At least once a month, as part of the MV Times’ ongoing Mental Illness series, Dr. Charles Silberstein will write a column that directly addresses issues Islanders have with mental health. Dr. Silberstein is a psychiatrist at Martha’s Vineyard Hospital.
There is an article that is being shared a lot on Martha’s Vineyard. It is about an addiction specialist who suggests that as assuredly as people bleed after being cut, a child who is abused seeks comfort. And for people who have had multiple traumas as children, the compulsive seeking of comfort is what we call “addiction.” He proposes that rather than call it addiction, we call it “ritualized, compulsive comfort-seeking.” Using drugs and alcohol, binging and vomiting, self-starvation in the form of anorexia, self-mutilation, gambling, compulsively belittling oneself, and becoming numb and tuning out are some of the ways in which people who have been hurt compulsively seek comfort.
The article (bit.ly/additiondocaces) was first sent to me by recovery coach Eric Adams. Titled, “Addiction doc says: It’s not the drugs. It’s the ACEs — adverse childhood experiences,” the article talks about David Sumrok, M.D., and focuses on helping people who have been traumatized to find ways to heal.
While the term “ritualized, compulsive comfort-seeking” is new, the idea is not. Renowned psychoanalyst Edward Kantzian, a part-time Vineyarder and a member of the board of advisors of Vineyard House, has written volumes about the “self-medication hypothesis,” debunking the idea that addicts are primarily conscienceless hedonists who are indifferent to the damage that they do to others or themselves. Rather, like Dr. Sumrock, he believes that addicts are seeking comfort for their wounds.
It has been suggested that the diagnosis post-traumatic stress disorder (PTSD) be changed to post-traumatic stress injury. In fact, the brains of children who are traumatized are permanently changed; when a child experiences trauma, his or her pliable, developing brain learns some mechanism for dealing with the trauma, and that mechanism becomes hard-wired. The “symptoms” of PTSD are in fact coping mechanisms for defending and comforting oneself in the setting of overwhelming pain and fear. The core symptoms include 1) re-experiencing the trauma, including in the form of nightmares; 2) emotional numbing, such as spacing out, not feeling, expecting to die early, and forgetting chunks of the past; and 3) (in contrast to emotional numbing) hyperarousal, high anxiety, and quickness to rage. It is as if the mind is saying, “I am going to protect you from future trauma by keeping you on guard for more danger, and comfort you by turning you off if it feels like too much.” Some people use the mnemonic “the three Fs”: Flight, fight, or freeze. All three are logical responses to real danger.
Compulsive comfort-seeking is standard operating procedure for people with PTSD. For many people, isolation, emotional detachment, or overeating provide comfort. In studies of different populations, 27 percent to more than 80 percent of people with PTSD compulsively use drugs or alcohol.
The work of Dr. Sumrock gains its power from one of the most important studies in medicine and public health. The Adverse Childhood Experience (ACE) Study surveyed over 17,000 Kaiser Permanente patients about their experience of childhood trauma. The volunteers were asked whether they had experienced any of 10 different kinds of childhood trauma. Take the survey yourself here: bit.ly/getacescore. The findings are powerful. Twelve percent of those surveyed had experienced four or more of these traumas. And those individuals were 700 percent more likely to become alcoholic, and 1,200 percent more likely to attempt suicide. Those with scores of at least five were seven to 10 times more likely to use illegal and intravenous drugs. And not surprisingly, rates of smoking, depression, anxiety disorders, and liver, heart, and lung diseases, along with cancer, go up dramatically as the number of ACEs experienced goes up.
When I talk to colleagues about this, we all see very high ACE scores in our patients who compulsively use drugs, alcohol, food, sex, cutting, and gambling for comfort. The stigma is oppressive, and the accompanying shame is almost universal. With every evaluation, mental health professionals ask patients about childhood traumas. When it is explained that all of these tools for comfort and pain avoidance are natural and normal ways of protecting oneself in the setting of overwhelming pain and fear, there is almost universal relief. I imagine that is why the article is being so widely read by people who are recovering on Martha’s Vineyard.
If the natural response to trauma is to seek comfort, and those sources of comfort become ritualized, compulsive, and destructive, then the natural cure is to find new, healthier sources of comfort. For people in Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, and other 12-step programs, connecting with a supportive, nonjudgmental group, turning to a higher power or God for help, and using prayer and meditation are all helpful and comforting. Exercise, writing, painting, cooking, music, and group and individual psychotherapy are also sources of comfort, and can be enormously healing.
There are several forms of therapy that are particularly helpful. My favorites are Internal Family Systems Therapy and Mindful Self-Compassion. Both therapies propose that healing and comfort work best when they come from oneself. In both of these therapies, a wise, healthy, internal self witnesses, and offers compassion, curiosity, and perspective to the parts of ourselves that are injured, frightened, and longing. Eye Movement Desensitization and Reprocessing (EMDR), cognitive behavioral therapy (CBT), and Dialectical Behavior Therapy (DBT), along with psychoanalysis, have helped countless others.
Dr. Sumrock, along with other experts in treating trauma and addiction, offers this simple formula: “Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.”
I shared the article with a young woman who is a recovering alcoholic and opiate addict. She loved it. She was so afraid that she couldn’t be around people without drinking or shooting heroin. She didn’t want to use substances, and on occasion she was able to put together two or three weeks of clean time. Then, “I was just so uncomfortable, so anxious, so unhappy that I just had to have something.” Now with a year of sobriety behind her, she attends NA and AA regularly: “I feel safe and loved there. When the anxiety and loneliness come back, I can always go to a meeting.” She also finds that walking in nature and praying really help. “And the medication makes it so I don’t feel overwhelmed when I do get triggered. It isn’t always easy now, but I am happier in my own skin then I have ever been in my entire life. I love the idea that all of that stuff that I did was just a way of trying to take care of that little girl in me that was so frightened by all of the horrible stuff that happened.”