick and dirty’, accelerator • Parasympathetic Nervous System – rest and digest, conservation, freeze response, brake, disengagement • Trauma remains on-line – high level of fear, relaxation is difficult • Traumatic memories, fragmented memories.
  22. 22. Symptoms associated with CSA • Flashbacks, nightmares, avoidance of memories associated with trauma • Overwhelming feelings of fear, anger, shame, horror – mood swings and negative feelings about self, others and the world • Feelings of detachment, loss of interest in significant activity, lack ability to experience positive emotions, or feeling numb
  23. 23. Symptoms associated with CSA • Symptoms can lead to self-medication, self-harm, anxiety disorders etc. • Trust and attachment issues, huge impact on relationships (avoidance/anorexia) • Confusion over sexual identity, impact on sexuality • Shame, self-blame, negative self-belief
  24. 24. Shame With thanks to Christiane Sanderson and One in Four
  25. 25. Plus the shame of addiction
  26. 26. So how do we deal with it?
  27. 27. Phased approach to treating CSA Healing stage: stabilisation • Safety (internal and external) • Grounding/resources • Psychoeducation/triggers Healing stage: processing • Re-storying, attributing blame, recognition, loss, emotional expression • Affect Tolerance • Finding a voice Healing stage: integration • Healthy relationships and boundaries • Sense of agency/self-identity • Power and control • Post-traumatic growth From Herman and Rothschild
  28. 28. • Making the link between CSA and trauma • Understanding what happened to then, not what is wrong with them • Recovery through connection • Access to specialist services • Post traumatic growth. What helps survivors who are also addicts?
  29. 29. Understanding people with CSA • CSA Trauma reactions - impact on mental, physical health, and relationship problems • Many survivors unaware of links between behaviour and abuse • Survivors often experience confusion and fear, which can lead to misdiagnosis and misunderstanding • Effective therapeutic support is critical to long-term understanding of CSA • Frontline workers can improve their understanding of CSA to respond to survivors more empathically
  30. 30. Understanding people with CSA • Fear of emotional intimacy with clinician • Perpetrator may still be in their close environment • Using avoidance strategies still? • Unhelpful responses to their disclosure • The desire to protect others from stigma and distress • Wanting quick fixes – recovery takes time!
  31. 31. What our project found helpful? • Greater understanding of the link between CSA and addiction - within services • Trauma support services/centres where survivors are educated about the impact of CSA and trained in self- management of trauma symptoms • “It’s been hugely important for me to know that I am not alone, and there are professional organisations, charities and voluntary groups offering support.”
  32. 32. Survivors’ stories in the room
  33. 33. In hindsight • What else would have helped and when? • Any other thoughts on how to best deal with disclosure? • When to approach the trauma? • Any other points or comments you’d like to make? • Any thoughts from the audience?
  34. 34. How can we all build links? • Survivors Trust (www.survivorstrust.org) • NAPAC (National Association of People Abused in Childhood) Helpline and signposting organisation 0808 801 0331 www.napac.org.uk • One in Four (www.oneinfour.org.uk) • Survivors UK (www.survivorsUK.org.uk)
  35. 35. Keep in touch: Lou Lebentz www.loulebentz.com www.thevoyageprogramme.com 07789 866922 lou@lebentz.com Clarinda Cuppage www.oneinfour.org.uk 07773 282862 clarinda@clarindacuppage.com
  36. 36. Bibliography Alcohol and drug treatment for adults: statistics summary 2017 to 2018. Public Health England (2018) Bradshaw, J. (2006) Healing the Shame that Binds You Carnes, P. J. (1998) The Betrayal Bond: Breaking Free of Exploitative Relationships Children’s Commission, (2015) Protecting children from harm: A critical assessment of child sexual abuse in the family network in England and priorities for action Cozolino, L. J (2002) The neuroscience of psychotherapy: Building and Rebuilding the Human Brain De Young, P. A (2015) Understanding and Treating Chronic Shame: A relational/neurobiological approach Finkelhor, D. et al (2014) Lifetime Prevalence of Child Sexual Abuse and Sexual Assault Assessed in Late Adolescence, Journal of Adolescent Health (2014) Vol 55 (3), pp 329-333 Felitti, V. J. et al (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experience (ACE) Study. American Journal of Preventive Medicine 14 (4). Fisher, J.(2017) Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation Hampden-Turner, C. (1981) Maps of the Mind Herman, J, (1992) Trauma and Recovery Kelly, L. and Karsna, K. (2017) Measuring the scale and changing nature of child sexual abuse and child sexual exploitation. Centre for expertise on child sexual abuse Larncer, D. (2014) Conquering Shame and Codependency. 8 Steps to Freeing the True You. Lodrick, Z. (2010) Victim guilt following experience of sexualised trauma: investigation and interview considerations. The Investigative Interviewer. Issue 1 Le Doux, J (1996) The Emotional Brain Levine, P. (1997) Waking the Tiger Prisoners’ childhood and family backgrounds. Results from the Surveying Prisoner Crime Reduction (SPCR) longitudinal cohort study of prisoners. Ministry of Justice (2012) Research Series 4/12 Parnell, L. (2013) Attachment-Focused EMDR: Healing Relational Trauma Radford, L. et al. (2011) Child abuse and neglect in the UK today. London: NSPCC Rothschild. B, (2000) The body remembers: The psychophysiology of trauma and trauma treatment Siegel, D. J. (2003) Healing Trauma: Attachment, Mind, Body and Brain Numbing the pain: Survivors’ voices of childhood sexual abuse and addiction. www.oneinfour.org.uk (downloadable) Sanderson, C. (2015) Responding to survivors of child sexual abuse: a pocket guide for professionals, partners, families and friends. One in Four. Sanderson, C. (2013) Counselling Skills for Working with Trauma: Healing from Child Sexual Abuse, Sexual Violence and Domestic Abuse (Essential Skills for Counselling) Van der Kolk, B. (2014) The Body Keeps the Score: Mind Brain and Body in the Transformation of Trauma

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