Teresa Glaze-Shields dissertation

Institute for Clinical Social Work

An Exploration of Subjective Connections between Child Abuse and Addiction

A Dissertation Submitted to the Faculty of the Institute for Clinical social Work in Partial Fulfillment For the Degree of Doctor of Philosophy

By

Teresa Glaze-Shields

Chicago, Illinois March 2017

Abstract This grounded theory study explored the lived experiences of adult substance users who reflected back on their childhood exposure to abuse, neglect and/or trauma.

The researcher conducted two separate rounds of interviews to obtain data and conducted open, axial and selective coding methods. A theoretical model was developed as a result of the coding process from the 25 participant interviews. There were 12 major findings which emerged from this research that are listed below in sequential ordering: 1. Growing up with an alcoholic father 2. Growing up with mothers who were emotionally distant and unavailable 3. Environmental impact on the child’s development 4. Exposure to abuse, neglect and/or trauma 5. Children growing up with uncertainty of their place in the family 6. Desire to fit in with others outside the family 7. Exposure to alcohol/drug use 8. Path(s) to addiction 9. Denial despite negative consequences 10. Ambivalence around trust issues 11. Choice to seek substance abuse treatment/help and 12. Reintegration back into society Lastly, a face validity test was conducted by the three experts regarding this developed theoretical model. .

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For my daughter, Tierra who has served as an unconditional support system

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Table of Contents

Page Abstract..............................................................................................................................ii List of Tables List of Figures Chapter I.

Introduction.................................................................................................1 General Statement of Purpose Significance for Clinical Social Work Statement of Problem and Specific Objectives to Be Achieved Objective Research Questions to Be Explored Theoretical and Operational Definitions of Major Concepts Statement of Assumptions Epistemological Foundation of Project Foregrounding Dissertation Outline

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Table of Contents—Continued

Chapter II.

Page Literature Review................................................................................................16 Early Childhood Development and Psychoanalytic Theory Coping Mechanisms Mentalization Attachment Impact of Childhood Abuse Neglect Trauma Substance Use Role of Empathy Summary

III.

Methodology........................................................................................................41 Rationale for Qualitative Research Design Rationale for Grounded Theory Methodology The Research Sample Information Needed to Conduct the Study Research Plan Data Collection Plan for Data Analysis Ethical Considerations Issues of Trustworthiness Limitations and Delimitations The Role of the Researcher Summary

IV.

Findings.................................................................................................................59 Introduction to Participants Introduction to the Family Members Early Environmental Impact Exposure to Adverse Childhood Experiences (ACEs) Early Environmental Impact outside the Family Conclusion

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Table of Contents—Continued

Chapter V.

Page Discussion...........................................................................................................124 Objective of this Study Developed Theoretical Model Experts’ Evaluation of the Model The researcher’s assumptions prior to conducting this study

VI. Conclusions and Recommendations.................................................................160 Theoretical and Clinical Implications Validity Researcher’s reflections Implications for future research

Appendices A. Sample Script for Substance Abusers.......................................................169 B. Sample Script for Family/Friends of Substance Abusers........................172 C. Interview Guide for Family Members.......................................................174 D. Interview Guide for Substance Users.........................................................176 E. Expert Questionnaire...................................................................................178 F. Substance Abuse and Victimization Survey Questionnaire.....................181 G. Individual Study Screener...........................................................................186 H. Family Study Screener................................................................................191 References...........................................................................................................194

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List of Tables

Table

Page

4.1 Sample of Substance Users...................................................................................62 4.2 Sample of Family Members’ Characteristics.....................................................63

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List of Figures

Figure

Page

5.1. Theoretical Model of Relationship between Childhood Trauma and Substance Abuse...............................................................................................................................132

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Chapter I

Introduction

General Statement of Purpose The purpose of this grounded theory study will be to explore the experience of childhood abuse, neglect and/or trauma as it relates to substance use in adulthood. My overall goal in using grounded theory is to develop a theory which will show how childhood abuse, neglect and/or trauma may contribute to later substance use problems among adults living in the greater Chicago area. At this stage in the research, adult substance users will be defined as participants who have a history of abusing illicit substances or be actively abusing illicit substances during this study. In order to classify as a substance user, the participants must meet the DSM-V criteria for substance use (excluding nicotine and caffeine spectrum disorders).

Significance for Clinical Social Work I chose the topic of substance use because it is a social problem that pervasively impacts our society in many ways. As a social worker I have witnessed an increase in the number of patients seeking treatment for substance use issues in adult life. However, the current treatment for this population often involves repeated relapses. This experience

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has spurred my curiosity about the underlying factors which contribute to developing a substance use problem in later developmental years.

The problem of substance use is of concern to the field of social work for various reasons. Substance users’ deviant behaviors often have a negative impact on themselves, their family members and the community at large. Substance use has been a contributing factor to children being removed from their parents’ custody for child neglect or child abuse by the Department of Children and Family Services (DCFS) for many families.

Substance users are also frequently the perpetrators of criminal offenses including burglary, theft, and robbery as a means of supporting their substance use habits. The legal system is overloaded with arrests and court cases resulting from charges filed against substance users trying to obtain controlled substances or being in possession of these illicit substances. There are approximately 120,000 people treated annually in the United States through drug courts. This does not include drug cases in the criminal courts (Drug Courts in the United States, n.d.). In 1989, the first drug court was created in Miami, Florida in response to crack cocaine. Currently, there are more than 2,400 drug courts alone in all 50 of the United States (Drug Courts in the United States, n.d.).

The substances being explored in this study include alcohol, marijuana, cocaine, PCP, crystal methamphetamines, barbiturates and heroine. This also includes alcoholics who are arrested for driving under the influence of alcohol. My research has also revealed many individuals who use substances, are often the perpetrators of domestic violence (Wells, 2009). Substance use may be a generational problem in families that perpetuates the cycle of substance use in later generations (Bennett & Kemper, 1994). This can especially be seen in the children of alcoholic parents (Bennett & Kemper, 1994).

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Substance users impact the overall economy by their non-participation in the work force.

Consequently if they are employed, their substance use problem can result in missed days from work due to hangovers, withdrawals or arrests after binging on drugs and/or alcohol. Observing these negative consequences have been the result of my personal experience working with substance users and their personal accounts as disclosed in the treatment groups I facilitated while working with them.

Therefore, substance use can be considered a plague in modern society; this has huge implications in the field of social work. In order for social workers to be effective in assisting their patients with achieving and maintaining sobriety, it is important to understand the etiology of this condition. Substance use is a problem that clinical social workers need to understand in terms of the internal conflicts patients suffer from, in order to help them in the healing and recovery process. Additionally, social workers need to be able to assess the way substance use is impacting their patients’ lives on a personal level.

Statement of Problem and Specific Objectives to Be Achieved Adult substance use has reached epidemic levels in the United States. According to the U.S. Department of Health and Human Services, in 2013 there was an estimated 24.6 million Americans who were current illicit drug users (National Institute on Drug Abuse, 2015). The literature review indicates there is a gap regarding this specific topic.

There are large amounts of literature that view substance use from different perspectives.

Some topics that have been researched include the perspective of intergenerational substance users who grew up with substance using parents (Bennett & Kemper, 1994).

The literature also shows research on substance users who were the perpetrators of

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domestic violence (Wells, 2009). Additional literature shows the impact on problems in adolescence leading to adult substance use (Grella, Stein & Greenwell, 2005). There has also been research on the categories of physical abuse and/or sexual abuse relative to substance use (Liebschutz et al., 2002). Yet there were no studies that investigated the topics of substance use resulting from either physical abuse vs. sexual abuse in childhood (Herrenkohl, Hong, Klika, Herrenkohl & Russo, 2013). There were also no studies that focused on substance use from the perspective of trauma (Green, 1995). For example, Green indicated children who were the victims of childhood sexual abuse often developed dissociation in childhood. Green also stated, “Abuse of drugs or alcohol might represent the victim’s attempt to blot out anxiety related to disturbing memories of the molestation as well as the accompanying painful affects” (1995, p. 661). Yet I was unable to locate research that looked at all of the categories of childhood abuse with neglect and/or trauma. While each study categorized them in varying combinations, there are relatively few sources of literature that deal with the topic of childhood abuse, neglect and/or trauma as it relates to adult substance use. My study will look at all three categories together including abuse, neglect and/or trauma in childhood through one study. This dearth in the literature further documents the need for my study to be done, in an effort to give more insight to the etiology of substance use and how the childhood experiences of abuse, neglect and or trauma possibly serve as contributing factors to this growing problem.

According to the literature, substance use and childhood abuse has not been explored in depth from this particular perspective including abuse, neglect and trauma in a single study. Herrenkohl et al. (2012) found “A higher percentage of those with

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maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse” (p.191). There has been some research that indicates that childhood abuse and neglect often have long term consequences resulting in depression and other mental health problems (Child Welfare Information Gateway, 2008), but little else has been published on this phenomenon.

The literature has a large focus on substance using mothers and the impact on their children and families (Brooks, Zuckerman, Bamforth, Cole & Kaplan-Sanoff, 1994). According to Brooks et al. (1994) mothers dealing with their own addiction often struggle to develop self-regulatory and self-soothing strategies that do not involve substance use. Therefore, the addicted mothers are unable to respond appropriately to their infants’ needs. However, this literature fails to address the contributing factors that resulted in the mother becoming a substance user. This literature also speaks to the possible generational effects of perpetuating the cycle of dysfunction to future generations of addicted mothers. However, the literature does not address how to understand the etiology of substance use thereby providing an effective way of breaking the cycle of maladaptive behaviors.

The literature also included Marcenko, Kemp and Larson’s (2000) study which primarily focuses on the role substance use plays in effecting the ability to parent. This study revealed a growing interest in the area of maternal substance use as it relates to the negative consequences on children and families. Marcenko’s et al., (2000) research also reported a growing trend of condemning addicted mothers by attempting to institute stronger legal penalties and controlling the reproductive rights of substance using women.

This research does not contend with the problem area of my research study. This

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research failed to look at the childhood experiences of addicted mothers. Therefore, it did not address any potential factors that may have contributed to the mother’s addiction.

The primary focus of this study was the negative impact the mother’s addiction had on her children and family.

Additional literature speaks specifically from the perspective of female substance users often being the victims of childhood sexual abuse (Green, 1995). However, it does not address the impact childhood abuse takes in the form of verbal, emotional and or/ sexual abuse. Additionally, it does not address the impact sexual abuse may have on male victims who end up developing substance use problems. It also does not indicate the role that childhood neglect or trauma plays in contributing to the later onset of substance use, in females as well as male victims. This further indicates the need to look at the phenomenon of substance use through a different lens. Again, this literature does not address the problem from my specific vantage point, which includes childhood abuse, neglect and/or trauma. While I agree with their findings, that female victims of childhood sexual abuse often develop substance use problems in adulthood, it still does not address the problem from the perspective of all substance users which also includes males. According to Brooks et al. (1994), their research findings have revealed that early sexual victimization is a key factor in female addiction.

According to Colarusso (2009), the impact that childhood sexual abuse has on later developmental phases includes substance use. His research focuses on four sisters who were the victims of the same priest in a Catholic Church. While all four sisters were sexually abused they never discussed their abuse with anyone, not even each other until the lawsuit was filed against the Catholic Church. Their developmental phases were

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tracked for over 50 years of their life following the childhood sexual abuse. It was found that none of the sisters developed substance use problems. However, he concludes the “Severity of the damage caused by childhood sexual abuse can vary from person to person and circumstance to circumstance” (2009, p.345). Each of the four sisters developed mental health problems including depression, post-traumatic stress disorder, dissociative amnesia, pathological gambling, compulsive lying and relationship problems. All of these negative outcomes appear to be the result of, the childhood sexual abuse suffered by all four sisters.

There is some literature that indicates the symptoms of substance use may emerge during adolescence and adulthood as a result of childhood sexual abuse (Briere, 1984).

Again Briere’s research looks at the problem of substance use, as one of the symptoms of childhood sexual victimization (1984). However, it does not look at the negative impact resulting from neglect, other forms of childhood abuse (emotional, physical or verbal), and/or trauma. Substance use was not viewed from the perspective of any other form of childhood maltreatment except sexual abuse.

The literature also produced evidence of a link between childhood physical abuse and later substance abuse. A study conducted by Bennett and Kemper (1994) controlled for a family history of substance abuse. The findings indicated that of the 733 respondents, 24% indicated a history of physical abuse, 24% indicated a family history of substance abuse, and 36% tested positive for substance abuse. Their study looks at the problem from the perspective of the respondent having a history of physical abuse and/or a history of substance abuse in their family. Nevertheless, this is a different perspective from the focus of my study. The study does not look at the problem of substance use

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from the perspective of childhood neglect, emotional or sexual abuse. According to Bennett and Kemper, their study focuses only on childhood physical abuse in relation to developing substance use later in life. This was achieved by controlling for respondents having a family history of substance use. The study reported children of parents who were alcoholics were four to five times more likely to develop alcoholism than other children (1994).

According to Hefferman et al., (2000), in an outpatient substance abuse clinic there were 105 female patients who were interviewed; of those respondents 104 indicated at least one out of the 14 categories of traumatic events. These were not limited to childhood physical and sexual abuse. Some of the categories included being a child who witnessed extreme parental violence as a child. This study did not target any specific substance or their association with childhood abuse. This study is the only research found that comes close to my area of research. While this study did not investigate any particular kind of abuse relative to a particular drug of choice, it did reveal a correlation between childhood abuse and substance use (Heffernan, et al., 2000).

This study takes a slightly different perspective and investigates whether childhood neglect, emotional or verbal abuse in addition to physical and sexual abuse has a relationship to developing substance use in later developmental years. This grounded theory study will explore the connection between childhood exposure to abuse, neglect and/or trauma in an effort to develop a theory which will impact future treatment of adult substance users. I am defining the problem of substance use in later developmental years (adulthood) relative to a childhood history of abuse, neglect and/or trauma. No one has explored it from this perspective of looking at the early developmental years. It is my

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assumption that there will be a direct connection between children who have suffered more than physical or sexual abuse. I believe children who have experienced any kind of early childhood trauma, emotional or verbal abuse and neglect will be at higher risk for developing substance use problems in adulthood. Substance use will include illicit street drugs as well as alcohol abuse.

Objective My objective is to explore the possible connection between victims of childhood abuse, neglect and/or trauma and the later development of substance abuse in adulthood.

I believe this research could be very useful to the field of social work by helping us develop more effective treatment methods for adult substance users and could ultimately lead to further research including how each type of childhood maltreatment contributes to the formation of adult substance use. Once we understand the childhood factors which contribute to adult substance use, there will be opportunities to develop prevention programs for children who are at risk for developing adult substance use behaviors.

Additionally, I would like to better understand the factors that contribute to developing a substance use problem in order to develop better treatment modalities. Developing better treatment for adult substance users is my long term goal for doing this research study. I believe this research could be beneficial in understanding some of the key factors that contribute to the substance use epidemic. Additionally, I believe the ultimate goal is to help further research in this area in an effort to promote prevention programs for children and adolescents, who may be at risk for developing substance abuse based on their childhood exposure to abuse, neglect and/or trauma. This research will provide a

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contribution to society for the problem of substance abuse. This research is an attempt to begin the development of effective methods to aid in the overall healing process and aid in the recovery of these victims.

Research Questions to Be Explored The central research question for my study is, “What is the theory that explains how exposure to early childhood abuse, trauma and neglect contribute to the development of substance use in adulthood?� The following sub-questions will be explored: 1. How do the participants remember their developmental experiences that include abuse and neglect or trauma?

2. How do they think about these past experiences as adults?

3. Do they think about these past experiences as influencing their lives, their interpersonal life, or their desire to use substances?

4. As an adult, what purpose does the use of substance serve?

5. When substance users recall abuse, neglect, or trauma how do you feel?

6. Do these feelings play into the desire to use substances?

7. What has made it difficult in your adult life to not use substances?

Theoretical and Operational Definitions of Major Concepts Child abuse.

According to the US Department of Health and Human Services Administration for Child and Families (n.d.), child abuse is defined as “The mistreatment of a child:

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severe mistreatment of a child by a parent, guardian, or other adult responsible for his or her welfare (physical violence, neglect, sexual assault, or emotional cruelty)” (p. 1).

Neglect.

Neglect is defined as “an act or failure to act which presents and imminent risk of serious harm to a child” (US Department of Health and Human Services, n.d., p. 2). An example of neglect could be a mother who does not return home to feed her children because she stayed out all night using illicit substances and spending the money allotted for food needed to nourish her children.

Childhood trauma.

Dr. Bob Murray defines childhood trauma as, “in addition to physical, sexual and verbal abuse, this can include anything that causes the child to feel worthless, unlovable, insecure, and even endangered, or as if his only value lies in meeting someone else’s needs” (2008, p. 2).

Substance abuse.

Substance abuse is defined as “the excessive consumption or misuse of substance: the excessive consumption or misuse of a substance for the sake of its non-therapeutic effects on the mind or body, especially drugs or alcohol” (O’Connor, n.d., p.1). For the purpose of this study, illicit street drugs include opiates, cocaine, marijuana, methamphetamines, barbiturates, heroine and PCP. Alcohol is also included when discussing the topic of substance use.

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This topic will be explored from the perspective of the operational definitions given above. The ontological stance of the researcher is to explore how the impact of childhood abuse, has affected the development of adult substance users. The findings of this research will be shared with colleagues in the field of social work to improve the treatment efficacy we provide to our patients.

Statement of Assumptions Assumption #1.

Abuse and neglect experienced as a child increases the likelihood that such a child will develop substance use as an adult. I base my assumption on the premise that any type of childhood abuse, neglect and/or trauma will impact subsequent developmental phases.

Assumption #2.

Depending on the severity, exposure to childhood trauma will increase the likelihood that such a child will develop substance use as an adult because any traumatic event experienced will impact subsequent developmental phases.

Epistemological Foundation of Project I will be conducting my research from a constructivism worldview. As a social constructivist I will be seeking to gain an understanding of the world through the experiences of adult substance abusers. According to Creswell (2014), people develop subjective meanings of their experiences. These meanings have a complexity to them

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that I will explore through the interviews and surveys being conducted in my research.

The goal of my research is to allow my participants to construct meaning of their lived experiences in an effort to understand how this has contributed to their substance use problem. My aim in using open-ended interview questions is to facilitate the exploration of subjective experiences of being exposed to child abuse, neglect or trauma in their overall development. Creswell (2014) indicates, by allowing the use of broad openended questions, participants are able to comprehend that their lives are the result of interactions formed with other people in a historical and social context. In my effort to achieve this, I will focus on the context in which participants live and work to better understand how they make meaning of their lived experiences. I also recognize that my own personal background will impact and help shape my interpretations of the data gathered during the interviews. My research will not start with any particular theory, but will generate a theory of meaning based upon the data received. The use of a constructivist worldview is based on the premise that any meaning being generated from this study will rely on social interactions between humans. Therefore, the constructivist worldview allows me to inductively gather information from my participants and develop a theory based on the data obtained. My exploration of the participants’ lives will allow me an opportunity to understand their experiences by sitting with them and listening empathically while they make meaning of their lives from a socially historical context. It is my belief that this approach will generate more meaningful data instead of collecting aggregate data used in quantitative research.

It is my ontological position that the data will reveal multiple realities for each individual participant. Therefore, the most effective way to understand the subjective

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realities of the participants is to work from a social constructivist position. Overall, the epistemology of my research will focus on making meaning (or generating theory) from the shared experiences the participants have socially constructed. My theory will be based on their individual interactions with others in their lives and the community at large.

Foregrounding It started to occur to me some years ago, that there must be some underlying contributing factors that lead a person to becoming a substance user. After working with this population over the past 20 years as a social worker, I started to recognize some common themes among my patients struggling with problems of substance use. I facilitated a substance use treatment group on an in-patient psychiatric unit for the State of Illinois. I often asked my group participants to share some personal experiences relating to their current substance use problem and their understanding of their situation.

After many years and many repeat patients (relapsed upon discharge and re-admitted to the hospital), I began to see a pattern. The majority of the patients’ struggling with substance use had something terrible happen (this includes, abuse, neglect and trauma) in earlier developmental years of their life. This resulted in the formulation of my research question for this project and my dissertation topic. I want to understand, “If earlier childhood histories of abuse, neglect and/or trauma were contributing factors to substance use in later life?� It is my desire to gain more insight into whether adult substance users who were exposed to abuse, neglect and/or trauma in childhood were contributing factors to the development of substance use in adulthood.

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Dissertation Outline This grounded theory study investigates the exploration of the subject with an introduction of the overall concepts in the first chapter, followed by chapters covering a review of the literature, methodology, findings, discussion and a concluding chapter which offers conclusions and recommendations. The Appendix consists of: 1. Sample script for substance users 2. Sample scripts for family/friends of substance abusers 3. Interview guide for family members 4. Interview guide for substance users 5. Expert questionnaire 6. Substance abuse and victimization survey questionnaire 7. Individual study screener 8. Family study screener Included is a list of tables utilized throughout this research.

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Chapter II

Literature Review The literature review was conducted using various search engines, government websites, psychoanalytic journals, library catalogues and medical journals and books.

My literature search utilized hit words including, “adult substance use,” “childhood abuse,” “childhood trauma,” “childhood neglect” and “childhood sexual abuse” as key terms in the search for literature. I used exclusion criteria which addressed adolescent substance use because I am only interested in adult substance use. I also excluded literature which focused on substance use related to developing mental health disorders such as depression, PTSD, and Bipolar illnesses. My reason for this exclusion is because I am primarily concerned with substance use relative to childhood exposure to abuse, neglect and/or trauma.

The Current Scope of Child Abuse/Neglect and Substance Use in America Substance use in the United States has been increasing. According to the National Survey on Drug Use and Health in 2013, there were approximately 24.6 million Americans over the age of 12 who had used a drug in the past thirty days. There has been a rise in marijuana use since 2007, resulting in approximately 19.8 million current users (National Institute on Drug Abuse, 2015). However, alcohol dependence has declined to

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17.3 million Americans in 2013 from 18.1 million Americans in 2002 (National Institute on Drug Abuse, 2015).

According to the National Institute on Drug Abuse (NIDA), there are approximately two-thirds of people currently seeking substance use treatment who have reported incidents of either being physically, sexually or emotionally abused during childhood (1998). However, the literature indicates researchers are currently faced with a broad gap in the literature. According to Dr. Cora Lee Wetherington, NIDA’s Women’s Health Coordinator, “But we lack hard data that clearly establish and describe the role of child abuse in the subsequent development of drug abuse” (1998, p. 1). One reason for the literature gaps seems to indicate the problem with the need for confidentiality and that information for minors is protected and not publicly available. Another factor which impacts the literature gap points to the victims feelings of secrecy resulting from feelings of guilt and shame. NIDA also reports women with a history of trauma are twice as likely to abuse drugs as those who only experienced one type of abuse (1998).

According to NIDA in 2013, the number of children who died as a result of abuse or neglect was approximately 1, 484 children. “Child abuse is linked to an increased risk of alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking and suicides later in life” (2013, p. 2). The literature indicates children who suffer from neglect are higher than any other types of child maltreatment (National Institute of Drug Abuse, 2013). NIDA also indicates the rates of physical abuse and sexual abuse have been declining over the past 20 years while rates of neglect are increasing (2013).

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According to Dr. Alan Leschner, Director of NIDA he indicates determining “the exact relationship between child abuse and drug abuse is exceedingly difficult given the role that variables such as poverty, family dysfunction, the level of social support for victims, or the child’s gender and age play” (1998, p. 1). As a result, these challenges pose difficult questions for researchers. Dr. Leschner emphatically states, “relatively little about the details of that apparent link between child abuse and later drug use” are known (National Institute on Drug Abuse, 1998).

Early Childhood Development and Psychoanalytic Theory A review of the literature revealed the impact that early childhood development can have on an individual’s growth and development into adulthood. The caretaker’s role is pivotal in the overall development of a person’s ability to function adaptively in adulthood. The capacity to internalize objects is contingent upon the nurturance received by the infant’s mother or (caretaking other), during their earliest phases of development.

Many psychoanalytic theorists have developed hypothesis regarding the impact of the mother’s ability to provide adequately for the infant. In essence, the quality of the mother’s caretaking will leave a lasting impression on the child’s development. Across theories there is a common thread which reverberates throughout their lives, regarding the mother-infant world. The convergence has to do with the child’s capacity in several domains. These domains include social interactions, affect regulation and personality development. Ultimately, the quality of one’s early childhood experiences influences the individual’s ability to function independently, as a member of society, despite psychosocial stressors or episodes of grief and loss.

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According to both Sigmund Freud and his daughter Anna, libidinal and aggressive drives are central to an infant’s earliest phases of development. The Freud’s believed these drives are at the seat of all human psychological development. Their theory indicates that drives get cathected to objects of satisfaction at each phase of development (Freud, 1965). The Freud’s also created the psychosexual phases of development that all people pass through on their way to reaching adult life. Accordingly, the infant’s drives and libido propels one through the oral, anal, phallic, latency and genital phases.

According to Sigmund Freud, the primary dilemma is for an individual to navigate the Oedipal Complex stage of development. Each phase must be successfully mastered in order to progress to a higher stage. Otherwise, psychological arrests and fixations result when these phases are not mastered (Freud, 1965).

The fixation points may occur as the result of traumatic experiences resulting from excessive frustration or excessive gratification of the drives (Freud, 1965). “By virtue of their very existence and according to the measure of libido and aggression with which they are cathected, the fixation points exert a constant retrograde pull on drive activity, an attraction which makes itself felt during all early development into maturity” (Freud, 1965, p.96). Sigmund Freud was the creator of classical drive theory in psychoanalysis. However, many future theorists built upon his theory of aggressive and libidinal drives. Kohut greatly expounded upon Freud’s classical theory.

According to Kohut the originator of self-psychology, an infant’s development follows from the caretaker’s capacity for providing empathy/affective attunement with her child. This empathy is at the essence of an individual’s self-cohesion. An individual’s level of self- cohesion determines their capacity to regulate their feelings.

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However, in order to develop a cohesive sense of self the mother must provide the infant with adequate mirroring functions, idealized parental imago functions, alter-ego functions and transmuting internalizations (Kohut, 1996). It is through the process of transmuting internalizations that Kohut believes psychic structures are built in the infant. Kohut postulates when the idealizations about the mother are gradually withdrawn, new psychic structures are formed which perform a psychological function which was previously performed by the idealized object (Kohut, 1996).

Idealization of the self-object occurs when the child grows to internalize the functions provided by the caretaker (object). The object functions as a source of idealization which the infant internalizes to make the object become part of the self. It is during this process that the infant makes the mother a part of the self and recognizes the object as being separate from the self.

The object must also provide mirroring functions for the infant. The caretaker (object) must mirror back to the infant that they are affectively attuned to the infant’s emotional state. It is during these mirror functions when the infant begins to recognize and anticipate certain responses from the mother during times of emotional distress and heightened anxiety (Kohut, 1996). Through these self-object functions, the developing mind builds self structure which provides the self cohesion or lack of self cohesion impacting affect regulation.

Kohut posits that the twinship transference must occur between the infant and the mother. In the absence of a mother, the caretaker other may also provide the same functions. This alter ego promulgates a climate of safety in the infant. The infant finds comfort in the mother’s reliability, particularly with the mother’s affective attunement

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(Kohut, 1996). This twinship provides the experience of feeling united and sharing a common bond with others. This leads to a feeling of being connected to another human.

This creates the capacity for the self to feel comfortable with another human as opposed to feeling alienated (Palombo, 2008).

Since infants are born in a narcissistic state, it is imperative the mother perform all the functions of idealized parental imago, mirroring and alter-ego functions in order for the child to grow from narcissism to a state of cohesion. The infant must recognize themselves as separate from their mothers, yet retain a part of the mother within themselves (Kohut, 1996). All of these prerequisites need to occur for a healthy self is to be established. Kohut elucidates that if these functions are not performed adequately by the mother, the infant will develop a faulty self-structure (Kohut, 1996). Thus, pathology follows from fragmentation of the self when self cohesion is less consolidated and vulnerable to life experiences. Kohut is the original creator of self psychology.

However, other theorists have also built upon his theory. Daniel Stern is another self psychology theorist who has expounded on Kohuts’ work.

According to Daniel Stern, the infant is originally born in a state of inactivity.

During these first two months the infant is alert but continually scanning the environment, as a way of beginning to take in external events (Stern, 1985). In Stern’s emergent self there are two components. Stern defined the emergent self as comprised of “Products of forming relations between isolated experiences and the process” (Stern, 1985, p. 47). It is through the process of amodal perception that the infant receives information in one sensory modality and translates it into another sensory modality (Stern, 1985). “It is presumably in this way that the different major self-invariants of

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agency, coherence, and affectivity become sufficiently integrated (with continuity in the form of memory acting as part of the integrating process) that all together they provide the infant with a unified sense of a core self” (Stern, 1985, p. 99).

All of the previously mentioned theorists have made a positive contribution to psychoanalytic theory as it is understood today. Each theorist has in their own unique way expounded on the developmental trajectory of the self. Each of them has determined a diverse perspective on the factors which lead to healthy development and which factors contribute to the development of some form of pathology in later years. None of these theorists have investigated the phenomenon of substance use most likely because their focus was on the internal workings of the human mind.

Coping Mechanisms Coping mechanisms have a direct link to the internal workings of the human mind. It is these coping mechanisms which result from the early relationships during childhood development. All infants have a built in response to the psychological impact of their early interactions with their caregivers. Therefore, the impact of early childhood nurturance has a tremendous effect on the infant’s ability to develop healthy coping mechanisms throughout life. The capacity to self-sooth tension states has implications on the infant’s future growth and development. The three primary areas in the literature which speak to the ability to cope include: affect regulation, transition states and mentalization. It is my belief that an adult’s ability to develop healthy coping mechanisms in adulthood arises from the coping mechanisms developed in early

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childhood. Therefore, I believe adult substance users have developed faulty coping mechanisms at earlier times in their development.

Affect regulation.

Affect regulation is a key concept in the ability to develop healthy coping strategies. A long accepted hypothesis is that substance users struggle to regulate their own affects. According to E. J. Khantzian’s , “Self-medication hypothesis (SMH), a psychoanalytically informed theory of substance addiction that considers emotional and psychological dimensions, substance addiction functions as a compensatory means to modulate affects and self-soothe from the distressful psychological states” (2003, p. 518).

Khantzian believes an individual uses substance addiction as an attempt to master psychological and physiological symptoms which include emotional pain, dysphoria and anxiety (2003). The substance users’ central problem is affect regulation and disturbance in relationships. It is believed substance addiction can be traced back to early episodes of aggression and how that aggression was managed (Khantzian, 2003). For example, cocaine being used to elevate mood, increase self-confidence and self-esteem, improve mental performance and decrease fatigue and increase productivity. Cocaine is selected as the drug of choice to regulate feelings of inner emptiness, boredom and depressive states (Khantzian, 2003). According to Christopher Bollas, affect regulation is achieved as a result of the infants’ earlier experiences of the object. In his book, Bollas indicated the infant’s affect can be traced back to the emerging thoughts of early memories of being and relating (Bollas, 1987). This is what he refers to as The Shadow of the Object.

In this model, the mother is conceptualized as a transformational object. One that

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encompasses the relationship of the self as an object can then be traced back to the transference of the maternal care system (1987). Bollas contends the adult will inevitably have two systems working at the same time. One system consists of the actual internalization and representation of the mother and father. The other system reflects the unconscious representations of the mother and father (1987). “Over a lifetime we objectify, know and relate to the many different states in our being. Emotional and psychological realities bring with them self states which become part of our history. The concept of self should refer to the position or points of view from which and through which we sense, feel, observe and reflect on distinct and separate experiences in our being” (Bollas, 1987, p.9-10).

The mother’s functioning as a transformational object, presents an opportunity for the infant to have a symbiotic relationship. The mother is known through a recurrent experience of being (Bollas, 1987). During this interaction the infant develops a subjective experience for the very first time. In the complexity of Bollas’ model he outlines how an infant regulates affect, deals with transition states via the transformational mother and leads to the capacity to symbolize and organize experiences.

Mentalization.

According to Fonagy (1998), mentalization is a key concept in developing healthy coping strategies. Fonagy defines mentalization as children’s awareness, of their own and other people’s feelings and thoughts. Children who have difficulty with mentalization are unable to use their prior experiences to develop the capacity to attribute mental states to others. Without the mentalizing function, children struggle to make

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meaning out of other people’s behaviors. This has a large impact on a child’s ability to make meaning out of his/her own psychic experiences. The child’s failure in mentalization deeply impacts their capacity for affect regulation, impulse control, and self-monitoring. It is my belief that substance users have had failures in the capacity to mentalize as children. Therefore, as adults they are unable to perform their own affect regulation, impulse control or self-monitoring. As a result, substance use becomes a dysfunctional attempt at dealing with both the intrapsychic and intrapersonal world around them. Ultimately, substance use is both a defense against reality and a selfprotective measure. Fonagy discusses internalization by the infant, performs a containment function which allows the caretaker to not only reflect the infant’s internal state but also to re-present it as a manageable image which can be tolerated and understood (1998).

According to Bowlby (1984), the transition states are also a key concept in developing healthy coping strategies. He discussed the importance of an infant being attached to the mother. However, if the mother had grown up in an abusive childhood environment themselves, they were more likely to abuse or mistreat their own children.

This ultimately leads to an insecure and/or anxious attachment. These various states of attachment have a huge impact on the infants’ ability to transition between affective states. If the mother is angry and experiences a high level of anxiety, this will ultimately impact the infants’ ability to self-sooth and regulate their own affective states (Bowlby, 1984). Eventually, these infants grow up into adults with the same inability to regulate their own emotions. Women who grew up in environments where separation was anticipated often reacted with high levels of anxiety and/or anger. The end result was, an

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inability to effectively transition between varying affective states because of the mother’s affective misattunement during infancy (Bowlby, 1984).

In summary, affect regulation and mentalization are key concepts in the development of a cohesive sense of self according to self-psychology theory. The absence of appropriate affect regulation provided by the mother during the infant’s early developmental stages can have life- long impacts on the individuals’ ability to provide their own affect regulation in adulthood. This is also true of mentalization. A child must learn during their earliest phases of development to mentalize the feelings of others.

Mentalization is the first experience between the mother and infant. If the child does not learn to adequately mentalize during their early development, the child will certainly be unable to mentalize with others affective states during adulthood.

Attachment.

Attachment theory is a major contribution in understanding the infant’s capacity to develop healthy coping strategies. There are many theorists who hypothesize the degree to which an infant bonds with their mother (or caretaking other) during early years of development, has implications throughout life into adulthood. There are varying levels of attachment, each resulting in different consequences on the infant’s ability to tolerate stress. A secure attachment is the quintessential element, in an individual’s capacity to tolerate emotional discomfort later in life. The actions of the mother in combination with the environment have profound implications, for an individual’s early development.

Factors such as exposure to family violence can significantly interfere with the parent’s ability to form a secure attachment with their infant. Children lacking the opportunity to

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form a secure attachment with their mothers are most at risk for developing pathological behaviors, in adulthood. Contributing factors which interfere with an individual forming secure attachments include; violent words or actions directed towards the child, being seduced by parents to take sides against another parent, or making scapegoats of the opposite parent. Additionally, the arrival of a new baby often results in less attention from the parent (Bowlby, 1984). The overall impact on a child forming a secure attachment with the mother (or caretaking other) serves the function of providing safety, security and love to the developing infant. The insecure attachment often results in an inability to develop a capacity for enduring situations, which threaten the infant’s survival (Bowlby, 1984). Therefore, the insecure attachment continues to impact an individual throughout their adulthood.

It is my contention that individuals who have failed to form a secure attachment in childhood, are at risk for developing problems with substance use in adulthood. These individuals are often unable to tolerate the stress of rejection, criticism and often struggle with regulating intense emotions. These problems with insecure attachments can be manifested in multiple ways throughout life. It appears “that sensitive loving care results in a child’s developing confidence that others will be helpful when appealed to and in his becoming increasingly self-reliant and bold in his explorations of the world, cooperative with others, and also-a very important point-sympathetic and helpful to others in distress” (Bowlby, 1984, p.13).

According to Bowlby, women who have suffered long periods of repeated separations and or threatened with abandonment often suffer from Anxious Attachment.

These women are often sensitive to different types of separation despite their

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commonplace in everyday life. This particular group has always longed for someone to care for them yet they expected rejection (Bowlby, 1984). According to Walker, Eric, Pivnick, & Drucker (1991), women who have substance use problems, particularly those with personal histories of abuse and violence, their children may be their strongest and most loving attachment…an attachment which is filled with hope for a better future (1991).

Impact of Childhood Abuse The literature reviewed has revealed a long history of childhood abuse impacting later phases of an individual’s growth and development. Childhood abuse has been traced to multiple factors inside the family system. These factors may include poverty, generational cycles of childhood abuse, a parent’s lack of education and substance using parents. While the literature cannot pinpoint the exact causes of childhood abuse, there are multiple contributing factors.

The research confirms that early sexual victimization is a central factor in female addiction (Brooks, Zuckerman, Bamforth, Cole, & Kaplan-Sanoff, 1994). The impact of childhood abuse can be devastating to a child in early phases of their development. The abuse can damage the child’s self-esteem, self-confidence and self-worth. Childhood abuse can have lasting implications on an individual’s ability to develop meaningful relationships later in life. Children who have been victimized in childhood often carry the shame and guilt of being abused. These children also grow up in an atmosphere of secrecy, which maintains their feelings of undeserved guilt. Woman who have been unable to resolve conflicts around their childhood abuse, often turn to illicit drugs to help

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them cope with their feelings (Regan, Ehrlich, & Finnegan, 1996). The research findings indicate many women who become abusive parents, were themselves abused during childhood. Yet, these women often present an idealized picture of their childhood despite the grim details of their abusive past (Bowlby, 1984).

Crack cocaine has had a profound impact on the family system. Mothers have been giving birth to crack addicted infants at an alarming rate. According to the U.S. Department of Health and Human Services an estimated 400,000 - 440,000 infants (1011%) of all births are affected by prenatal alcohol or illicit drug exposure (n.d.). This has resulted in an increased number of children being placed in the foster care system.

However, there is a lack of effective interventions to reduce the number of children being removed from their substance using parent’s custody (Berrick, Needell, Barth, & Johnson-Reid, 1998). These mothers often resort to physical abuse of their own children during times of intense anger or anxiety. This often results in an intergenerational problem within the family system. The physical abuse perpetrated by an addicted mother creates further blame and trauma to the parent. The literature reveals there is a complexity to addressing this problem. There needs to be more research conducted to understand the dynamics contributing to a mother becoming addicted to illicit drugs.

This will increase intervention programs which will address the patterns of physical abuse. Often this is a learned behavior and exposure to services such as parenting classes, can be implemented to break the cycle of abuse. It has been revealed, there appears to be some link between childhood trauma and adult substance use or “the relationships between maternal substance use and child maltreatment� (Marcenko, M., Kemp, S., & Larson, C. 2000, p. 316). However, there is still a lack of attention on the

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complexity of this relationship. My research will seek to understand the factors which may be contributing to this complex problem. It has been speculated the reason for increasing failure rates among substance use treatment programs, results from not understanding, nor addressing the exposure to trauma, the substance abusers have experienced during earlier levels of development (Marcenko et al., 2000).

Children who have been the victims of sexual abuse often suffer many negative consequences in their psychological growth and development as they mature. The literature indicates children who have suffered repeated episodes of sexual abuse ultimately develop Post Traumatic Stress Disorder. This often results in the child having “Revisualizations and reenactment of the molestation, nightmares and hyper vigilance, increased autonomic hyper arousal, avoidance of situations reminiscent of the traumatic event, and intensification of symptoms on exposure to situations resembling the abuse” (Green, 1994, p. 655). These children often suffer negative psychological symptoms including dissociation. This is often manifested through impairment of memory or identity (Green, 1994). The psychological impact on children, who have suffered from a history of physical, verbal, emotional or sexual abuse during childhood, is traumatic regardless of the type of abuse suffered. The problems which appear in later phases of development can be categorized as symptoms of depression, hysteria, gender identity and/or abnormal sexual behavior (Green, 1995). “Abuse of drugs or alcohol might represent the victim’s attempt to blot out anxiety related to disturbing memories of the molestation as well as the accompanying painful affect” (Green, 1995, p. 661). Anxiety generated by psychological and sexual intimacy during a sexual encounter in adolescence or early adulthood often results in the initiation of substance use (Green, 1995).

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Neglect Childhood neglect can have implications into adulthood. Children that did not receive adequate emotional responsiveness from their caretakers, often struggle with their ability to adequately care for their own needs later in life. This can be seen in children who grew up in a home with at least one substance using parent. “Mothers who are actively using become increasingly preoccupied with their drug use. Money and resources that would otherwise support their children are used instead to support their drug habits” (Marenko, Kemp & Larson, 2000, p.318). The cycle of intergenerational substance use often repeats itself. As the substance use increases, the mother often becomes preoccupied with her quest to obtain more illicit substances. Resulting in the children under her custody, receiving less and less provisions for food, clothing and shelter depending on her drug of choice and frequency of substance use. As the parents’ substance use increases, the children receive less emotional involvement and often less supervision from their parents. The impact of substance use on the parents often leads to deteriorating physical and mental health (Marcenko, et al, 2000). The end result is substance use has negative implications on the quality of parenting being provided.

The literature reviewed further revealed the results of child abuse impacting adult functioning in several domains. The study sought to find out whether there was a relationship between childhood experiences of abuse and subsequent adult functioning in the following domains: substance use severity, psychological distress, social support and parenting knowledge and attitudes. The findings of Marcenko’s study found that over half of the women (53%) reported incidents of physical and sexual abuse in childhood.

Additionally, 59.1% of the mothers in this sample of 127, reported current or past use of

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alcohol or other drugs to intoxication at least three times a week, for a period of one month or more. The study also went on to explore whether substance use resulted in the children being placed into foster care placements. It was determined, half of the mothers sampled (n=63), had at least one child in out of home placements. This would imply there were at least half of the kids exposed to various types of neglect to warrant removal from the mother’s custody. This study was interesting regarding my topic of substance use. However, it did not capture the information I am interested in exploring which includes physical, sexual abuse, verbal abuse, neglect and/or trauma. The results of the study have led me, in desiring to gain more insights into the impact these categories have on substance use in adulthood. There seems to be a lack of information regarding the various types of neglect which may contribute to the development of substance use in adulthood. The study simply reinforces the idea of failed parenting being the result of substance using parents.

Another study which looked at the “Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health” was reviewed. This was a longitudinal study which spanned a 30 year period. Interviews were done repeatedly over time and yielded the following results. “A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse” (Herrenkohl, Hong, Klika, Herrenkohl & Russo, 2013, p. 191). The “Evidence suggests that child abuse and neglect are linked developmentally to various problems in adolescence and adulthood, which include diagnoses and symptoms of mental health disorders, substance use and abuse” (Herrenkohl et al, p.

191). Another study done by Thornberry, Henry, Ireland, & Smith (2010) looked at

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multiple factors including childhood maltreatment predicting the use of drugs and problems from drug use in adolescence maltreatment. This study found that child maltreatment during adolescence was a contributing factor to negative outcomes including criminal offenses and arrest in early adulthood.

Trauma There seems to be a growing trend towards substance use in women often being the result of sexual abuse in childhood. These women may use drugs in an effort “to alleviate painful affect associated with early traumatic experiences (Davis, 1994; Regan et al., 1987, p.317).

A study entitled Associations among Childhood Trauma, Adolescent Problem Behaviors, and Adverse Adult Outcomes in Substance-Abusing Women Offenders was conducted by the University of California. The study examined a sample of 440 women who are currently incarcerated, in the California penal institution. The goal of this study was to examine the relationship among exposure to childhood traumatic events, adolescent problem behaviors, and later adult manifestations of criminality and psychological distress among a sample of substance using woman offenders in California.

The surveys conducted among the incarcerated women shows that a majority meet the criteria for substance use, mental disorders or both (2005). This information looks at multiple factors including adolescent behaviors and the criminal offenses resulting from substance use. However, it does not discuss explicitly the direct relationship between childhood trauma and substance use in adulthood only. It explores multiple factors which have implications in adulthood, mainly antisocial behaviors in adolescence.

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Substance Use The literature reviewed has provided multiple ideas regarding the development of substance use in adulthood. There has been research done which looks at the precipitating factors which may contribute to the development of this problem. There are multiple studies which approach addiction from different vantage points. Some studies view substance use from the disease model. This views substance use from a notion of genetic predispositions. One study developed by Arif and Westermeyer looked at children who are born to alcoholic parents. Their findings indicated the children of alcoholic parents were 4 to 5 times more likely to develop an addictive disease as those in the general population (Brooks et al, 1994). Cocaine was not initially considered an addictive substance due to the lack of withdrawal symptoms. However, there currently appears to be some withdrawal symptoms involving affective symptoms (Brooks et al, 1994).

The psychiatric model considers psychopathology being at the root of addictive behaviors. This model considers addiction to be a form of self-medication (Khantzian, 1985). This model emphasizes substance users ingesting drugs or alcohol as a way to medicate painful or disordered affect. “Psychoactive drugs help individuals self-soothe and self-regulate and are especially important to addicted individuals because of their difficulty in the areas of affect, self-esteem, relationships, and self-care� (Brooks et al, 1994, p. 207).

The trauma model is also another approach to understanding addictive behaviors.

This model focuses on the traumatic experiences suffered by substance users. This approach was derived from the treatment of PTSD in war soldiers returning home. This

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same PTSD disorder has been recognized in the victims of childhood sexual abuse and other psychological or physical trauma. The victims of PTSD also have multiple symptoms indicating their traumatic past experiences. Van Der Kolk and his associates also looked at the data of their research and discovered addicted women often experienced a high rate of trauma (1987).

The systems theory model is derived from the premise that addiction is the result of a dysfunctional family system. This model focuses on the family system either allowing or encouraging substance use. In addition, the family system is also the source of considerable amounts of neglect to the children within the family (Brooks et al, 1994).

The social model of addiction focuses on the environmental factors including poverty, poor job availability, and a lack of housing, lack of education, sexism, racism, family disintegration and drug availability being the causes of addiction. This model views substance use as the result of despair and hopelessness (Brooks et al, 1994).

The reviewed literature includes multiple theories about the origins of substance use. The various models differ in their etiology of the problem and results in various theories about the factors contributing to the development of this problem. However, my research seeks to explore the various types of abuse being experienced in childhood and its’ impact on the development of substance use in adulthood. The literature indicates that childhood physical abuse may be a factor in the development of substance use in later phases of life. However, there seems to be an inference to adolescence being the primary phase of introduction to the use of illicit substances. The literature also leaves a gap as to the various factors which constitute childhood neglect. There also seems to be some information regarding childhood trauma leading to the development of PTSD.

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However, there has not been a study which explores only childhood abuse, neglect and/or trauma being directly tied to the development of substance use in adulthood, without investigating any other mediating factors. Therefore, my study shall seek to explore specifically all 3 categories of childhood exposure to abuse, neglect and/or trauma being the primary factor in the development of adult substance use. I wish to explore whether there are any differences in the amount and types of exposure to childhood maltreatment, impacting the development of substance use in adulthood. I am curious whether rates of abuse are different from rates of neglect or trauma in the development of substance addiction. I am also curious about whether the frequency of exposure to childhood maltreatment, makes a difference in the development of substance use in adulthood.

Depending on the theory being examined, substance use may serve a social function for some adults. Many substance users have discussed the role of getting high, as a way to be among peers who share the same habit. The substance users develop a separate system of interacting with one another, apart from non-abusing friends and family members. Many of my patients have shared their stories with me over the years, while I was facilitating different substance use treatment groups. There has been a repeated theme among my patients, of feeling “they are accepted for who they are,” among fellow substance users. My patients have often verbalized their feelings of alienation, among family members and friends resulting from their problems with substance use. They have also indicated feelings of guilt and low self-esteem, as a result of their substance use problems. This often leads to more feelings of alienation and will result in increased time being spent with their ‘get high buddies’, along with increased substance use. The social function of substance use has had a powerful impact on the

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development of alliances and friendships being formed around their shared struggles.

Individuals who get high together have revealed they end up sharing resources, such as money or transportation, in an effort to secure more drugs and/or alcohol. They also develop their own internal support system for each other. This support system is often activated, during an individual experiencing various trials and tribulations in their personal lives. Therefore, the pattern of substance use often serves as a social function to the individual members of their secret society.

It has been revealed through my work with substance users, childhood experiences often have a longstanding impact on them. Many of my patients have verbalized the role peer pressure has played in their initial experimentation with substance use. Friends and family members often entice one another to try a new drug with them. This will often lead to adolescence being a phase in which exposure to drugs is increased. Some patients have insisted they were able to abstain from substance use until they reached adulthood. This has often been fascinating to me as a clinician.

Therefore, my study seeks to explore the relationship between childhood experiences and the development of substance use in adulthood. My study will focus on adulthood as opposed to adolescence, being the phase when substance use commences.

Some theories have focused on the role of substance use serving a self-soothing function for individual abusers. Theorist like Khantzian, have focused on substance use aiding abusers in the management of affective states and self-soothing (2003). It is believed substance users have a hard time managing their feelings. Therefore, substance use becomes an unhealthy way to handle their emotions. It has been stated the particular drug of choice is closely paralleled to the affective states of the individual substance user.

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There has also been some literature which emphasizes the types and frequency of childhood abuse is directly related to the drug of choice. The individual’s selection of their drug of choice is based upon the inability to tolerate or manage the painful memories or affects associated with their past experience of abuse. This selection is also believed to be relevant in the study of substance users who have developed PTSD (Khantzian, 2003). “Higher levels of repression and emotional inhibition would predict one’s preference for alcohol; higher levels of depressive affect or the need for elated psychological state would predict one’s preference for cocaine and higher level of anger or trauma would predict one’s preference for heroine” (Suh, Ruffins, Robins, Albanese & Khantzian, 2008, p. 520).

Role of Empathy According to Kohut, empathy is a central factor in the development of a healthy and cohesive sense of self. Kohut puts forth the importance of a mother (or caretaker other’s) role in being affectively attuned with the infant. If the mother fails to provide the basic functions of being available and responsive to the infants’ affective states, this often leads to the development of pathological defensive structures, in later phases of development (1996). This environment often leads to an absence of parental empathy.

Victims of sexual abuse are often preyed upon due to the parent’s lack of empathy and parental protection (Leahy, 1991). Very often sexually abused children are residing in incestuous families. Therefore, children fail to feel safe in disclosing to their mother’s, the sexual abuse occurring inside the family. It has long been believed the mother’s role is central to the incestuous relationship. Therefore, the child (victim) often discloses the

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abuse to teachers, relatives and family friends (Leahy, 1991). As a result, these children grow up in an environment where they did not feel safe. This leads to an internalized feeling of worthlessness, depression and low self-esteem. These factors contribute to them being placed at increased risk of developing substance use in later phases of development. As a result, the childhood victims have failed to receive affective attunement and never developed the capacity to manage their affective states.

Henceforth, substance use becomes a dysfunctional way of receiving ‘toxic nourishment’ (Pansulla, 2014).

Summary The literature review has provided many different lenses through which to hypothesize about how substance use develops. There have been views which look at substance use from the perspective of having an intergenerational family history of substance use. The literature has also looked at childhood sexual abuse as contributing to female addiction. The duration and exposure to a history of childhood physical and sexual abuse was also explored. The problem of domestic violence as the result of a substance abusing parent was also investigated. There was a predominant amount of literature which viewed exposure to physical abuse in childhood as being a factor in developing pathological coping strategies in adulthood. However, a gap in the literature, definitely exist relative to understanding the impact of childhood exposure to abuse, neglect and/or trauma in contributing to the development of adult substance use. My research will ultimately explore all three areas of childhood abuse, neglect and trauma relative to the development of an addiction to substances in one study. My ultimate goal

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is to explore the interpersonal lives of substance users to gain insight into their childhood experiences.

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Chapter III

Methodology Introduction The purpose of this grounded theory study will be to develop a theory that defines the experience of being abused, neglected or traumatized as a child and the development of a substance use problem in adulthood. This will be achieved through the exploration of the lives of adult substance users, examining their early childhood developmental years for evidence of childhood abuse, trauma and/or childhood neglect. In seeking to develop the theory, the study will address seven research questions: The central research question for my study is, “What is the theory that explains how exposure to early childhood abuse, trauma and neglect contribute to the development of substance use in adulthood?� The following sub-questions will be explored: 1. How do the participants remember their developmental experiences that include abuse and neglect or trauma?

2. How do they think about these past experiences as adults?

3. Do they think about these past experiences as influencing their lives, their interpersonal life, or their desire to use substances?

4. As an adult, what purpose does the use of substance serve?

5. When substance users recall abuse, neglect, or trauma how do you feel?

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6. Do these feelings play into the desire to use substances?

7. What has made it difficult in your adult life to not use substances?

This chapter describes the study’s research methodology and includes discussion around the following areas: 1. Rationale for research approach 2. Description of the research sample 3. Overview of research design 4. Methods of data collection 5. Analysis and synthesis of data 6. Ethical considerations 7. Issues of trustworthiness and 8. Limitations of the study The chapter will finish with a brief concluding summary.

Rationale for Qualitative Research Design The goal of this qualitative study is to develop a model which should help in improving the treatment of adult substance users. I hope to better understand how early childhood abuse, neglect and/or trauma may be connected to substance use in adulthood.

This will be achieved by obtaining an improved understanding of the complex factors facing this population. Through the use of interviews, I will be present as the participants reflect on their lived experiences of childhood and their understanding of the impact it has had on their decision to use illicit substances in adulthood. As clinical social workers, we can only impact positive change by addressing the unconscious and

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conscious thought processes that our patients are experiencing. Hopefully, this research will leave a positive impact on their lives, by helping them break the generational cycles of abuse within their family systems.

Qualitative research is being conducted because the goal of this study is to explore the lives of adult substance users, in an effort to better understand their internal emotional and psychological worlds. This exploration of their subjective experiences will drive the grounded theory methodology being utilized in this research, to develop a model for providing future treatment to this population.

Rationale for Grounded Theory Methodology According to Corbin and Strauss (2015), grounded theory is selected by some researchers because it helps explore the inner experiences of the participants. This methodology also uses a holistic and comprehensive approach to aid in the study of the phenomenon of substance use. According to the literature, qualitative research is being selected because it allows the researcher, to become a part of the process along with the participants. Corbin and Strauss (2015) have indicated the grounded theory method is often selected by researchers because it allows an exploration of how meanings are formed and transformed in the lives of the participants. The problem of substance use is an area of study which could benefit from utilizing the grounded theory method for conducting qualitative research. This approach will afford me the flexibility and opportunity to conduct data analysis at multiple stages of inquiry. In grounded theory, the theory is driven by the data collection process (Creswell, 2014). Ultimately the goal

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of this grounded theory research is to develop a model which will impact the future treatment of substance users.

The Research Sample According to grounded theory, the purpose of the research is to better understand the lived experiences of the participants. Therefore, this researcher has elected to interview a combination of participants including the actual substance users, the friends and family members of the users-who have been impacted by the substance use problem of their loved ones and a few experts in the field of substance use. This comprehensive sample will help to view the phenomenon of substance use from various perspectives.

Ultimately, the goal is to better understand the various lived experiences of the research participants and to develop an emerging theory. The research will attempt to obtain a sample size of approximately 20 substance users, 5 family members/friends and three experts. Participants who are under the age of 18 years old will be excluded from this study.

Substance users.

A total of 20 substance users will be recruited for this study. There are several inclusion criteria that have been set for this research, which include: a cut-off age of 18 or older, substance users who meet the DSM-V criteria for adult substance use (excluding nicotine and caffeine spectrum disorders) and a period of abstinence of no less than three months prior to participation in this study, which can include their time spent in a recovery program. Participants will also need to attend NA/AA support group meetings

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for a minimum of 60 days prior to participation or have past experiences with aftercare treatment upon discharge from a treatment program for a minimum of 60 days.

Participants need to have experienced some history of childhood abuse, neglect or trauma to be included in this research study. Participants will also need to have some insight into their treatment needs as evidenced by their ability to verbalize appropriate insight into achieving and maintaining sobriety. Participants should possess the ability to actively verbalize their feelings, relative to their childhood developmental years. The number of male and female participants will be dependent upon the number of each gender available at the time of conducting interviews. It will also be dependent upon the number of each gender in attendance at the NA/AA support group meetings.

Participants who are actively engaged in substance use and have no insight into their treatment needs will also be excluded. Participants who appear to be under the influence of substances (i.e. dilated pupils, aggression or displaying the smell of alcohol consumption, etc.) will be excluded. Participants who are emotionally unable to tolerate the anxiety provoked from discussing memories and episodes of childhood abuse, neglect or trauma will be given the option to drop out of the study. Participants have a right to verbalize their discomfort at any time during the interviewing process and elect to discontinue their participation in the study with no negative consequences for doing so.

I will recruit this sample by posting multiple flyers in various locations.

Permission will be obtained from appropriate sources when necessary, to post the flyers in locations such as NA/AA, hospitals, local grocery stores, libraries, and support group meetings, or what is known as a purposive sample. I will explore the feasibility in posting flyers at local substance use treatment programs. I will also inform colleagues

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who work with the substance use population to post flyers at their places of employment, when allowed by their agencies protocol. I will provide the inclusion criteria on the flyers and provide my contact information (name and phone number) for potential participants to reach me.

Family/Friends.

Five family members and friends of adult substance users will also be included in this study. These collateral participants will provide observations; regarding the impact substance abuse has had on the lives of substance users whom they care about. Family members will also be able to provide information about the participants earlier phases of development including childhood experiences and exposure to abuse, neglect and trauma.

These participants may possibly be able to contribute data that the substance user has suppressed or forgot. A separate flyer will be used for friends/family members of substance abusers (collateral sources). These flyers will be posted at ALANON meeting sites. I will provide the inclusion criteria on the flyers and provide my contact information (name and phone number) for potential participants to reach me. The inclusion criteria for family members/friends includes that they must have had a close association with the substance user for at least two years during their active substance use. The family member/friend must also have insight into how the substance use affected the lifestyle of the substance user. They must also be able to tolerate discussing their experiences with the substance user.

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Experts.

This study will also include interviewing three experts in the field of substance use. These experts must have at least 10 years of experience working with adult substance users. They must have insight about the cycle of relapse, treatment modalities and effective treatment. Their clinical experience will be included to help make connections about the various themes that will emerge from this research. I will use word of mouth to recruit experts in the field of substance use. I currently work very closely with this population and have an ongoing opportunity to reach out to experts in this field on an individual basis. I will make contact with the experts and explain my dissertation topic and invite them to participate in my research via interviews. I will obtain the necessary signed consent forms and proceed to schedule a time in the future to conduct interviews in person or via telephone (based on time constraints for both parties). The recruitment process for my three experts will be achieved through word of mouth referrals.

Demographics.

This grounded theory study will explore the lives of approximately 20 adult substance users who have experienced exposure to childhood abuse, neglect or trauma in their earlier developmental years. The participants will consists of adults 18 years or older and will be made up of a combination of males and females who meet the DSM-V criteria for adult substance use. The following demographics will be collected: gender, age, marital status, education level, race, and questions pertaining to history of victimization and substance use.

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Research Plan The following list summarizes the steps I will implement to carry out this study.

Following this list is a more detailed discussion of each step.

1. First, the adult substance users will be recruited. Flyers will be posed at AA/NA meeting sties or other locations. These individuals will contact me by phone or email, and those who qualify will be provided with a date and time for the interview.

2. The interviews with the adult substance users will be completed and the data will be transcribed and analyzed.

3. Next, I will then conduct a second interview with the substance users to clarify the data gathered and ask any new questions that emerged from the analysis.

4. Next, the five family members/friends will be recruited. Flyers will be posted at ALANON meeting sites. These individuals will contact me by phone or email, and those who qualify will be provided with a date and time for the interview.

5. The interviews with family members/friends will take place face-to-face.

Prior to the start, the consent form will be explained a final time and then signed by the participant. The demographic questionnaire will also be collected at this time.

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6. After the interviews with the family members/friends have been completed, the data will be transcribed and analyzed. Information from the analysis may be used to modify the interview scripts for the experts.

7. The three substance use experts will be recruited lastly. I will attempt to recruit these individuals by talking to directors of substance use programs for the State of Illinois and by referrals. I will contact potential participants by phone or email, and those who qualify and agree to participate will be provided with a date and time for the interview. The consent form will also be discussed at this time.

8. The interviews with experts will take place face-to-face or through VSee. Prior to the start, the consent form will be explained a final time and then signed by the participant. The demographic questionnaire will also be collected.

9. After the interviews with the experts have been completed, the data will be transcribed and analyzed. Information from the analysis may be used to modify the developed grounded theory model. Any recommendations about changes to this research will also be documented and followed.

10. Lastly, I will then transcribe the qualitative data and conduct a final analysis.

Data Collection The researcher will utilize an unstructured interview process. According to Corbin and Morse (2003), the unstructured interview provides the richest source of data for theory building. They indicate that the unstructured interview allows the participants

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to talk more freely and does not constrain them to answer predetermined interview questions only. I feel this approach will provide the best possible insight into understanding the internal worlds of the adult substance users. The literature reviewed indicated the unstructured interview has the advantage of allowing the participants to determine what subject they wish to discuss and at what pace, in what order and to what depth they feel comfortable. This allows me to offer an opportunity to follow up with subsequent interviews with the same participant. This approach used in grounded theory research will yield the most valuable data as opposed to preconceived questions being asked of each participant (Corbin & Strauss, 2015). According to Corbin and Strauss (2015), the unstructured interview does not require an interview guide. However, I will provide a basic interview guide of some generic questions that I will use to help guide the interviews. It is to be noted that each participant will be able to freely disclose their narratives to the degree they feel comfortable doing so. Therefore, each participant may not answer the same questions depending on the level of personal disclosure, to be decided by each participant.

Phase I: Demographic survey.

A demographic survey will be presented to participants who have suffered with the problem of adult substance use, in addition to experiencing childhood episodes of abuse, neglect and/or trauma. The selected data collection method will be based on questionnaires of adult substance users’ (Appendix A). The information to be gathered will provide some history of their childhood abuse/neglect and any history of trauma this population may have experienced in earlier stages of development. The information

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gathered will also reflect the current or past substance use patterns of the participants in this study.

This researcher will also utilize a demographic questionnaire on all participants in this research process. The questionnaire will gather demographic information and screening questions. This approach will be used to help describe each of the main three participant groups and identify those individuals who meet the study criteria. In essence, the data collected from this questionnaire will be separate from the information collected in the individual interviews. According to Corbin and Strauss (2015), there are many different sources of data used in grounded theory qualitative research. Corbin and Strauss indicate one or a combination of sources may be used in grounded theory.

After the participant signs the consent form, I will hand the demographic questionnaire to the participant and allow them to complete it independently. There will be no identifying information obtained by the researcher while handing out the questionnaire or upon receiving back the completed questionnaire. Upon completion of the questionnaire, the researcher will proceed with the unstructured interview.

Phase II: Interviews.

All interviews will be conducted in person when possible. The location of interviews will be conducted at the site of the NA/AA support group meetings if space is available. However, if there is no space available to conduct the interviews, I will invite participants to the office of my private practice, to complete the interviews. This will provide a secure location for participants to disclose their confidential information without the possibility of people overhearing their personal accounts. The same process

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will be conducted relative to the family members/friends of the adult substance users.

However, the office location will be flexible when interviewing experts in the field of substance use. If the expert prefers me to travel to their office location, I will be willing to accommodate them to get the interview completed. I will also inform the experts that if any direct quotes or paraphrasing is used in my dissertation, I will cite them as the source of my information, according to APA guidelines.

Plan for Data Analysis When analyzing the data gathered from the individual interviews, the data will be coded according to any emerging themes or concepts which emerge upon completing each individual interview. According to Corbin and Strauss (2015), the open coding method is used because the data will be analyzed first section-by-section of the interview and eventually line by line. Then as emerging themes come to the forefront I can begin to analyze the data from the interviews line by line. Each subsequent interview will provide validation if the same themes continue to emerge in each subsequent interview.

The data analysis will be an ongoing process that continues upon completion of each subsequent interview. Therefore, as more interviews are completed, the researcher will analyze the data and look for any repeated themes and/or categories and begin to group those together. According to Corbin and Strauss (2015), this process is considered axial coding. Axial coding is often conducted along with open coding throughout the data analysis phase. When the data analysis becomes saturated the last level of coding is completed called selective coding. Through selective coding the data that has emerged from the interviews is integrated and refined throughout each of the previously

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established categories or themes. According to Corbin and Strauss (2015), this process is the essence of grounded theory. As the data is gathered, it drives the process of grounded theory. The end result of the data analysis will help the researcher develop a theory that has been grounded in the data received from the interviews of all the research participants. The data will be analyzed continually throughout the research process until each level of open coding, axial coding and selective coding has reached a point of saturation. Saturation according to Corbin and Strauss (2015) is reached when no new themes or categories can emerge from the data.

The questionnaire will be used to bring better clarity to the emerging concepts and categories emerging from the interviews. However, due to the structure of the questionnaires, the information will be coded differently than the interviews. I will use a scoring system to analyze the data obtained from the questionnaires. This will be done in order to assist me in describing my three main participant samples. A basic code sheet will be developed to help me summarize the data.

Ethical Considerations According to the policies implemented under the Code of Federal Regulations, the participants of this research study are considered a marginalized group due to their substance abuse status. However, I will treat them with the utmost respect and courtesy throughout the research process. Their information will be received for research purposes only and their identity and confidentiality will be protected at all times.

According to Corbin and Strauss (2015), confidentiality is of the utmost importance, but if the researcher hears something that could be deemed harmful to the participant or

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others, the researcher has an obligation to report this information to the proper authorities. Because substance users have histories that often include illicit behaviors, I will apply for a Certificate of Confidentiality (CoC) through the National Institute on Health (NIH). A CoC helps to protect against forced disclosure of research data. The research application will address the reason that illegal substance use information must be retained, and indicate whether a CoC has been obtained or will be sought. The consent form must address the collection and retention of substance use information, confidentiality protections, and include standard language describing the protections of a CoC. The appropriate consents will be signed and obtained by each participant.

Information will be stored in a locked file cabinet in the researcher’s office for a period of five years. No one will have access to the participant’s information except the researcher.

In the event the questions asked in the questionnaire or interview cause some psychological distress to the respondents, the respondents will be provided a list of referral sources to seek assistance in the event a crisis results from the questionnaire or interview. The list will contain free or sliding fee scale mental health and substance abuse providers (including locations and telephone numbers) which can be accessed by the respondents.

Issues of Trustworthiness In using the grounded theory methods there are some built in checks and balances that help reduce the negative impacts of biases. The continual comparison made when data is compared or matched against subsequent data for similarities and differences aids in the researcher developing consistent meanings and conceptualizations throughout the

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research process (Corbin & Strauss, 2015). This method will assist in the credibility and dependability of the research participants. The particular procedures that will be used by this researcher to achieve credibility will also include peer review, member checks and rich thick descriptions obtained by the research participants. Dependability and transferability does not pertain to grounded theory methods because they are more appropriate for quantitative research according to the Bloomberg and Volpe (2012).

Another method used by researchers in grounded theory, is writing a journal to assist in reducing the researcher making assumptions or having biased opinions. The researcher can write their personal thoughts and feelings down in the journal throughout the research process. This journal can be a tremendous help in helping the researcher identify any biased thoughts or prevent them from jumping to any conclusions (Corbin & Strauss, 2015). I have already begun to keep a journal to help me avoid these particular pitfalls. I will continue to use my research journal until the completion of my research.

Limitations and Delimitations Grounded theory is a particular method of qualitative research that has some limitations to this particular design. The ability of the researcher to become involved in the personal lives of their participants can sometimes create unexpected reactions in the researcher. Often these unconscious feelings in the researcher become evoked when interviewing a participant who has some of the same or similar life events. Participant’s information being revealed during their interviews with the researcher, can stir up old or unresolved feelings in the researcher that can impact their analysis of the data. The use of journaling, member checking and debriefing with a colleague can be helpful in resolving

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this limitation. However, one of the biggest limitations of this methodology is that I cannot generalize my findings to a larger population. According to Creswell (2013), grounded theory can pose challenges to the researcher because I will need to abandon any preconceived notions about the topic under investigation to “allow analytic, substantive theory to emerge� (2013, p.89). This method is not fixed or mechanical and allows for the flexibility of the data to drive the grounded theory.

The grounded theory offers a process of constant comparisons throughout the data gathering and data analysis process. The analysis goes on continually throughout the research process. This is one of the strongest features of this particular methodology.

Therefore, this allows the researcher multiple opportunities to re-evaluate how they are interpreting the data. This will ultimately impact the development of themes or concepts related to the core idea of the research being conducted.

The Role of the Researcher My role throughout this research process is one of an insider. I have an opportunity to speak with the participants in an intimate and very personal way. I can share in their life narratives through hearing first hand from the participants their life experiences regarding some very personal and painful experiences. I am to be supportive throughout the research process. My role is to remain non-judgmental and unbiased throughout the research process. I am to remain flexible as the data is gathered and the themes emerge from my research. I am to refrain from forming any preconceived ideas about the subject I am investigating. Therefore, I should remain neutral and allow the data gathered to guide my research until the information comes together in a coherent

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theory of model regarding the impact childhood abuse, neglect or trauma has on adult substance users.

Summary I will explore the lives of adult substance users who have experienced childhood abuse, neglect, or trauma in their early phases of the participants’ development to develop a theory that will show the subjective connections between early childhood abuse and neglect and adulthood substance use. I will utilize the grounded theory method in an effort to develop a model which will help gain insight into the internal and psychological worlds, of the substance users. I will use a survey questionnaire and unstructured interviews to gather my data. I will utilize flyers and word of mouth to recruit participants for my research study. The goal of my research is to examine the lives of approximately 20 adult substance users, composed of both males and females who meet the DSM-V criteria for adult substance use. I will also interview approximately five family members or friends of adult substance users to gather insight into their perceptions about the lives of adult substance users and their earlier phases of development. I will also seek to interview approximately three experts in the field of substance use, to gain insight into the knowledge and expertise they possess relative to working with this population. My grounded theory method will be driven by the data I gather and analyzed throughout my research study. I will utilize open coding, axial coding and selective coding to analyze the data and develop any emerging themes or concepts, which has been obtained from the raw data gathered through interviewing my participants. It is the goal of this study to develop a model which will enlighten and help serve the professional

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field of clinical social workers. By utilizing a grounded theory methodology, I hope to promote healing and recovery to the participants suffering from the problem of adult substance use.

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Chapter IV

Findings The purpose of this grounded theory study was to explore the childhood experiences of adult substance users for evidence of exposure to childhood abuse, neglect or trauma during their early developmental years. The research questions to be answered by this study were: 1.

Are adult substance users the victims of physical abuse in childhood?

2.

Are adult substance users the victims of sexual abuse in childhood?

3.

Are adult substance users the victims of emotional abuse in childhood?

4.

Are adult substance users the victims of childhood neglect?

5.

Are adult substance users the victims of any type of childhood trauma?

Grounded theory was selected for this research because it is a form of inquiry in “which the researcher derives a general, abstract theory of a process, action or interaction grounded in the views of the participants” (Creswell, 2014, p. 14). This method of inquiry provided me an opportunity as the researcher, to become immersed in the participants’ lived experiences with addiction to substances. Not only did the researcher have the opportunity to sit with them; as they relived their individual life stories from childhood into adulthood; they also provided in-depth memories of their childhood experiences, as it related to their exposure to abuse, neglect and/or trauma. Some of the

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participants have lived through some horrifying and traumatic childhood experiences.

The interviews also allowed the researcher to become engaged with the participants as they recalled various factors, which may have impacted their journey into substance use in adulthood. Additionally, sitting with them during the interviews, allowed the researcher to observe their various affective states as they disclosed these painful memories. The researcher found the interviews to be rich in data, while also impacting the researcher’s ability to hold all of these painful affective states without becoming judgmental or biased in this research exploration.

Introduction to Participants Using the grounded theory methodology a total of 25 individuals (16 males and 9 females) were recruited to participate in this study, which included adult substance users (n=20) and family members (n=5). Thus, the target sample of 25 total participants was achieved. The adult substance users were recruited by posting flyers at various NA/AA substance abuse and ALANON groups. Additional flyers were posted at local libraries in South Suburban Cook County. Participants were also recruited via word of mouth, from other research participants; thus a snowball sampling technique emerged in this study.

Prior to all interviews, the researcher reviewed the study consent form with them, witnessed their signature and asked them to provide a pseudo name, which are used to reference the participants throughout the remainder of this dissertation. The interviews with all participants were conducted in-person by the researcher at her office, during both the first and second round of interviews. Participants were also given a stipend of ten dollars prior to each interview.

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At the onset of the first interview, the research participants were asked to complete a questionnaire to gather demographic information, prior to beginning the interview process. Each participant agreed to provide the researcher with their identifying information which included the following: 1) their self assigned pseudo name, 2) their age, 3) their gender, 4) their marital status, 5) their race and 6) their highest completed educational level. There was one unique category for family members, which defined the relationship to the substance user.

The average age of the substance users was 50 years old. There were 16 males and 4 females. The marital status of the participants was as follows: single (n=8), married (n=6), divorced (n=5), and widowed (n=1). The race of the participants was as follows: 16 Black participants, two White participants and two Hispanic participants. The educational level of the participants was as follows: participants who earned a high school diploma with some college (n=9), less than high school (n =3), high school diploma (n= 4), GED (n=2), college degree (n=2). (See Table 4.1).

Family members.

There were five female participants including: three Blacks, one Hispanic and one White participant. The average age of the family members was 52 years old. The substance users’ relationship to their family members was as follows: Ex-husband (n=1), Niece (n=1), Brother (n=1), Uncle (n=1), and Father (n=1). There was one family member who discussed both her father and uncles’ substance use. However, the primary focus of the interview was on her father. I did not count the uncles in the sample size.

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Below are two charts which display the demographic summary data for both groups (see Tables 4.1 and 4.2).

Table 4.1 Sample of Substance Users (n=20) Pseudo Name Monclaire

Age

Gender

Marital Status

Race

Education Level

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Male

Married

Black

G Devil Chelle

52 39 49

Male Male Female

Married Single Separated

Black Black Black

Billy Frenchy Dave XFile

48 50 46 64

Male Female Male Female

Married Single Single Married

White Black White Black

Mack

53

Male

Single

Hispanic

Pretty Tony Randy

51 59

Male Male

Married Single

Black Black

Huffman Mae Devoe

51 51

Male Female

Married Widowed

Black Black

Joe Sausage

62

Male

Single

Black

Guido Flash

51 53

Male Male

Separated Separated

Black Black

Paul

36

Male

Single

Hispanic

Henry

54

Male

Separated

Black

James

53

Male

Divorced

Black

Tom

26

Male

Single

Black

M=50 Min=26 Max=64

Males=16 Females=4

Single=8 Married=6 Divorced=5 Widowed=1

Black=16 White=2 Hispanic =2

Some college w H.S. diploma H.S. Diploma GED Some college w H.S. Diploma H.S. Diploma College Degree College Degree Some College w H.S. Diploma Less than High School GED Less than High School H.S. Diploma Some College w H.S. Diploma Some College w H.S. Diploma H.S. Diploma Some College w H.S. Diploma Some College w H.S. Diploma Some College w H.S. Diploma Some College w H.S. Diploma Less than High School N/A

n=20

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Table 4.2 Sample of Family Members Characteristics (n=5) Pseudo Name Rachel God’s Child Joy BooWho Sandy n=5

Age

Race

Gender

48 48

Black Black

Female Female

55 52 58 M=52 Min=48 Max=58

Black Hispanic White Black=3 Hispanic=1 White=1

Female Female Female Female =5

Relationship to Substance User Her Uncle Her Father/Her Uncles Her Brothers Her Niece Her Ex-Husband N/A

There were 20 substance users who participated in the research. The researcher will provide a brief summary of each individual participant. This introduction is an opportunity to become familiar with the back stories of their individual lives. Below will follow an introduction into the participants individual experiences based on their memory recall, as summarized by the researcher.

Monclaire.

Monclaire is a 49 year-old, married, Black male who disclosed he experienced bullying and extreme racism during his childhood. He reported feeling unsure of his place among peers in grammar school because he was always taunted for having a light complexion. He disclosed this was an extremely traumatic experience for him while growing up. Additionally, his father never displayed any affection to him, his younger sibling or his mother throughout his entire childhood. The first time his dad ever hugged him was after he returned home from the military, while he was well into adulthood. He verbalized experiencing feelings of emotional neglect from his dad throughout childhood.

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G. G is a 52 year-old, married, Black male who disclosed he experienced physical and emotional abuse during childhood. He also disclosed that he was neglected during childhood beginning at the age of 10 years old. He reports often being yelled at by his parents during childhood. He also received physical spankings, punches and he considered this discipline abusive. G also disclosed he was often left to care for his younger sibling which essentially made him feel like a parentified child. Both of his parents indulged in alcohol and drug use while he was growing up. Additionally, all of his older siblings were substance users.

Devil.

Devil is a 39 year-old, single, Black male who reports he was often yelled at by his mother during childhood. He also reported receiving physical spankings which he considered to be abusive while growing up. Devil grew up without a father figure in the home. He believed the absence of a father had a traumatic impact on his childhood development.

Chelle.

Chelle is a 49 year-old, separated, Black female who reports she experienced physical and emotional abuse during childhood at the hands of her father. Chelle also reports she was sexually abused during childhood by a non-family member. Her father was an alcoholic who chased her and her mother from their home, with a butcher knife

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while intoxicated. This childhood memory was a very traumatic experience which she still recalls vividly in adulthood.

Billy.

Billy is a 48 year-old, married, White male who reports he suffered physical and emotional abuse at the hands of his step-father. He also reports childhood neglect from the ages of 2-15. He was removed from his mother’s care by DCFS and placed in multiple foster homes including homes of relatives. He recalls being frequently humiliated during childhood, being yelled at often by parents and received physical beatings which left him with broken body parts.

Frenchy.

Frenchy is a 50 year-old, single, Black female. She reports being the victim of childhood physical and emotional abuse. She also recalls being neglected by her parents at the age of six. She disclosed being frequently humiliated during childhood by her parents. She also reports being yelled at often by her parents and made to feel like a bad person while growing up. Frenchy recalled the painful memory of being sexually abused by her biological father during childhood. Additionally, her parents divorced when she was 6 years old and this was an added traumatic experience during her early developmental years.

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Dave.

Dave is a 46 year-old, single, White male who reports that he was the victim of physical and emotional abuse during childhood starting at the age of two, at the hands of both his mother and step-father. Dave also reports suffering emotional and physical neglect and had both legs broken when he was 6 months old (in the crib). He recalls being frequently yelled at by his parents during childhood and he was also made to feel like a bad person while growing up. Dave remembers being thrown from a moving car, by his step-dad while growing up.

XFile.

XFile is a 64 year-old, married, Lesbian, Black female. She disclosed experiencing physical and emotional abuse during childhood, at the hands of her father starting at the age of five years old. XFile also reported being physically abused and being frequently humiliated by her parents during childhood. Her parents often yelled at her while growing up. Additionally, XFile reported being sexually abused by her biological father. This resulted in her becoming pregnant by her father on 3 different occasions. After each pregnancy she was given illegal abortions, which occurred in a neighbor’s home (located in the housing projects of Chicago). Further traumatic memories were reported, when her unborn fetuses were thrown in the incinerator of her housing project by XFile and her mother.

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Mack.

Mack is a 53 year-old, single, Hispanic male. Mack reports he experienced both physical and emotional abuse during childhood in two different countries. He experienced abuse in Cuba at the hands of his father. He fled to the USA as a child without family and ended up in Chicago as an orphan, being taken in by the street gangs.

He suffered further abuse at the hands of gang members. He recalls being yelled at often during childhood by both family members and gang members. The gang members also perpetrated physical assaults against him whenever he refused to carry out orders by high ranking gang leaders.

Pretty Tony.

Pretty Tony is a 51 year-old, married, Black male who reports experiencing both physical and emotional abuse at the hands of his father during childhood. The abuse began at the age of seven years old. He also recalls being yelled at by his parents on many occasions during childhood. Pretty Tony also reported receiving physical spankings by his father, which he considered abusive during his childhood. Additionally, he recalled his father was emotionally cold and distant throughout his entire life. He only recalls his father smiling once or twice throughout his early development.

Randy.

Randy is a 59 year-old, single, Black male who endured both physical and emotional abuse during childhood. He recalls the abuse starting at the age of 15 years old. He also recalls being emotionally neglected by his father at the age of 15 years old,

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following the death of his mother. Randy reports he was frequently humiliated by his parents during childhood. In addition, his parents also yelled at him on many occasions.

He says his parents made him feel like a bad person while growing up.

Huffman.

Huffman is a 51 year-old, married, Black male. He reports growing up with a father who was physically abusive and disciplined him using physical spankings. He says one particular spanking left him with an intense fear of his dad. Following that particular beating, Huffman didn’t feel he could ever have a close relationship with his dad. However, he currently maintains a close relationship with his mother. His father was an alcoholic who became explosive when intoxicated.

Mae Devoe.

Mae Devoe is a 51 year-old, widowed, Black female. She disclosed that she was frequently yelled at by both parents during childhood. She also reports receiving physical spankings at the hands of both parents, which she considered abusive during her childhood. Mae Devoe also reports being traumatized in childhood, by the death of her older sister. She didn’t disclose the details of her sister’s death.

Joe Sausage.

Joe Sausage is a 62 year-old, single, Black male. He reports being the victim of physical and emotional abuse during childhood. He recalls being 10 years old when the abuse started. Joe Sausage received physical spankings which he considered abusive.

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However, he feels the emotional abuse by his dad, left him with few positive childhood memories of his father. Joe reported that he always wanted to have a close relationship with his dad, but it never happened. He recalls his dad not interacting very much with him and this always left him feeling neglected by his father.

Guido.

Guido is a 51 year-old, separated, Black male who recalls being the victim of physical and emotional abuse during childhood. He recalls the abuse starting at age eight years old. He also reports being frequently humiliated during childhood by his parents.

Guido also reports being yelled at frequently by his mother while growing up. He was made to feel like a bad person during childhood. Additionally, he also received physical spankings, hits, punches by his parents during childhood. Guido told a story of his mother hitting him in the head with a cast iron skillet and busted his head open.

Flash.

Flash is a 53 year-old, separated, Black male who endured both physical and emotional abuse during childhood. He recalls the abuse starting at age 13 years old. He also reports being yelled at frequently by his parents during childhood. Flash was made to feel like a bad person while growing up. His dad abandoned the family when he was 10 years old. He was the oldest sibling in the family and became the caretaker for his younger siblings, after his dad left. He hated the responsibility of caring for his younger siblings while his mother was working 10 – 14 hours per day. He recalls the discipline was harsh and was achieved using belts, extension cords, or being punched with fists.

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Flash recalled a memory of being told to get undressed and get into the bathtub. While in the tub, he was beaten severely while soaking wet with an extension cord.

Paul.

Paul is a 36 year-old, Single, Hispanic male. Paul recalls being emotionally neglected during childhood starting at the age of four years old. Paul recalls his mother being a loving person. However, his dad abandoned him and his mother. This abandonment was the beginning of a hard and difficult life for him and his mother. Paul feels the lack of a male role model in the home had a huge impact on his childhood decisions, adolescence and his poor decision making in adulthood. Additionally, the abandonment by his dad left him feeling traumatized during childhood by the absence of a male role model.

Henry.

Henry is a 54 year-old, separated, Black male. He recalls a childhood history of neglect beginning at the age of six years old. He recalls his parents getting a divorce which was very traumatizing in his childhood development. After his parents divorced, he lived with his mom and she was an excellent provider. However, he recalls telling his mother, he wanted to live with his dad and she allowed him to move in with his father.

After moving in, he quickly realized he had made a bad decision. His dad would leave him at home alone for days at a time. He would not have food or the necessary clothing to attend school. Henry recalls his entire personality changing as a result of the physical neglect he endured in childhood. He wanted to survive and was willing to do anything to

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make it happen. Henry began doing petty crimes to obtain food and clothing during childhood, as a result of his dad’s neglect.

James.

James is a 53 year-old, divorced Black male. He recalls experiencing physical and emotional abuse during childhood. He recalls growing up in a hippie household. He says he mother “partied,� she indulged in narcotics and alcohol. His dad was in and out of the family home. However, his dad would physically abuse James and his mother, whenever he did come around the family. He recalls feeling helpless and hopeless whenever his dad left again, because his mother would always be crying.

Tom. Tom is a 26 year-old, single, Black male. Tom reports a history of physical and emotional abuse during childhood beginning at the age of seven years old. He reports being frequently humiliated by his parents during childhood. He also recalls being frequently yelled at during childhood. Tom also reports, his family made him feel like a bad person while growing up. He endured physical spankings which he considered abusive during childhood.

Introduction to the Family Members Rachel.

Rachel is a 48 year-old, Black female who is the niece of her substance using uncle. Rachel described her uncle as being the life of the party in his younger days. He

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began hanging with the wrong crowd and exposed to drugs and alcohol. She is uncertain whether or not he considered his physical spankings abusive. However, she does recall a very traumatic experience he endured during his earlier development. Her uncle was diagnosed with a learning disability in high school. As a result, he was teased and bullied by his peers during his teenage development. These events promoted feelings of low selfesteem and self-worth. It also made him feel alienated at times among his peers.

God’s Child.

God’s Child is a 48 year-old, Black female who is the daughter and niece of three substance using uncles. She discussed her experiences with both her father and two of her uncle’s while they struggled with substance use. God’s Child first discussed the impact her father’s substance use had on her and the family system. Her mother eventually divorced her dad as a result of his substance use, when she was 6 years old.

This resulted in her mother having intense anger towards her dad. She also reports her father would ‘disappear’ for long periods of time during her childhood development. She believed his absence was partly due to his substance use and his embarrassment to be seen by family members. This resulted in a strain on the family system. Eventually, her dad achieved sobriety, but this did not happen until she was an adult. Her father grew up without his dad in his life. Her father felt emotionally neglected by his dad. His mother was physically abusive and emotionally cold and distant.

God’s Child also discussed the impact substance abuse had on her after she became an adult with her uncle’s. She disclosed owning a family building, allowing her maternal grandmother and three substance using uncles, to reside in the apartment on the

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first floor. As a result of living in the building with them, she had an opportunity to witness the impact their substance use had on the entire family. She reports her uncle’s grew up, with both parents being addicted to alcohol. As a result, the family home was plagued with episodes of violence, lack of parental supervision and basically chaotic.

The family grew up in the housing projects of Chicago and she believed the environment had a major part to play in their problem with substance use.

Joy. Joy is a 55 year-old, Black female who is the sister of two substance using brothers. Unfortunately, one of her brother’s actually died during the process of this research, as a result of his addiction (overdose). Her other brother, also continues to struggle with substance use, including crack cocaine and heroin abuse. She reports her brother’s grew up in a home with an alcoholic father, who had episodes of violence while intoxicated. Additionally, her brothers endured physical spankings by their father which were considered abusive.

Boo Who. Boo Who is 52 year-old, Hispanic female who is the aunt of a substance using niece. Boo Who reports her niece grew up in a two parent family. However, it was discovered during her treatment for self-injurious behaviors (cutting herself) that she was the victim of repeated sexual abuse, by another family member during her early developmental years. Boo Who described the emotional roller coaster, the family

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continues to experience as a result of her niece’s addiction to substances. Her niece is addicted to heroine.

Sandy.

Sandy is a 58 year-old, White female who was married to her ex-husband who struggled with substance use throughout the course of their 20 year marriage. Her exhusband was physically and emotionally abused during childhood by both parents. He was kidnapped by his mother and moved to a different state, without his father’s knowledge or approval. This resulted in a very traumatic experience for her ex-husband, because he was taken by his mother after school and driven to California. This resulted in her ex-husband losing contact with his father for several years. Her ex-husband struggles with abuse of alcohol, marijuana and cocaine to this present day.

Major Themes As a result of the coding process involving open and axial coding, 6 major themes emerged in the selective coding process (Strauss & Corbin, 2015). They are listed here and then explained in more detail with supporting statements from the participants: 1. The alcoholic father 2. Mothers 3. Early environmental impact 4. Early environmental impact outside the family 5. Early exposure to drugs and alcohol 6. Participants own addiction experience

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Alcoholic father.

One of the first common codes which were identified in the data analysis phase of the research was a common theme about the fathers of the substance users during their early childhood development. Many of the substance user participants shared a common theme of their fathers’ behaviors during their early childhood memories. The most common theme the researcher heard consistently throughout the interviews was “my dad was an alcoholic.” Several research participants disclosed their fathers were typically not talkative, Monday through Friday. However, on the weekends when their fathers’ began to drink alcohol, their entire personality appeared to change. Joy stated, “he was cool until he started drinking, then he would clown every single weekend.” Their fathers would go to work and provide for the family all week long and the weekends was their time to relax and have some cocktails.

Walking on eggshells.

A large number of the participants described the atmosphere in their home would change, when dad was under the influence of alcohol. Some participants relived their experiences of “being on eggshells when dad came home on Friday’s after work,” because they did not know what to expect, if he had stopped at a bar after work before arriving home. They also reported most of their fathers were quiet men. Their dad’s did not engage in a lot of verbal communication until he was under the influence of alcohol.

Essentially, the participants reported the unpredictability of their father’s mood or behavior whenever he was intoxicated. As a result, it left all members of the household

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being uneasy or uncertain of how they should behave because of their intense fear of dad, whenever he was under the influence of alcohol.

Violence in the home.

If dad was under the influence of alcohol, he was often prone to violent outbursts.

There were several accounts of dads coming home and beginning disputes with their mothers, often resulting in physical violence and the police being called to their home. G reported how his father would get so angry after he had been consuming alcohol. This would always result in him breaking up furniture and destroying the contents of the family home. A great deal of time was then spent by the mothers and children, trying to clean up the mess made after dad’s angry episodes. Furniture would have to be thrown out, broken glass would need to be cleaned up and often mom needed to be helped with her injuries. The injuries sustained by mom during their father’s alcoholic rants could range from a minor cut, scrape or black eye to something more serious. Sometimes these injuries included a stabbing, or resulted in bloodshed, thereby prompting an emergency room visit or the police/ambulance being called to the family home. This chaotic environment seemed to be a consistent theme from both the substance users’ perspective and family members’ perspective as well. Additionally, the discipline of the children when dad was under the influence seemed to be more extreme. A typical whooping when their dad was sober, may involve a spanking with a belt or hand. However, if dad was under the influence of alcohol, he may punch with his fists; use an extension cord to administer spankings or hit them with much more force, resulting in much more serious injuries. Huffman reported, “He beat my ass so bad, he put fear in me after that last ass

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beating, I never wanted to get on his bad side again.” Huffman said he never got another whooping, because he lived in constant fear of his father after that one experience. He was still traumatized by the memory because during the interview, he began to shed tears as he relived the painful event.

Dad’s impaired judgment.

Another theme which repeatedly came up included dad’s judgment being impaired when under the influence and he would make decisions that he would not normally make. A few of the participants told their personal memories of their fathers’ taking them to their mistresses’ homes and leaving them sitting in rooms or on couches alone for hours. After becoming adults, they realized, their fathers were taking them to their girlfriend’s homes while he had sex and they were being taken as a decoy to keep their mother’s from suspecting their father’s infidelity. The idea being, if he took the kids with him, he couldn’t be doing anything with another woman. However, after leaving the other women’s homes, these participants all reported being sworn to secrecy by their father’s and never telling their mother where they had been. Additionally, their fathers instilled fear in them, if they ever wanted to disclose the ‘secret’ to anyone in the family, especially their mothers. The participants reported feeling confused and angry their father’s would place them in a position to hide things from their mothers.

Therefore, this impacted the lines of communication in the family system. Instead of there being a sharing of information amongst family members freely, their dad’s controlled the flow of communication from the children to their mothers or siblings.

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Dad was the disciplinarian.

Another common idea was alcoholic fathers demanded to be the disciplinarians in the family home. The mother’s would only be allowed to tell dad of the children’s inappropriate behavior, when he arrived home from work and he would in turn administer their punishment. This often resulted in the children having strong feelings of dislike towards their father’s. As the children progressed into adolescence, they reported, “We just did not get along with my dad, we hated him.”

Family abandoned by Dad. Alcoholic fathers would sometimes abandon the family all together. The participants reported this would often leave mom, ill prepared to handle the family and home after dad’s departure. Their mothers were unable to handle meeting the emotional needs of her children, after the father abandoned her. The mothers would often suffer episodes of depression and isolate themselves in their bedrooms, where the children could hear her crying herself to sleep at night. Additionally, this left the children feeling unloved and unwanted after dad abandoned the family. Some participants admitted they felt to blame for dad leaving the home. Consistently, dad’s abandoning the home left the mother and children feeling traumatized and feeling unloved. Many of the mothers were homemakers and never worked outside the family home. However, after dad left, the mothers were forced to gain employment for which they were uneducated and untrained; resulting in low wages and ultimately threw the family into deeper poverty. This increased mom’s social withdrawal from providing the much needed emotional support to her children. If the family system consisted of a large number of children, the

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emotional support from their mother seemed non-existent. Ultimately, dad’s alcoholic behavior had a very negative impact on the individual childhood development of the substance user and overall negative impact on the family system as a whole.

Mothers.

The research participants consistently disclosed their experiences of their mother’s role in their early childhood development. Mothers were viewed from various perspectives by each of the research participants. Some mother’s displayed the appropriate amount of affective attunement and emotional nurturing to her children.

However, this was not consistently experienced among many of the participants.

Mothers who showed warmth and nurturing were only experienced by some of the participants. Yet, many other participants experienced mothers who were not emotionally available to meet their needs affectively.

Growing up with mothers who were emotionally unavailable.

The research participants described basically two different reasons for their mothers being unavailable to meet their emotional needs. The first situation was discussed by participants, who lost their mothers to death at an early age. Children who grew up without their mother in the home described very traumatic memories, which brought each of them to tears as they relived their childhood during the interview process.

Randy said, “His mom was his everything, until she died.” He reported feeling lost and having no direction after her death. Randy reports the immediate lack of nurturing he never received from his father following the death of his mom. He cried as he spoke of

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never getting any more hugs, or being tucked in at night by his mom. His father was emotionally cold and distant. His father didn’t believe men should hug and kiss little boys. So, he never received that warm fuzzy feeling again after losing his mom. Randy recalls feeling unloved and unwanted by his father due to the lack of emotional warmth he failed to receive. He recalls his younger sister also complaining about the lack of caring from their father. Randy believes this led his sister down a path to promiscuity, because she was looking for love in “all the wrong places.” He believes this lack of warmth led him to become involved in gang activity. Randy reported, “Everyone needs to feel loved” and he did not. Upon reflecting back on his life, he thinks that a part of him died with his mother. He remembers feeling that nobody loved him and he would never love anybody again. Randy went on to engage in a life of gang and criminal activity, which resulted in him spending 31 years of his adult life incarcerated. He became one of the founders and highest ranking gang leaders in a prominent Chicago street gang. He says he went through adolescence angry and mad at the world because his mother died. Randy’s dad was physically and emotionally abusive, so he left home at 16 years old. He grew well into manhood with no concern or feelings for others. This eventually, earned him a position on the streets as ‘cold and ruthless’. He proceeded to speak of his drug use, only increasing his anger and lack of concern for others. Randy began to commit gangland style executions and was sentenced to 31 years in prison. He says it was prison, which caused him to get clean and sober. He attributes all of the negative things in his life concerning gangs, murder and drugs; to be the indirect result of growing up without his mother. Currently, he is genuinely remorseful for the many lives he took and now spends his time trying to volunteer and help young men avoid the

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pitfalls, he made in his past. Randy reports his current goal in life is to be a “productive part of society,” because he has wasted 31 years of his life.

The other situation that emerged from the data regarding emotionally unavailable mothers was when moms either struggled with their own addiction, mental illness or ‘her own demons’. Frenchy reported being a bright child and eager to please her mother. She cried when recalling how she had earned a report card in 6th grade with straight A’s. She smiled when she disclosed how proud her teacher was of her accomplishments. Her teacher encouraged her to go straight home and show her mother the report card with her good grades. Frenchy said, she remembers running home faster than ever before, to share the good news with her mother. Her mother was sitting on the couch when she arrived home and she excitedly showed her mother the report card. Frenchy says her mother looked at it and said, “oh you got all A’s, what do you want me to do about it”? She reports being devastated and traumatized by her mother’s lack of praise for her accomplishments. Frenchy went on to tell how she went through high school, trying to be an over achiever and maintaining good grades. The end result was she received absolutely no praise from her mother, when she got home. She says’ she developed an attitude which was based on the idea, that “Being a good girl didn’t get her anything, so fuck it.” She decided to hang with anti-social peers and engage in multiple sex partners that led her to drugs and alcohol use. Frenchy said she enjoyed getting high, because she knew, “It would piss her mother off if she ever found out.” This eventually led her down a path to substance use. Recalling her mom being emotionally unavailable, sent her into a downward spiral during her addiction. She kept having kids and dropping them off at her mother’s home, only to return to the street life of binging on drugs and alcohol, for

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days and weeks at a time before returning home. Frenchy eventually recognized her life had become unmanageable and sought drug treatment. While in treatment, she learned her mother was probably clinically depressed throughout her entire childhood and remains depressed until today. Frenchy reports how difficult it is to accept that, when she is looking for praise or validation for her accomplishments; her mother is not, nor has she ever been, emotionally available to support her. She is now thankful she has the education and tools to handle this situation, while simultaneously maintaining her sobriety.

Feeling betrayed by mother.

Another theme which resulted from the data analysis included substance users’ feelings of betrayal by their mom. Quite a few of the participants who indicated their parents were separated or divorced, verbalized “they did not like it after dad abandoned the family.” This was especially true when “my mom would let dad come back home/or spend the night, after he had previously abandoned the family.” This also left the substance users feeling uncertain of their place inside the family home. Frenchy was very clear that her parents’ behaviors sent her mixed signals. When dad was away, mom would allow her freedom in the home and “she could eat whatever she wanted and sit wherever she wanted.” However, if her dad came to visit, her mom’s attitude would change towards her and she was treated differently. Her mom would say, “You know you don’t sit in my living room, or you can’t have two hot dogs.” This would infuriate Frenchy and she admitted whenever her dad was present, she felt confused about her place inside the home and struggled with ideas of where she fit in. She said this was

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especially true when her mother would call her dad over to discipline her. Frenchy reported, being angry with her mom for the mixed messages. Her dad had been in and out the home for the past few weeks and she was frustrated with his inconsistencies. She decided in adolescence, she would confront her mother about being “so weak and stupid because her dad was just using her for sex.” Frenchy recalls her mom crying and telling her to “get out of her home.” She reports leaving for a few hours and eventually returning home. She remembers being out done, when getting inside the house and finding her dad sitting on the couch again. He told her, “To go in her room and pull her pants down because he was going to beat her ass.” She reportedly asked her dad “for what?” He responded, “For being a smart ass with your mother.” Frenchy admits still struggling with; why her mother felt it was appropriate for him (of all people), to administer discipline after he had previously abandoned the family. This ultimately led her to feel uncertain of her place inside the family and where she fit. She says she recalls feeling that “Obviously her dad leaving meant he always had his place. He could come home and sleep in the bed with her mom, give her discipline and leave again.” Yet, she was there all the time and never sure of her place.

Early Environmental Impact The research participants each shared the various factors they believed, to be the result of their exposure to early environmental factors. The environmental impact each participant shared during the interviews, was the result of their unique individual lived experiences. The environmental factors discussed by each participant appeared to have a powerful impact on the participant’s early childhood development.

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Inside the home.

All 20 of the research participants reported the impact their environment had on their childhood development and their decision making. Many of the participants reported the home environment being a major contributing factor in their poor decision making. For example, Tom reported that his mother was always “on the go.” She used narcotics and basically neglected her children, because she was dealing with her own painful realities. Therefore, he identified with his mother’s behavior and when given an opportunity, he wanted to indulge in narcotics himself. Tom remembers sneaking into her room and stealing some cocaine and taking it to his friend’s house to experiment with. He recalls the first time he got high on cocaine and he did not like the after effects of his use. He reported a ‘cocaine drain’ down the back of his throat and he did not like the sensation he felt. From then on, Tom began to drink alcohol and experiment with other drugs. This experience led him on a search for a drug, he enjoyed without the negative consequences. He says he enjoyed alcohol for many years but eventually graduated to heroine use. Heroine then became his drug of choice and took him down the path to addiction that almost killed him.

The home environment may be lacking the necessary items to equip the children with making good decisions. A large number of the participants discussed being home alone, because the parents were either single parents and had to work or the parents were neglectful and just failed to come home and provide for the children’s needs. These situations became prime opportunities for the substance users to sneak and consume their parents’ alcohol, because it was easily accessible and always available. Additionally, this

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was true for substance users who went to visit friends, who had parents indulging in alcohol or drugs.

Several participants indicated they witnessed drug and alcohol use inside the family’s home, whether with parents or older siblings. This resulted in a misconception about the normalcy of use. Children were of the misconception, if this is what my parents or siblings do in our home; they developed a belief this must be what everyone is doing in their home too. Billy stated, “My parents smoked pot, my friends’ parents smoked pot, so we starting smoking pot too, because we thought everybody did it.” The environment appears to be a very powerful contributing factor to youth, who go on to develop substance abuse problems in adulthood.

Environmental factors included additional things that went on inside the family home. Several participants reported their parents were having parties inside the family home, which included drugs and/or alcohol. When parents would send their children, to get a beer out the fridge, children in turn, would sneak a sip of their parents’ beer as a result of their own curiosity. Participants stated the home environment was kind of quiet and boring until the parents had a party, with alcohol being provided to guest. Then, the whole atmosphere seemed to change inside the home; into what appeared to be exciting and adventurous, with music playing in the background. The end result would be increased curiosity by the substance users during childhood. The children would then want to experience or imitate what they observed their parents doing. If drinking alcohol is what they witnessed inside the home, they wanted to experiment with alcohol if given an opportunity. The same was true of drug use inside the family home. If parents indulged in smoking marijuana, then the kids had a curiosity about marijuana and wanted

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to experiment with it, if given the opportunity. Therefore, imitating the behaviors of parents or even older siblings became the goal of inquisitive children.

Children grow up with uncertainty of their place in the family.

Children who experience abuse, neglect or trauma during their early development repeatedly discussed their feelings of low self-esteem, low self-worth, isolation and feeling alienated from not only family members but their peers as well. The children who experienced maltreatment found themselves struggling with their own self-identity. They had been abused, neglected or traumatized by their parents. After all, as children we are taught that our parents are the ones charged with the responsibility to keep us safe from all hurt, harm and danger. For these children, this reality was shattered by their exposure to maltreatment. Therefore, they didn’t feel safe at home, because their parents were often the perpetrators of their childhood abuse. The children experienced a lack of support, nurturing, or encouragement they needed to thrive in life. Their lack of selfconfidence and assurance resulted in them feeling unsafe outside the home as well.

Parents who were neglectful were often absent, from the day to day supervision required in rearing children. Therefore, this responsibility was often handed down to the oldest sibling inside the family home. Though still an adolescent themselves (sometimes younger), they were expected, to cook, clean and prepare their younger siblings homework and for bed. This added responsibility, known in the clinical world as ‘parentified child syndrome’, left young children performing the adult duties in their early developmental years. This created a huge degree of anger, resentment and uncertainty of their place inside the family home. If the parents were not there for

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supervision, it became their duty to supervise younger siblings. If the parents did not come home and cook a meal for the family, this also became the older siblings’ responsibility. These added adult duties and responsibilities created a dilemma for the substance user during their childhood. They were expected to behave and perform like adults inside the family home. Yet, when they went outside to attend school or interact with others in the community, they were expected to behave like age appropriate children or adolescents. Being forced to function in dual conflicting roles, left the young person feeling confused and bewildered about what their true role and identity was inside the family system. Flash relived how he was always being left to handle his younger siblings inside the family home, because his mother wanted to “run the street and party with her friends.” His father was absent from the family home and he was the oldest male sibling.

Therefore, Flash felt his job was to protect and provide for his younger siblings because his mother was not performing her parental responsibilities at all. Even when she was at home, he was forced to take all of his younger siblings with him wherever he went. This included going to the park or going to the library; wherever he went. He felt like his siblings were “his children.” When Flash was able to hook up with the guys at school who were cool, he was encouraged to leave his siblings at home with his mother. He knew that was never an option, so he elected to just stay at school and never come home until it was real late in the evenings. This led him to be involved with the kids who were drinking and smoking pot. Flash said, when he was first allowed to smoke weed, “he didn’t know which he enjoyed more, getting high or hanging with peers, without his younger siblings tagging behind him.” This was his new method of escape from his household responsibilities, of caring for his younger brothers and sisters. Flash became

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overwhelmed with the new found sense of freedom, he was now experiencing. He wasn’t home cooking, cleaning and doing homework. Flash was hanging out with peers and smoking weed. This was his idea of fun and he enjoyed every minute of it. Therefore, children who experience abuse, neglect or trauma in their early childhood often struggle with identifying their appropriate place within the family system. X-File discussed how she hated her mother, because she knew that her husband (father) was sexually abusing her daughter and she didn’t do anything about it. X-File firmly believed, her mother allowed the sexual abuse to continue, “Because my mother would rather my dad be fucking me, than fucking her. My mother basically prostituted me to my own father, for her freedom and I’ll always hate that bitch.” This is another example, of a child being forced to perform adult responsibilities inside the family home, but then expected to behave age appropriately outside the family home, when at school or in the community.

The end result was a conflicting idea about their appropriate place within the family.

This feeling of alienation within the family often spilled over into feeling uncertain of their place outside the home as well. Some participants reported their personalities conformed to their lived experiences inside the family home. For example, if they were the victim of physical abuse inside the family. They in turn became the perpetrators of physical abuse outside the family. In other words, if they were a victim at home, they became the aggressor outside the home. This often resulted in them making other people (usually peers), the victims of their physical abuse in adulthood. Frenchy put it this way, “Why didn’t they value me? Since I was not valued by my parents in childhood, I do not value anyone in adulthood.” The bottom line comes down to this, if substance users were violated in childhood, they struggled in adolescence with having no place to turn for

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emotional support. This is the direct result of the abuse, neglect or trauma occurring inside the family home. After all, if a child can’t feel safe at home, then where can a child feel safe?

Exposure to Adverse Childhood Experiences (ACEs) The data from this research has overwhelmingly revealed, that children who grow up with some type of exposure to adverse childhood experiences go on to develop problems with substance use in adulthood. The literature supports the researcher’s findings according to Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study indicates in its’ conclusion the following, “The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parental use” (Dube, Felitti, Dong, Chapman, Giles & Anda, 2003, p.1).

All 20 of the research participants disclosed their exposure to some type of childhood abuse, neglect, and/or trauma in their early childhood development. Each of the participants relived their painful childhood memories of exposure to some type of abuse, neglect or trauma. Several participants indicated they were “happy children until the abuse, neglect or trauma occurred.” Some participants even reported they considered themselves as spoiled by their parents and received everything they wanted until the abuse happened. James stated, “In childhood you could have bright potential but still feel vulnerable if neglected or abused at home.” This participant was reliving how he was involved in academic honors programs in school and experienced exposure to opportunities the average child would never get to experience. Yet, despite his academic

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success, he still felt vulnerable because he was being abused and neglected at home. This ultimately overshadowed his desire to succeed academically. Eventually, James found himself experimenting with drugs or alcohol in an attempt to avoid the emotional and physical pain, he was experiencing inside the home.

Frenchy reported being sexually abused by her dad in childhood, left her feeling confused about what was appropriate or inappropriate behavior with the opposite sex. A couple of the female participants discussed being angry with their mothers for not protecting them, from the sexual abuse they experienced by their fathers or step-fathers.

X-File indicated her traumatic experience with sexual abuse by her biological father, led her to choose an alternative lifestyle as a lesbian.

Many of the participants made reference to feeling abandoned by God. They could not understand why God would allow a child to experience such abuse, neglect or trauma. X-File emphatically stated, “I was a kid, I did not deserve that,” referring to the sexual abuse.

Some participants who experienced physical whoopings with belts, extension cords or tree switches described the physical abuse and how it shattered their self-esteem and self-confidence in childhood. A few of the female participants discussed how being pregnant in adolescence, left them feeling alienated and isolated. Their teenage pregnancies left them feeling like they had missed the opportunity to be a normal teenager. Additionally, the teenage pregnancy caused them to develop a self-perception that they were “bad” children. Mae Devoe described her feelings of despair following a teenage pregnancy, which resulted in her making a suicide attempt. She felt emotionally alone and isolated because her life as a teenager was over; because she had to provide for

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a newborn baby. She believes her childhood sexual abuse led her to promiscuity as an adolescent, which resulted in an unwanted teenage pregnancy. Monclaire, another male participant discussed his early childhood exposure to racism which resulted in him being singled out and alienated during his early development. In response to the racism and bullying, he began to isolate himself from his peers. This proved to be the precursor to him experimenting with drugs, in an attempt to finally fit in with his peers. Monclaire reports always being rejected and outcast during childhood. Therefore, when he was offered drugs and alcohol, it seemed to be appealing to him, because he was finally being included instead of excluded. Monclaire ultimately felt like he needed to prove himself to his peers, that he was worthy of their acceptance. Substance users who recalled their childhood home being plagued with violence, resulting in the police being constantly called to the family home eventually made them feel unsafe in childhood. This also resulted in childhood feelings of depression. Other factors including the impact of their parents’ separation or divorce shattered the family system and caused the child to feel they were somehow responsible for their parents’ marriage breaking up. Another traumatic experience in childhood was the death of a close family member including: mother, father, grandparents, siblings, aunts or uncles. The loss of a close family member left the substance user experiencing an irreplaceable void in their lives during childhood. Another recurrent theme was the substance users’ anger towards their mother, for not leaving their fathers/step-fathers following repeated episodes of domestic violence. All of the above circumstances could appropriately be identified as Adverse Childhood Experiences (ACEs). Children who experience exposure to abuse, neglect or

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trauma are reportedly at increased risk for developing substance use problems in adulthood.

Early Environmental Impact outside the Family The environment outside the family home was also identified as a repeated theme throughout the interviews. Participants repeatedly discussed the impact their environment had on their early developmental years and exposure to drugs and alcohol.

There were situations which involved the parents working outside the family home that resulted in the children being home alone without parental supervision. When the parents were away, the children would sneak outside to interact with their peers. If the peers in the neighborhood were engaging in alcohol consumption, this would be a point of curiosity for the unsuspecting child or adolescent. The natural desire to engage in what they saw their peers doing, it seemed like fun. The end result was children often participated in what is going on around them, in each particular environment. We have a saying in our society that, “children are the products of their environment.” This is basically what is meant by this statement. Joe Sausage reported he never had a desire to experiment with drugs or alcohol. However, when his parents were at work, he would hang out with his friends. All of his friends were smoking marijuana, and he did not want to be considered a “nerd.” Therefore, his introduction to marijuana was with friends and he stated, “Everybody was doing it, so I tried it too.” Therefore, environmental factors appear to be a critical component in substance users’ exposure to drugs and/or alcohol in their early developmental years.

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Relationship to others outside the family: Desire to fit in with others outside the family home.

The alienation experienced by victims of childhood abuse, neglect or trauma often results in strong tendencies to isolate themselves for fear of embarrassment, being criticized, or even being blamed for their abuse. This often results in substance users not knowing how to reach out for help, because they fear being stigmatized by others outside the family. Despite this fear, they long for a desire to fit in with others outside the family and ultimately being accepted for who they are. This feeling of rejection they experienced by their own family, compels them to seek acceptance from others.

Unfortunately, the acceptance they are seeking is often found in the streets, with others who are seeking acceptance as well. The old proverb, birds of a feather, flock together becomes their self-motto; they look for acceptance and it is usually found in peers engaging in experimentation with sex, drugs, and alcohol. The recurrent theme which came up during the interviews was the concept of “street acceptance.” It became important to feel accepted by people on the streets; either in social cliques, gangs, drug circles or crime rings. The whole idea of knowing where to fit in; becomes a pivotal concept for young people exposed to childhood abuse, neglect, or trauma. Flash reported, if “I can’t get love and acceptance at home with my family, I went to the street and got acceptance in a gang.” This became the avenue by which he was exposed to drugs and alcohol. He reported being willing to do anything to gain acceptance by his street gang. He believed if he did all the crimes he was ordered to execute, the street gang would love and accept him more. Flash recalls, selling drugs, stealing, robbing and doing whatever, his gang leader ordered him to do. It wasn’t until he was caught by the

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police, and sentenced to prison that he realized, even the gangs didn’t really accept him.

They were only using him to make money and commit crimes. He recalls it became clear to him, when he served 10 years in prison. Flash admits, not one gang member came to visit him or write him a letter. He reports it was a cold reality. All he had done in the name of acceptance by the street gangs cost him his freedom. He realized in prison that he had to accept himself. Flash now devotes his career as a recovery coach to helping substance using individuals to learn skills in forgiveness and self-acceptance. Flash stated during his interview, “If nobody else ever loves me, I love myself.” He believes his path from childhood abuse to adult substance abuse was predestined, to help him arrive where he is today. He enjoys helping other people that are struggling with substance use, along a path he himself is very familiar with.

Many of the male participants who grew up without a father figure in the home also reported struggling with, where do they fit in? Not having a male role model often left them feeling unable to relate with older males and feeling alienated outside the home.

They longed to have a connection with an older male and often this led to street connections. They reported not having a dad, made them want to be accepted even more by an older male. The opportunity for acceptance often came in the form of being offered a drink or a pull off a joint, by older guys in their neighborhoods. This was often their gateway exposure to drugs and alcohol (if not with peers their own age). Fitting in for guys often meant, they wanted to be ‘cool’. Usually in certain neighborhoods, this came with some type of initiation ritual, including their first time use of drugs or alcohol.

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Inability to trust others.

As the result of long term substance use, many participants reported problems with thinking clearly. It was only after achieving sobriety, they realized they had been experiencing impaired judgment while under the influence of drugs and alcohol. Many participants reported periods of increased paranoia while at the height of their addiction.

There were reports of feeling, “like everyone was watching them.” As a result, of this increased paranoia, many participants reported, they didn’t know who to trust. This often carried over into their relationships inside their individual families. Guido reported, going to visit his mother after being on a cocaine and heroine binge for several days. His mother told him, “He looked a mess and needed to stop using drugs.” Guido recalls telling his mother, “He did not have a problem with drugs.” When he relived the experience during the interview, he remembers feeling uncertain of his mother’s intentions towards him. He admits her genuine concern for his well-being never crossed his mind. All he recalls, was his mother was trying to get in his business and he did not trust her. Guido always believed he was the “black sheep of the family.” For this participant, he believed his mother had always preferred his other siblings, leaving him feeling alienated and outcast within his family system. His feelings of alienation always caused him to be suspicious of any comments made by his immediate family members.

He was unable to trust their actions towards him as authentic. This often resulted in feelings of discomfort, thereby leaving him uncertain of whom he could trust. James, discussed the importance of knowing who his enemies were, when he was deep in his substance use. He often recalls feeling targeted by other substance users, for their own exploitation of him. He told of situations, when getting high acquaintances would

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attempt to befriend him, while at a get high session inside the drug house. James says, “You cannot trust their true motivation for attempts at befriending him.” As a result, he was always unable to trust someone, he did not know previously. Additionally, it also meant being unable to trust people, he had previously known. James describes it this way, “In addiction, substance abusers grow up, to develop trust issues and boundary issues. “We don’t know who to trust or how much to reveal about ourselves and our past,” he stated. He made the connection to his past with exposure to childhood abuse, neglect and trauma. As a result, of being the victim of a turbulent childhood plagued with abuse, he developed problems with trusting other people. This would make sense, given the fact that he was unable to trust his family to protect him and keep him safe throughout his early childhood development. He grew up with an inability to believe, his family cared about his best interest. This only increased his inability to trust others outside the family system. Pretty Tony reported, “Being the victim of childhood abuse, I never learned how to deal with the hurt, shame, fear and anger from my childhood.” He believes this resulted in him being an “emotional wreck in adulthood.” The whole theme of being unable to trust others seems to be in direct response to their unstable childhood environments and experiences they were exposed to during early childhood development.

X-File discussed her problems with developing new relationships with members of the opposite sex. As a direct result of her path through addiction, she reports having an inability to trust men. During childhood, she was sexually abused by her father. This inability to trust men was carried forward into her adulthood. While engaging in substance use, she reports often being exploited or victimized by men. “The game is different for women, when we are getting high. Men seem to assume, that because we

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engage in illicit substance use, we have no morals and are willing to do anything to obtain drugs, including performing sexual favors for strangers we meet in the drug house.” X-File reports, this is one of the main issues she has with an inability to trust others, especially men. She reports being sexually violated and raped on multiple occasions, while at the height of her substance abuse. This abuse in adulthood further compounded the abuse she experienced as a child. Going forward into her sobriety, she admits still struggling with not “knowing who to trust or what they wanted from her.”

Billy also shared his experience with entering substance abuse treatment for the first time.

He admits struggling with having to obtain a sponsor as part of his 12 step program. He had always been on the receiving end of abuse or trauma, as far back as he could remember. Therefore, it was difficult for him to wrap his mind around, a sponsor, being available to help him when he was in crisis. Billy reports, he had never trusted men at any time in his life. Now, here he was being instructed to contact a sponsor, to help him maintain his sobriety upon discharge from substance abuse treatment. The entire concept of trust was foreign to him. Billy reports, it took many months, before he felt safe confiding honestly about his life, with his new sponsor. It appears, regardless of the participant being male or female; they all appeared to have difficulties with issues around trust. This would sometimes present as a barrier to knowing how to reach out for help.

In addiction trust has had far reaching implications, throughout the lives of substance users.

Early exposure to drugs and alcohol.

Each research participant was able to relive their personal memories of their initial exposure to drugs and alcohol. Each participant’s exposure was unique to their

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individual experiences. Some participants experienced their first exposure inside the family home. Other participants experienced their first exposure outside the family home. Regardless of where their initial exposure occurred, the end result was detrimental to each of the participants. Their exposure led each of them into a pattern of events which had a negative impact on their overall development.

Exposure.

Exposure to drugs and alcohol became a repetitive theme during the coding process. As previously mentioned, the participants of this research journeyed through multiple paths to addiction. However, each participant was very clear regarding memories of their first exposure to drugs and/or alcohol. Many participants reported their first exposure to alcohol, often occurred inside their family home. It was either sneaking a drink off the table, which was left behind from their parent’s earlier consumption or sneaking a sip when told to get a beer out the fridge by their parents.

Access.

Younger substance users also reported having easy access to alcohol if older siblings, who consumed, were still residing inside the family home. Older siblings would often sneak a pint or can of beer, into their room and consume it at night when parents were asleep. Younger siblings would watch to see where their older siblings hid the alcohol from their parents. The younger siblings would then retrieve the alcohol from its’ hiding spot and sneak a sip. Some participants reported exposure to alcohol, resulted from their parents hosting a party inside the home. Some participants said, “When the parents were partying, they would sneak a cup left on a table and consume the alcohol

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contents.” This in home exposure was also true regarding drugs including marijuana and cocaine. A few participants reported “hitting my parents’ stash of weed or coke and stealing some to experiment with my friends.” Some substance users admitted after they had taken some of their parent’s weed, they still didn’t know how to roll it into a joint.

This resulted in them having to engage the help of an older, more experienced peer to help them prepare the joint for consumption. Some participants also indicated their older siblings would sneak a few pulls from a joint and put it out before an adult arrived. The younger siblings would then take the leftover portion of the joint and share it with their own peers. Regardless of their first exposure being to drugs or alcohol, there were several participants who indicated their exposure started at home with their own families.

Peer pressure.

Another opportunity for exposure to drugs and alcohol often occurred outside the family home. Many of the participants relived memories of having a desire to fit in with peers, either at school or in their neighborhoods. This usually resulted in them doing, what they witnessed their peers doing (consuming alcohol or drugs), as a means of social acceptance. This was also true of younger siblings wanting to fit in, with their older siblings. Most participants talked of the social interaction, which was a key factor in their exposure to drugs or alcohol. The researcher cannot recall any of the participants reporting their first consumption of drugs was done alone in isolation. Alcohol was the exception as previously discussed, because it was easily accessible inside the family home. However, many of the participants reported drug use occurred with either peers or older siblings. Peer pressure was a major factor in using drugs/alcohol for the first time.

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Children, who felt alienated or isolated, were willing to do almost anything to gain acceptance from their peers. Therefore, if their only opportunity to gain acceptance was through group participation in drug use, they agreed to indulge. This was especially true for the male substance users. Males are expected to be team players, especially in their neighborhoods. James reported, “Nobody wants to be labeled ‘lame’ by their peers, you just have to show no fear.” This was his experience when first being introduced to marijuana. He recalls being afraid to smoke the marijuana, but clearly knew the implications it would have on his reputation in the neighborhood or at school, if he refused. Therefore, the peer pressure felt overwhelming, and he agreed to smoke weed.

He admits enjoying the effects of marijuana because it made him feel “relaxed and mellow.” He believes the marijuana reduced his social anxiety and he began to consume on a regular basis with peers. It goes back to the whole concept of having street acceptance. As adolescents, one of the milestones in their development is the ability to socialize with peers outside the family system. Adolescence is considered by some as the second separation-individuation process to occur in psychological development.

Therefore, the notion of socially being accepted by peers is a crucial part of their individual development. This was especially true of substance users who resided with parents who failed to provide the adequate amount of parental supervision, structured activities or parental involvement. If young substance users did not receive this parental oversight and involvement, they became drawn to street life and usually experienced an increased desire to gain acceptance outside the home. Often times their exposure to drugs or alcohol becomes their method of escape from the pain they experienced, resulting from their exposure to childhood abuse, neglect, or trauma. According to

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Hosier, “Childhood trauma is the root cause of why people in general use alcohol, and other psychoactive substances such as illicit drugs, to self-medicate (i.e., attempt to ameliorate their emotional and psychological pain)” (2016, p. 1). The data strongly suggests children who are exposed to abuse, neglect or trauma have a strong desire to escape feelings of anger, disappointment, confusion and emotional pain caused by their maltreatment.

Gang affiliation.

Another path which leads to exposure to drugs and alcohol was the result of gang affiliation. Randy reported that he was exposed to drugs by the gang, when he was told to begin selling drugs on the streets of his neighborhood. He admits to never having a desire to use drugs because he was addicted to making money. However, he was propositioned by a young lady to engage in “using his product” before having sex with her. Randy described his exposure to drug use through the following situation.

The first time I ever used drugs, I was sitting in the house, I was cutting up the drugs and was bagging it up and I’m not going to put it on a young lady. But the young lady was smoking some, and I later found out it was cocaine. But I asked her what she was smoking? She said, “You want a hit?” And I hit it and I felt a relief, fear, pain, anything else I was feeling was gone, it was just- I was happy.

So I was trying to get that happiness back, but I never get it back, I didn’t know that I became addicted to my own product.

Mack explained his immigration to the USA from Cuba. He reported they didn’t have drugs in his country when he was a child. He came to the USA as an orphan and became

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a gang member upon his arrival. His entire family was back in Cuba because he had run away, to flee his father’s extreme physical abuse. Mack indicated the first exposure he had to drugs was by the gang which took him in. He began using marijuana because it was the first drug he was offered. Mack admits “loving to smoke weed.” The only reason he has refrained from his substance use is because he is on parole and must submit to random urine drops. Mack also indicates that as soon as he gets off parole, he wants to resume his marijuana use because “weed makes me happy.” Joe Sausage reported he was a young musician who was talented enough to play with a band comprised of adult musicians. He recalls every one of the band members got high on something. Joe Sausage said, he went on tour with the music group and one of the older musicians offered him drugs. He says, “they were all doing drugs, so I started doing drugs too because it enhanced his musical performance.” The research seems to indicate that exposure to drugs occurred inside the family home or outside the home amongst peers.

Therefore, exposure to drugs and alcohol seems to be connected to socializing within certain environments.

Participants’ own addiction experience.

Path to addiction.

Each of the 20 participants experienced their own unique journey down the path to addiction. Some members reported they only consumed drugs on Fridays. Since they went to work all week long, substance use on the weekends did not seem like addiction.

As a result of their exposure to childhood abuse, neglect, or trauma, the participants overwhelmingly reported they had an intense amount of self-hatred. Their self-hatred

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kept them from developing a motivation to change their addictive habits. They overwhelmingly reported in hindsight, they lacked the necessary insight to avoid the pitfalls of substance use. The participants discussed how they developed defensiveness about their use of substances. This resulted in them being hyper-sensitive to any criticism they may have received from family members, friends, or peers. The addiction may have resulted in a negative impact on their health, by developing such medical problems such as asthma or heart problems, yet this did not decrease their use. Multiple participants reported the barriers to stop consuming alcohol and drugs, were the result of years of observing their parents or older sibling’s consumption inside the family home.

Billy indicated, “In addiction drugs become your soul mate, nothing else matters. The goal every day is to go out to get drugs, and come back home to keep getting high.”

Other participants reported there is a cycle to addiction which involves: getting the money, ‘chasing’ (obtaining) the drug, consuming the drug, getting high, having sex, and get more money to start the process all over again.” The entire process of substance abuse was known as a routine. In the beginning, participants reported getting high “was fun.” It was not boring and drugs seemed to offer excitement to an otherwise mundane life. There was also the socializing function included with substance use. “The people who got high together, loved to party together.” The key factor was one of being accepted, by their “get high buddies.” Many of the participants recounted the routine included sex, partying, socializing and being accepted. Using cocaine was reportedly used to increase sexual desires and sexual activities. Several participants reported “the first hit of drugs was mind blowing and the euphoria is what you keep chasing.” For some participants, they believe this was the beginning of their cycle into substance use.

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Addiction often involved episodes of drug binges where the users would leave home for days or weeks at a time and engage in non-stop getting high sessions. Attending these get high parties often involved being introduced to different drugs. Flash stated, “Eventually, one drug led to another drug.” He used the example of starting with cigarettes, then progressing to alcohol, on to marijuana and eventually engaging in cocaine or heroine use. As a result of their repeated interactions around getting high, “we developed our own social clique.” Sometimes this process involved offering drugs to their friends or family members, as a way to introduce them into the clique. Once becoming a member of the clique, the members worked together to obtain drugs by sharing and pooling their resources to obtain more drugs. The members of the get high club are often loners because they feel alienated from their family of origin. This offers an opportunity to gain acceptance by fellow substance users, in their underground culture of substance use. Eventually the continued drug use leads the substance users to become master manipulators. The predominant theme about this path to addiction, involved the concept of selfishness, on the part of the substance user. In addiction, “Substance users have no regard for others including family, friends, the only factor is trying to obtain more drugs.” Some participants reported, “Their parents’ disapproval of their consumption of drugs or alcohol in adolescence drove their desire to be rebellious.”

Continued use of drugs and alcohol caused a cycle of mood swings. Participants discussed their moods rapidly changed from happy to sad. They would then become angry and ultimately feel rejected if they did not get their wish. Frenchy indicated, “Addiction in adulthood can be a self-inflicted perpetuation of childhood abuse, because using drugs can be self-inflicted hurt.” X-File, another participant described her

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addiction as, “The use of alcohol and drugs was my escape, release, coping strategy for dealing with family drama, chaos and previous exposure to trauma, because it mellowed me out.” It was repeated by many participants that continued drug use, causes users to give up hope in themselves and promotes feelings of worthlessness. James reported, “Drugs became an unrealistic attempt at problem resolution.” All of this falls in line with the literature reporting the difficulty users experience in stopping the consumption of drugs and alcohol. According to the literature, A main reason that many find it so hard to stop or reduce their reliance on such self-medication is that they are unaware that the origin of their addictive need to self-medicate lies in their traumatic childhood experiences and that the adverse psychological consequences which they seek to numb by excessive drinking or drug taking are symptoms of this trauma (Hosier, 2016, p. 1).

Denial about addiction despite negative consequences.

It is a well-known idea, that despite negative consequences, some substance users have to “hit rock bottom,” before they acknowledge their substance use has gotten out of control. Many of the participants disclosed they were in denial about their addiction; at some point during their increased consumption of drugs and alcohol. X-File indicated, “All I wanted to do was numb my pain, escape reality, forget the traumatic memories from the past, and enhance her sexual activity.” X-File described her constant vivid memories of the sexual abuse she suffered at the hands of her father. She didn’t want to experience the pain or have the recurring memories. Once she began to get high, she

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realized drugs offered her a temporary escape from the situation. She soon realized the drugs only worked for a limited period of time and the painful memories would reemerge. She decided to keep getting high, because it would numb the pain for longer periods of time. She was in denial that she had developed an addiction to substances because she was sure, “all I did was to keep numbing my pain.” Participants also talked about the impulsivity which goes with substance use. They would often make hasty decisions while under the influence of drugs and alcohol. The normal reaction was to get high, whenever they experienced feelings of anger, disappointment, or helplessness. XFile disclosed that she had an anger management problem. She rationalized her anger was because, “I have a desire for justice--my childhood was unfair.” A couple of the participants recalled their substance use got out of control, upon returning home from the military. Exposure to war crimes and witnessing mass deaths among their own troops and those of the enemy resulted in them coming home with problems like PTSD. Their substance use was increased in response to the trauma they experienced during their military service to our country. Several participants recalled some of the negative consequences they experienced included legal charges for driving under the influence (DUI), committing domestic violence against family members while intoxicated, participating in crimes including theft, burglary, robbery and murder while under the influence of drugs and alcohol. Guido disclosed being arrested for the first time in his life at the age of 50 years old, when he was busted trying to buy drugs. He recalls going to court and the Judge asking him, “Why are you here? You don’t have any previous arrests.” Guido states it became very clear that his drug use had gotten out of control.

Guido reports, being manipulative with the Judge by convincing her, that he “had a

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problem with drugs and needed help.” The judge ordered him to attend substance abuse treatment. Guido reports, immediately upon completing his substance abuse treatment he was discharged from the program. The first thing he sought to do upon re-gaining his freedom was to go out and get high. This started his path to addiction all over again.

Looking back in hindsight, Guido admits that “He wasn’t really ready to stop getting high when he told the Judge; he needed help for his addiction.” Some participants reported how impulsive and explosive they became when under the influence of alcohol. Several participants reported having access to money was an immediate trigger for them to use drugs. For example, if a participant unknowingly received a check or money, their impulsive thinking led them immediately to the drug house to purchase drugs. They then discussed, what happened if they ran out of drugs and still had more money. They would not hesitate to think about the consequences of spending all of their money, their impulsive thinking resulted in them going to get more drugs, with the goal being to keep getting high. This could often result in days or weeks of getting high in non-stop succession, often known as drug binging. Their impulsivity would immediately take over, and back to the drug house they went, to purchase more drugs. Many participants report in the moment “their minds were convinced they had a plan which could produce an opportunity for them to get high, they never stopped to think about the consequences of their actions, and they just started the cycle to get high.” For some participants they reported, “Their decision to stop using was only due to legal consequences or on the job drug testing to maintain their employment.” Each of the participants experienced multiple negative consequences prior to their decision to get help for their substance use.

Ultimately, each of the participants discussed some form of denial, regarding their

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substance addiction prior to seeking help. For some participants, the comments and concern expressed by family members did very little to motivate them to change.

However, each participant shared their unique journey down the path to addiction.

Overall, the reasons that eventually motivated them to stop were unique and specific to each individual participant. Mae Devoe shared her motivation, being the pain she was unintentionally inflicting on her small children. She decided that even though she wasn’t physically or sexually abusing her kids (like she experienced in her childhood), she was not being an effective parent. It wasn’t until her children approached her with tears in their eyes and told her, “Momma, you need to get some help, we don’t want you to die.”

Mae Devoe said this was the deciding factor for her to seek help. However, she cannot explain why all the other negative consequences she experienced while deep in her addiction, did not motivate her to change. These negative consequences included being arrested, performing prostitution to get money or drugs and her physical appearance significantly deteriorating. Currently, Mae Devoe is sober and at the conclusion of her interview she stated, “I can’t afford to mess this up any more than I have already, my life depends on my sobriety and my children’s lives are in my hands and I can’t let them down again.” She is thankful that drug treatment provided her with the necessary tools, to resist the temptation to return to drug use. She attributes her success to staying away from people, places and things as taught by the 12–Step program. Other participants disclosed their denial about having an addiction to substances. Pretty Tony described his denial, “As a constant need to stop using drugs versus the desire to use more drugs.”

Depending on the individual’s specific drug of choice, discontinuing use can have its’ own set of negative consequences. Flash discussed his problem with heroine addiction

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and the physical pain he experienced when attempting to discontinue his use. However, he recalls previously, he had never really experienced any sickness in his life. However, withdrawal symptoms from heroine proved to be extremely painful and debilitating. He recalls having body aches, chills and cold-like symptoms accompanied by vomiting and diarrhea. After only 2 days of trying to withdraw, he found himself back out on the street, trying to score more heroine to aid in reducing his painful symptoms. He continued using heroine for several more years until, his medical health became a factor.

He was diagnosed with heart problems and strongly encouraged to stop using drugs. It was only after he was subjected to a hospital stay, in which he decided to seek treatment after leaving the hospital. His stay in the hospital was the only time he had been sober, for any period of time in many years. After completing, the treatment program, Flash realized just how strong his addiction had really become. According to each of the research participants, denial appears to be one of the road blocks experienced at the height of their addiction. Yet the desire, to achieve sobriety in an attempt to regain some sort of control over their personal lives, required them to acknowledge their denial and confront it head on. For many of the participants, this included enrolling in a formal substance abuse treatment program.

Substance abuse treatment.

The path to addiction and the journey through the physical and emotional degradation leaves substance users feeling worse about themselves than previously before. Most often they have suffered physical deterioration, along with mental and emotional decompensation. The path through addiction has usually been a long and

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painful process. There were several participants who spoke about “burning bridges” with loved ones. Dave said, “Under the influence, I made so many mistakes, hurt so many people, broke the hearts of my loved ones.” Almost each and every one of the participants spoke on their inability to cope with any painful emotions, while they were deep in their substance use. The overwhelming consensus among all participants was, “I used no coping strategies in addiction and my coping was to get high.” As a result, many, if not all of the participants reported there was an intense desire to use drugs and alcohol, whenever they were faced with situations which left them feeling angry or vulnerable. However, there were many other participants who discussed, “getting high” as a way to escape reality. As Randy indicated, “In addiction, I did not cope, I avoided coping with things all together.” The participants reported their use of drugs and alcohol was an attempt to mask their feelings or emotions. Pretty Tony described his experience as, “In addiction my coping was I self-medicated with drugs. It was never me looking to solve the problem.” It appears that the common thread among the participants was their inability to regulate their own emotions during times of distress. Participants told of countless stories when they used drugs and alcohol when faced with difficult situations in their life. The drugs and alcohol were the only way they knew to handle the painful feelings. Some participants, who were in the military also, shared their experiences with witnessing death and the smell of dead bodies; they endured when fighting in the Iran/Iraq war in the 1980’s. Upon coming home, they reported a strong desire to use drugs to avoid experiencing the symptoms of PTSD. Other participants talked about the crowd they were hanging with and the role substance use played with their peers.

Monclaire said, “In addiction the crowd I was hanging with, everybody was doing it.

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Additionally, I turned to friends that I drank and got high with to cope with my feelings and that wasn’t helpful.” The experiences revealed during the course of each interview, revealed a common problem experienced among substance users. There seemed to be an inability to regulate painful affective states, and/or to tolerate events which resulted in them feeling alienated or alone, in the situations they were experiencing. Guido described his experience as follows; “I used no coping when I was deep in my addiction.

There was no perseverance other than trying to get another hit and it was straight survival mode.” There seemed to be some connection with the severity of childhood trauma and the extent to which participants sought to numb the pain of those distressing memories.

Billy, who experienced extreme childhood abuse, neglect and trauma, said his addiction destroyed his life. He indicated, “In addiction I wasn’t thinking, I lost my wife, I lost my house, I lost everything because of it and still getting high was the most important thing to me at that time. Nothing else mattered.” This participant cried as he relived the pain from his past as a child and the consequences he suffered as an adult because of his addiction. He made it clear during his interview, the pain he endured in childhood, was simply too much for him to bear in adulthood, without self-medicating with drugs and alcohol. Frenchy discussed the role anger played in her substance use. She was able to identify the relationship between her experiencing episodes of anger and the amount of drugs she consumed following feeling that way. Frenchy simply stated, “In addiction my attitude was fuck you, I’m mad.” When she got to this level of thinking, her desire to get high took over all rational thought processes and decision making. Devil believed during the height of his addiction, “There was a demon inside of me, it was not me.” He recalls the depths of desperation he experienced in an attempt to obtain more drugs and alcohol.

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He reported there was nothing he was not willing to sacrifice or do, to obtain his next high. Devil simply stated, “In addiction, you roll with the punches because you still want to get high.” Another repeating theme which was revealed through the interviews was an inability for the substance user to accept the consequences of their actions. Several participants indicated, “I was selfish and I hate being compassionate because people take advantage of you and step all over you.” The participants told of countless situations when they were faced with a decision to get high or handle some personal business.

Overwhelmingly, the desire to get high seemed to outweigh any rational decision making processes. The participants discussed the struggle they faced with knowing the right thing to do. The solution was simple; the participants should exercise good judgment and ‘just say no’ to avoid drug use. However, for various reasons, there was an inability to think clearly. The desire to get high seemed to always outweigh the decision to use good judgment. Another theme which emerged as a result of the interviews; the substance users’ feelings, always outweighed their thinking in addiction. For various reasons the participants who struggle with substance use, never headed the warning signs on their path to addiction. They also failed to use any type of critical thinking skills, to problem solve any conflicts they may have been facing at the time. Despite experiencing negative consequences and suffering rejection, isolation, and criticism from family members, friends and loved ones, they continued down a path to self-destruction. It was the result of their self-destruction which led them to a place in their lives, considered by many to be “rock bottom.” Billy reported, “He was so low in his addiction, the only place for him to go, was up.” As a result of them suffering extreme losses including families, homes, jobs, future opportunities for self-improvement, they were unable to focus on the future.

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Most of the participants indicated a desire to live in the moment. They couldn’t deal with tomorrow or even the consequences, their decisions of today may have created. All they wanted to do was numb the pain. Yet, at some point their attempt to numb the pain, became a “slow path to suicide.” Many participants described their substance use resulted in some pretty horrible consequences. Ultimately, the desire to seek professional help was the only path available to them, in order to break their addiction to substances.

Not each and every participant experienced a formal substance abuse treatment program.

However, they all had come to the conclusion that “They had become sick and tired of being sick and tired. It was time to do something about being sick and tired.” They each arrived at a decision, only they could make for themselves, the desire was to get clean and sober by refraining from any further substance use. Some participants experienced recovery in varying ways. Some reported, leaving the state they resided in to avoid the people, places and things they had become accustomed to in their addiction. Some people went cold turkey and stopped getting high without professional help. Frenchy stated that it was her experience, that people who went cold turkey, maintained sobriety longer. However, people who went to formal treatment programs often reported several relapses into substance use. Some participants reported attending multiple treatment programs before finally achieving sobriety. Despite which path was chosen by each individual participant. Each member of this study had made a conscious choice to change their negative habits and attain life skills to handle things they were unable to handle in the past. Some people used religion to achieve sobriety. Some participants used NA/AA support group meeting to maintain an improved quality of life, without drugs and alcohol. Some participants enrolled in intensive in-patient treatment programs.

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Other participants engaged in outpatient substance abuse services. Yet, there were still others who used a combination of the above approaches. The participants in the research demonstrated a resilience to seek sobriety, despite all negative odds being against them.

Some participants discussed the negative stigma attached with admitting they were addicted to drugs. Their particular drugs of choice also came with different stigmas attached to them. For example, people who used alcohol felt they were better than participants who used drugs. When I questioned, their line of thinking, the answer was very clear. People who used alcohol, agreed, obtaining liquor is legal in all 50 states.

Therefore, they felt better about being labeled an alcoholic versus being labeled a drug addict. Another example involved people who smoked marijuana. The participants who smoked marijuana felt less stigmatized, than people who smoked crack cocaine or heroine. There was definitely a difference in their own self perceived stigmas versus the perception of their peers. It was only in treatment, the participants reported being confronted with the cold hard truth about their substance abuse. The bottom line was that addiction is addiction, despite your individual drug of choice. At the end of the day, if they didn’t have a serious problem with drugs and/or alcohol, they would not be sitting in the same treatment program, NA/AA support group meetings, or living in the same halfway houses. Many participants agreed that it was only after treatment, they were able or willing to acknowledge their addiction to drugs or alcohol was problematic. As a result of their problems with substance use, all the participants agreed, there needed to be some type of intervention, to help them break their individual cycle of addiction. Therefore, seeking treatment for their substance use problem was no longer optional, it had become mandatory.

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Re-integration back into society.

Substance users, who had achieved sobriety for the first time in many years, reported the difficulties they faced in attempting reintegration back into society. It did not matter whether they were attempting re-integration as the result of extended periods of incarceration, completing an in-patient treatment program or going cold turkey. There were some hard cold facts that each of them, had to experience upon achieving sobriety.

The most common theme which emerged was their thinking, under the influence of drugs and alcohol, had been impaired. Frenchy reported, “In addiction, I tend to be by myself.

I was taught that way in childhood because I was taught, not to connect, because my mom was so depressed in my childhood she was emotionally unavailable.” This proved to be a difficult barrier, upon transitioning back into society after completing substance abuse treatment. The participants talked about their struggles with handling their previous tendencies to be impulsive. Now that they were clean and sober, they had to manage those painful affective states, without efforts to numb them through selfmedication with drugs or alcohol. They had to learn skills which included the ability, to identify their triggers to substance use. What was it that made them feel vulnerable?

How could they handle these feelings in sobriety differently than previously during their addiction? The participants also had to learn skills which enabled them to put other peoples’ needs ahead of their own selfish desires. For some participants, this continues to be an area of struggle. Randy described it this way, “In addiction, I had no emotions, you are just existing, you are a float at sea in the darkness, just drifting away.” Now in sobriety, their feelings were alive and confronting them on every turn. Mothers, who had children reported the difficulties, they experienced upon returning home from treatment.

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One mother indicated, “While sober, I am compelled to please others, especially my family, and I don’t want to let them down.” Huffman reported, “Getting clean for myself is ok, but doing it for others is more meaningful, because I have hurt them in the past and I don’t want to hurt them again because of my actions.” Another difficult reality according to G was, “Learning in sobriety to start evaluating and assessing what happened, what brought me to this level?” All of these new tools and coping skills were not easily received upon reintegration into society, after years of substance use.

Subsequently, James stated, “I handle things better because of acceptance. I own up to the part that I play and my rewards and punishment, just taking responsibility and accepting I have a part to play. The responsibility lies with me.” Others talked about the importance of having a Higher Power to maintain their sobriety. The participants shared the belief that achieving and maintaining sobriety, could not be done independently.

Each of them required some assistance, outside of themselves. They realized it was them; that got them into the situation to begin with. Therefore, it was absolutely mandatory, to engage in help from their spiritual support system. Some people discussed attending church as a way to gain strength upon reintegration. Other participants discussed the use of meditation, prayer and learning not to wallow in self-pity. Frenchy reported the use of Facebook, was beneficial by helping her, maintain sobriety. She reports using Facebook as a platform to give inspiration and positive messages to other people, especially those struggling with substance use. James shared his new found discovery, “In recovery, you make sacrifices for others; you unconsciously expect something in return. Then realizing the feelings are not reciprocated, for the ones you made the sacrifice for.” The accounts of experiencing various difficulties, in making the

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transition back into society upon achieving sobriety, added another layer of complexity to maintaining it. Overall, the participants shared their fears, anxieties and realities about the differences they were experiencing while enjoying a life of sobriety. All of these experiences were considered new ways of dealing with reality, because their previous patterns of substance use had resulted in their avoidance of dealing with reality.

Monclaire described it as, “Learning to live life on life’s terms, without escaping the reality by using drugs.”

Presentation of Findings Each of the research participants completed two in-person interviews with the researcher. The first interview with each participant lasted approximately 60 minutes.

After each initial interview was completed, the researcher then uploaded the audio files to a transcription service for transcription. After receiving the interviews back from the transcription service, the researcher read each interview, while listening to the interview recordings to check for mistakes and make the necessary corrections to the hard copy.

After checking each of the transcriptions for errors, the researcher began the first step in the data analysis phase of the research. The first step involved reading each transcribed interview to look for initial themes. Since grounded theory is driven by the data collection process, the researcher was not allowed to use any preconceived ideas or categories to develop the coding process. According to Corbin and Strauss (2015), the research has to be driven by the data. The initial open coding was completed by the researcher in which several initial coding concepts emerged. Open coding is defined by Corbin and Strauss as, “breaking data apart and delineating concepts to stand for

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interpreted meaning of raw data” (p. 239). There were well over 250 initial open codes identified after the first and second interviews.

The researcher then proceeded to complete the second round of interviews with the participants. The second round of interviews served as ‘member checking’ with the participants. Next, the researcher simultaneously analyzed the additional data obtained in the second interview, with the data obtained in the first interview. “After initial data are collected, the researcher analyzes that data, and the concepts derived from the analysis forms the basis for the subsequent data collection” (Corbin & Strauss, 2015, p.7). The researcher then performed axial coding, during which similar relationships were located among the open codes and then grouped into smaller, coding categories (Corbin & Strauss, 2015). According to Bloomberg and Volpe, axial coding is defined as a process where, “one of the categories is selected and positioned within a theoretical model” (2012, p.37).

As a result of the second interviews, new codes emerged but they were also checked against the existing open codes completed in the first interviews. The axial coding became a very labor intensive effort in which the researcher manually typed out all of the open and axial codes on a Word document. After printing the Word document, the researcher began to cut each code into strips of paper. The researcher was then able to move the strips of paper around until my final selective coding categories began to emerge. The selective codes emerged as a result of identifying the core variables among all the codes (Corbin & Strauss, 2015). These selective codes were then used to develop the researcher’s grounded theory. This was achieved by looking for overarching ideas or concepts which could be used to generalize a certain theme that existed among both the

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open and axial codes, gathered in the data collection process. The overall premise of this methodology was to develop a theory or model which could help the researcher develop a theory to help further an understanding of how a history of abuse, neglect and/or trauma may be related to substance use in adulthood.

The research participants displayed an over representation of men. The researcher had 16 males participate and four females participate in this research. The researcher suspects the number of males, were over-represented in this study, as a result of the location of the researcher’s recruitment sample. The participants were recruited from AA/NA support group meetings in south suburban Cook County, which had an overrepresentation of males in attendance, at the meetings compared to females who were in attendance. This researcher believes this is the main contributing factor, in the disproportionate number of males represented in this study. This researcher also believes that women who suffer from substance use, while raising children and handling other responsibilities to their families, are prohibited from attending support group meetings as often as men. The researcher spoke with single female parents, who reported the difficulties they experienced in seeking help for their substance use problems, because of their need to provide care for their children. Frenchy reported having to make the difficult decision of seeking treatment and losing her children to DCFS custody. She had no additional family support and had to let them go into the guardianship of the State of Illinois, in order to address her problem with substance use. Upon completing treatment, Frenchy had the dual responsibility of trying to maintain her sobriety and fight to regain custody of her children from DCFS (which often made her want to relapse) because of the increased level of stress and anxiety she experienced in this process.

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Additionally, this study has an over representation of Blacks compared to Whites and Hispanics. This researcher also believes this large number of Black participants, is a result of the location of the recruitment sample. The NA/AA meetings in south suburban Cook County were heavily attended by Blacks compared to other racial groups during the recruitment process. This researcher also realized during the interviews, that many of the Black male participants were unemployed. They were often on probation and living in sober living environments. However, the Hispanic and White participants were all employed for the most part, despite having legal problems. Regarding the White and Hispanic participants, they maintained connections to family support systems despite residing in sober living environments. This may be contributed to the fact that many Black substance users have, ‘burned bridges’ with their family members/friends.

Therefore, seeking treatment for substance use was the only way, to keep them from becoming homeless. Overall, the Hispanic and White participants seemed to have more extended support systems in place, from family members and friends.

Also, there were seven research participants who did not return for round two of the interviews. Henry, one of the participants was arrested. The researcher was informed by his girlfriend of his incarceration, when the researcher called his cell phone to confirm his second interview appointment. Devil and Paul, two of the participants had disconnected cell phones and the researcher was unable to locate them for the second interview. Tom, X-File, Chelle, and Mae Devoe; these four participants scheduled second interviews, but failed to show up for their scheduled appointment times. The researcher reached out to them on several different occasions and still never received a reply back, regarding their failure to attend their second interviews. The researcher

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suspects these four participants may have relapsed, back into substance use and no longer available to participate in the research. The researcher actually received a message from Tom stating, “I’m cool” on the researcher’s voice mail in response to the message left for him, indicating he had missed his second interview appointment. This particular response left the researcher feeling that Tom’s thinking was somehow impaired, because he left no further explanation. The researcher highly suspected him to be under the influence of drugs or alcohol. When he left the voicemail message, his voice did not sound the same as recalled from the first interview. The other three participants did not bother to respond to any of the researcher’s attempts to reschedule. The researcher also suspected they may have relapsed and possibly too embarrassed to continue with the second interview because the inclusion criteria, required sobriety for a minimum of three months.

There were five family members who participated in the research, who were recruited from Al-Anon support group meetings in south suburban Cook County. All five family members have experienced the painful impact substance use has had on their loved ones. They agreed to participate in the research to discuss their personal lived experiences with substance use. Family participants also shared the impact substance use had on their individual lives and the overall impact on their families. All five participants were females. There were three Blacks, one White and one Hispanic participant. All five participants had first-hand knowledge of the impact, their loved ones’ substance use had on their family system. Each participant revealed some very painful memories and also shared some success stories.

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The audio files from the family members’ interviews were also uploaded to the transcription service. Upon receiving the transcriptions back, the researcher checked them for errors and made the necessary corrections. The same process was also employed in coding the data for family members, as was used in coding the substance users’ interviews. The researcher first read the interviews of family members and began the process of developing open codes. The open codes were then used in the second interviews to develop more coding themes. The axial coding process allowed the researcher to begin grouping themes, which had similar relationships among the open codes. After reading and re-reading the interviews, the researcher used the same process of typing the codes on a Word document and then printing them out on paper. After printing the codes, the researcher began cutting them into strips of paper and assembling them into the various categories used in the selective coding process. The process for coding both the substance users’ interviews and the family members’ interviews was identical in all three phases of coding: open, axial and selective.

Conclusion In conclusion, the researcher continued to read and constantly search for consistent themes throughout the data analysis phase. The data analysis initially started with well over 250 codes, which emerged during the open and axial coding phase. The researcher continued to analyze the data and constantly compare the codes in an effort to achieve the selective coding phase. As a result of analyzing the data, there were 6 selective codes which emerged from the data obtained from participants’ interviews.

These 6 selective codes were assembled to direct the flow of information in developing

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my grounded theory. Therefore, each of these selective codes were explored by the researcher and presented in these findings. In the discussion chapter of this dissertation, the researcher will directly answer all research questions, present the theory that emerged from the data, provide a discussion on the implications to social work practice, discuss strengths and weaknesses and make recommendation for future research.

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Chapter 5 Discussion The purpose of this study was to explore the lives of adult substance users for evidence of exposure to childhood abuse, neglect and/or trauma. The researcher used a grounded theory methodology to explore the lived experiences of adult substance users and family members. The researcher conducted two separate rounds of in-person interviews with a research sample of: 20 adult substance users and five family members of adult substance users (not the participants of this study). The substance users and family members also completed a demographic questionnaire prior to beginning the interview process.

Additionally, the researcher completed one exit interview with the three experts in the field of substance addiction. The end results of this research process; was the analyzed data resulted in the development of a grounded theory model. The grounded theory model was then presented to each of the three experts in their individual interviews. The purpose of interviewing three experts was to allow an opportunity for the researcher to obtain their professional feedback, regarding the efficiency and accuracy of the model developed (from analyzing the data); as it relates to their professional understanding of childhood abuse, neglect and/or trauma relative to the development of problems with substance use in adulthood. The experts in substance addiction were not required to complete a demographic questionnaire. However, they were required to

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provide the number of years they have experience, working in the field of addiction.

Additionally, the experts were asked to provide their working job titles prior to beginning the interviews. The central research question for this study is, “What is the theory that explains how exposure to early childhood abuse, trauma and neglect contribute to the development of substance use in adulthood?”

This chapter will present a full examination of the theoretical model developed from the grounded theory process and implications for practice. The model and aspects of it are analyzed in relation to the development of a cohesive self and the ability to develop healthy coping and self-soothing strategies. Also, the initial study assumptions will be revisited and the validity and limitations of the study will be discussed, as well as the implications for clinical social workers. Ultimately, the chapter will conclude with some recommendations for future research.

Objective of this Study The researcher’s objective was to explore the possible connection between victims of childhood abuse, neglect and/or trauma and the later development of substance abuse in adulthood. The researcher believes this study could be very useful to the field of social work by helping to develop more effective treatment methods for adult substance users. Additionally, it could ultimately lead to further research, including how each type of childhood maltreatment contributes to the formation of adult substance use. The central research question for this study is, “What is the theory that explains how exposure to early childhood abuse, trauma and neglect contribute to the development of substance use in adulthood?” The following sub-questions will also be explored:

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1. How do the participants remember their developmental experiences that include abuse and neglect or trauma?

2. How do they think about these past experiences as adults?

3. Do they think about these past experiences as influencing their lives, their interpersonal life, or their desire to use substances?

4. As an adult, what purpose does the use of substance serve?

5. When substance users recall abuse, neglect, or trauma how do you feel?

6. Do these feelings play into the desire to use substances?

7. What has made it difficult in your adult life to not use substances?

Question 1. How do the participants remember their developmental experiences that include abuse and neglect or trauma?

According to the 20 substance user participants in this study, they all remembered some negative events from their early childhood development. Each of the participants entered the research with their own individual social history; and their development occurred in unique contextual settings including environmental factors and differing parenting styles. Overall, each of the research participants disclosed a vivid childhood memory including some form of childhood abuse, neglect or trauma as experienced in their earlier developmental years. Every single participant experienced some form of adverse childhood experiences (ACEs) during their early developmental years.

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Question 2. How do they think about these past experiences as adults?

Each of the participants was able to reflect back on their childhood experiences from an adult perspective and verbalize their exposure to childhood maltreatment. Each of the participants was able to verbally categorize their experiences in childhood; as either abuse neglect, and/or trauma. Some participants endured multiples forms of abuse; and they were able to verbalize their lived experiences, to the researcher during their interviews. Some participants endured a combination of trauma, in addition to physical/sexual abuse. Other participants experienced neglect in conjunction with abuse.

Overall, each of the participants looked back over their earlier developmental years and verbalized insight into the emotional and physical pain they endured at the hands of their parents.

Question 3. Do they think about these past experiences as influencing their lives, their interpersonal life, or their desire to use substances?

The answer to this question was not clear cut. Some participants were able to give insight into the role their childhood experiences had on their later developmental years. However, the participants seemed to have obtained more insight, with an increased length of time associated with sobriety. For example, a participant who had 20 years of sobriety was able to give more insight, into the role their childhood played in developing a problem with substances in adulthood. On the other hand, someone who had only six months of sobriety was not as insightful, into the connection between the impact of their childhood exposure to abuse, neglect or trauma had relative to their substance use problem in adulthood.

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Question 4. As an adult, what purpose does the use of substance serve?

The overwhelming consensus among a majority of the substance users was their ability to acknowledge using drugs; their ability to cope with life and the everyday stressors involved in day to day existence. Using drugs was an attempt to escape reality, avoid dealing with life on life’s terms and basically an attempt to deal with their own painful affective states. Many participants talked about their inability to control their anger during earlier years of development. These participants grew up to have anger management problems in adulthood. The drug use was an attempt to self-soothe their intense feelings of anger and rage. A majority of the participants’ use the term “selfmedicating” was the purpose for their substance use.

Question 5. When substance users recall abuse, neglect, or trauma how do you feel?

Each and every one of the participants of this study was clearly experiencing feelings of painful memories, as they relived their childhood experiences of abuse, neglect and/or trauma during the interviews with the researcher. Some participants actually began to cry intensely as they relived their childhood. Other participants clearly displayed strong feelings of anger, as they relived the traumatic events from their past.

The researcher did not observe any participants, completing the interview process without displaying some sort of shift in their emotional state. Some participants expressed feelings of being treated unfairly by their parents or being ostracized by other family members. Participants also shared feelings of guilt around being victimized in childhood.

Participants indicated feelings of being unloved and unworthy of love and affection, from

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their parents. The research revealed in situations where the substance user grew up in a two parent home; the maltreatment by the abusive parent tended to overshadow any warmth of nurturing received by the non-abusive parent. Therefore, their childhood memories were dominated by their negative childhood experiences, compared to their positive ones.

Question 6. Do these feelings play into the desire to use substances?

The substance users in this study reported their desire to use drugs and alcohol, was often driven by their emotional state. Overwhelmingly, their feelings of rejection, despair, anger, hopelessness, inferiority and self-hatred all played a role in their desire to use drugs and alcohol. Additionally, feelings of rejection within the family system played a crucial role in their substance use problem. The participants emphatically stated, their fellow substance users, accepted them for who they were. Therefore, the participants’ desire for acceptance and validation compelled them to continue socializing with fellow substance users.

Question 7. What has made it difficult in your adult life to not use substances?

The research participants indicated their struggle to maintain sobriety involved several factors. Their ability to identify triggers was crucial, in their struggle with an addiction. For example, a participant may have not been able to get high, because of a lack of resources on any given day. However, the moment they had obtained access to cash, or came up with a potential plan to manipulate someone out of money, relapse

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became a very real problem. Additionally, their exposure to people, places and things became a barrier to sobriety. Participants who had achieved sobriety needed to avoid being around their old get high buddies (the people). Participants also verbalized their need to avoid going in certain neighborhoods, for example; avoiding the block where the drug man sells dope. This is considered staying away from the places, involved in their attempts to maintain sobriety. Participants of this study also discussed their need to avoid ‘doing things’ previously associated with their drug use. For example, participants should, keep avoiding stopping for a drink at the local bar on Fridays, after getting off work (before taking the money home). Additionally, participants discussed their need to refrain from avoiding conflictual situations by running away to get high. The participants had to learn the importance of confronting uncomfortable situations, without using illicit substances to avoid the situation. Khantzian believes an individual uses substance addiction as an attempt, to master psychological and physiological symptoms which include emotional pain, dysphoria and anxiety (2003). The substance users’ central problem is affect regulation and disturbance in relationships.

Developed Theoretical Model The theoretical model developed by the researcher includes 12 findings that emerged from the participant interviews (see Figure 5.1). These 12 findings included in sequential ordering of the model are: 1. Growing up with an alcoholic father 2. Growing up with mothers who were emotionally distant and unavailable 3. Environmental impact on the child’s development

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4. Exposure to abuse, neglect and/or trauma 5. Children growing up with uncertainty of their place in the family 6. Desire to fit in with others outside the family 7. Exposure to alcohol/drug use 8. Path(s) to addiction 9. Denial despite negative consequences 10. Ambivalence around trust issues 11. Choice to seek substance abuse treatment/help and 12. Reintegration back into society Each part of the model will be explained in detail below. Further, a discussion of how each part influences the next will be conducted and a face validity test of the model with experts will be provided.

132 Figure 5.1. Theoretical model of relationship between childhood trauma and substance abuse

Growing up with father who displayed alcoholic behaviors

Environmental factors both inside & outside the home

Growing up with mothers who were emotionally unavailable

Exposure to ACEs

Children grow up with uncertainty of their place in the family

Desire to fit in with others outside family (life in general)

Exposure to alcohol/drugs

Path to addiction

Denial despite negative consequences

Illness, hospitalization, incarceration, death

Substance users don’t know who to trust

Choice to seek substance abuse treatment

Re-integration back into society

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Finding 1: Alcoholic fathers.

The participants consistently reported growing up with fathers who were alcoholics. A consistent theme which resulted from the interviews was the participants’ experiences, of growing up in the home with an alcoholic father, and the impact on the entire family system. Multiple participants disclosed their experiences of growing up with fathers who were not very talkative or engaged with their children. While growing up in a home where dad was the dominant role model, participants discussed his behavior while under the influence of alcohol. There were several participants who considered their fathers’ to be alcoholics during their early childhood development. The participants also discussed their father turning into a different person while intoxicated. The father would often come home and begin verbal and/or physical confrontations with their mothers. However, these confrontations typically occurred when their father was under the influence of alcohol. The participants also discussed the severity of their discipline was dramatically more intense, whenever their fathers were under the influence of alcohol. Essentially, the fathers were working men, who provided for their families all week long. However, on the weekends, their fathers would get drunk and become verbally, emotionally and/or physically abusive to his children and his wife. The fathers basically instilled fear in every member of the family. The children’s fear increased whenever their father was intoxicated. This is consistent with what is available in the literature. In the ’90s, a landmark study conducted by Kaiser Permanente, California, and the Centers for Disease Control and Prevention examined the social factors that precede the development of disease and disability. Called the Adverse Childhood Experiences (ACE) study, it asked over 17,000 patients to answer a host of questions about their

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physical health and childhood experiences. In almost 27 percent of the cases, the study found a history of household substance abuse (1998).

Finding 2: Growing up with mothers who were emotionally distant and unavailable.

These participants reported experiencing their mothers as emotionally distant and unavailable, during their early childhood development. The researcher sat with participants who relived their experiences of growing up with mothers who struggled with depression. Their mothers were unable to develop emotional bonds with their children, as a result of their own mental illness. Usually, mothers who are depressed rarely seek treatment to help alleviate their symptoms. Therefore, the children suffer from their mother’s lack of emotional warmth and nurturing. Additionally, mothers who were victims of domestic violence often isolated themselves within the home environment. This also resulted in children failing to receive adequate emotional support and nurturing. There were also some participants who disclosed the difficulty experienced during childhood, following the death of their mother in earlier years.

Growing up without a mother can be a major source of emotional deprivation in a young child’s early developmental years. Participants who grew up without a mother explained their painful reality, of having only a father in the home. Fathers are typically not warm and nurturing by nature, therefore this leaves children longing for the warmth and comfort previously provided to them, prior to their mother’s death. There were also some participants who revealed their experiences of being removed from their mother’s custody by DCFS and placed in the foster care system. This experience was also very

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traumatizing and left an emotional void within the young child’s emotional development.

Overall, growing up without a mother in life is difficult regardless of a person’s age; yet in early developmental years it can be a very traumatic experience. The data revealed, the lack of having a mother during early childhood, was a contributing factor for young people developing problems with substances in adulthood. According to Hill, there are seven consequences of having an emotionally detached parent. People often turn to substance abuse/dependency to help them cope with the pain and sorrow which “takes them away” or “dulls the pain” (2016, p.1). In addition, to mother’s being emotionally unavailable, there were other factors which prohibited mom from functioning effectively in her maternal role. There were also some instances when the mother’s parenting was interrupted by forces beyond her control. This would include instances when death occurred or the children were removed from her care or custody.

Finding 3: The environmental impact on the child’s development.

The participants disclosed the environmental impact both inside the home and outside the home; was a crucial factor in their early childhood development. Both growing up with an alcoholic father and an emotionally unavailable mother was found to have a detrimental effect on the child’s immediate environment. Children are known to be curious and willing to experiment with new things in their early developmental years.

The research participants shared their experiences of growing up in certain neighborhoods; and the impact they feel the environment played on their growth and development. Environmental factors included, being exposed to peer-pressure or bullying while growing up. Almost all of the participants in this study discussed the

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impact their individual neighborhoods played in their childhood development. Some participants discussed growing up in the Chicago housing projects. Growing up in Chicago housing projects had implications; regarding the role poverty played on the child’s early developmental years. This particular living environment was often plagued with poverty, gangs, drugs and violence. As a result, children who grow up in this environment, learn the importance of survival in such environments. The participants discussed knowing how to spot the drug dealers, the ‘look out boys’ (who watch for the police) and how to avoid being shot by random bullets. Gun shots and gang wars were often everyday occurrences in housing projects. Additionally the role of environment may also include, growing up in a home with a parent who has problems with substance use. Ultimately, the substance users discussed the role played by living in an environment with substance using parents. Some participants discussed the role drugs and gangs had on their environment. In a neighborhood where there is a real high poverty level, the tendency is to seek a substance which is relatively inexpensive to consume. Therefore typically alcohol, marijuana and crack cocaine or heroine, are the preferred methods of seeking intoxication in poverty stricken environments. These substances are relatively inexpensive and easily accessible in low income environments.

This often results in the environment being a contributing factor, in individuals who develop substance use problems in adulthood. The data from the literature supports this finding. According to Crum, “neighborhood disadvantage might function as a determinant of exposure opportunity, an intermediate step on a path toward starting to use drugs illicitly” (1996, p. 155).

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Environmental factors also included the substance user’s exposure to trauma during their early childhood development. Trauma played a significant role in the early developmental years of most participants. Trauma may have been experienced by poverty, exposure to crimes, gang involvement and death, which happened outside the family home. Additionally, factors which occurred inside the home may have been traumatic as well. Children, who witnessed their parents engage in episodes of domestic violence, reported being traumatized by living in their home environment. The entire first tier (inside the bubble) of the developed theoretical model (Figure 5.1) displays these key factors. Children who grow up with alcoholic fathers and emotionally unavailable mothers are often exposed to trauma. Exposure to adverse childhood experiences can also be traumatic depending on the circumstances. Poverty which has a profound impact on a person’s development can be extremely traumatizing. Factors such as poverty, gang violence and drugs all contribute to a persons’ inability to develop into a productive member of society. Without having adequate resources to function in our society, living a productive life can be almost impossible. Therefore, the impact of poverty cannot be excluded, when exploring the contributing factors which potentially aids in a person developing a substance use problem in adulthood. Trauma can occur in addition to childhood abuse and neglect. However, trauma can also occur independently from exposure to childhood abuse or neglect. Therefore, the environmental factors which emerged from this research must include poverty as a part of the participants lived experiences of exposure to trauma.

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Finding 4: Exposure to abuse, neglect and trauma.

Each of the participants in this study shared their personal lived experiences of their childhood exposure to abuse, neglect and/or trauma. Children who grew up with exposure to abuse, neglect and/or trauma are the victims of maltreatment in their early developmental years. The participants disclosed some very painful memories from their early years of childhood development. The stories were endless regarding physical abuse, sexual abuse, neglect, verbal abuse or traumatizing experiences. Participants talked about being thrown from moving cars in childhood. Other stories detailed the sexual abuse perpetrated on females by their biological fathers. Yet, other accounts disclosed being beaten so severely, children experienced broken body parts and needing hospitalization. Stories of violence including death, shootings and stabbings seemed to occur rather frequently for some of the participants during childhood. Some participants discussed being left at home alone for days at a time; requiring them to fend for themselves in their parents’ absence. Honestly, as the researcher, it was difficult to listen repeatedly too many of these self-reported accounts of child maltreatment. It was an important step for the researcher, to stop interviews for a few days to allow time to debrief (or regroup), from hearing all the traumatic stories disclosed in the process of conducting interviews. Overall, despite a child’s type of exposure to abuse, neglect and/or trauma, it has detrimental effects on a young child’s overall development.

Therefore, adverse childhood experiences could range from a singular type of exposure to abuse, neglect and/or trauma or in some cases a combination of multiple types of child maltreatment. Adverse childhood experiences regardless of the specific types of maltreatment, all seem to have a negative impact on the child’s early development. The

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literature indicates there is a strong relationship between adverse childhood experiences and developing substance abuse in adulthood (Felitti et al., 1998).

Finding 5: Children have ambivalence of their place inside the family.

The participants all discussed experiencing ambivalence of their place, within their respective family systems, during their early childhood development. There was an example of a young female participant who was repeatedly sexually abused by her biological father. This young lady discussed the confusion she experienced when she was expected to perform sexual acts with her father; causing her to operate in the role of an adult within the family. Whenever she was in trouble or forced to interact with other people outside the family, she was expected to behave as a child. Therefore, her role within the family became one of conflicting emotions. She had to have sex with her father (like her mother/an adult) but then expected to go play with dolls and cars with her siblings (like a child). This exposure to sexual abuse at an early age caused the participant to be uncertain of her place within the family. There were other participants who shared similar experiences; including functioning in the role of a parentified child inside the family home. These participants were expected to provide care for their younger siblings, including cooking, cleaning and homework during a parents’ absence.

Yet, they were expected to return to their traditional role as a child, when they went outside the home. Attending school with peers, these participants realized their home experiences were not the same for everyone. Therefore, this left the participant struggling with developing an age appropriate identity role in childhood; this was especially true of their appropriate place within the family system. These dynamics left

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young children struggling with the idea of ‘where to fit’, inside the family. There appears to be a gap in the literature regarding the impact childhood experiences of abuse, neglect and trauma have on the child’s uncertainty of their place within the family. The literature has vast amounts of information regarding the negative consequences of childhood maltreatment. However, the literature does not specifically address the impact family dynamics has on the individual child, who was victimized. According to “Understanding Child Abuse and Neglect,” “Less attention has been given to the short and long term consequences of child neglect and physical abuse. Only recently has public awareness expanded to include recognition of the psychological consequences that stem from even the most subtle forms of emotional maltreatment” (1993, p. 208).

Finding 6: The child wants to be accepted by others.

Each of the participants discussed their desire to be accepted by others, especially outside of the family. This is a natural response from the previous finding. Children, who grow up with uncertainty of their place within the family system, seek acceptance outside the family home. This finding involves the child’s desire to fit in, outside the family system. This desire to fit in often goes hand and hand, with social acceptance by peers. Children want to belong to a group in early childhood development and adolescence. After all, exposure to school gives children an opportunity, to engage with others outside the family home. No child wants to exist in a vacuum of isolation during their early developmental years. Therefore, these children are often seeking acceptance and validation from peers or older adults outside the home (including teachers and neighbors). Unfortunately, the children seeking acceptance often gravitate to other

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children seeking acceptance. This often results in a child’s involvement with gangs or giving in to peer-pressure because of their desire for acceptance. Many participants disclosed their lack of interest initially in experimenting with alcohol or drugs. However, if their peers were engaging in such illicit activities, they didn’t want to feel excluded by social rejection of their peers. After all, they were already experiencing feelings of rejection within the family home, as a result of their adverse childhood experiences.

Therefore, the willingness to participate in drugs or alcohol consumption was never about the sensation of getting high; it was always about being accepted by their peers to avoid further feelings of rejection. The same was true for the female participants of this study.

If the female experienced sexual abuse in childhood, she began to look for love in all the wrong places during adolescence. This usually involved activities including promiscuity, lying to parents in order to hang out with the wrong crowd or experimentation with drugs because of peer acceptance. Regardless of the specific accounts which were remembered by the participants, they all wanted to experience feelings of acceptance and validation outside the family. According to the famous study done by Harlow (1962), stated, Moreover, not only animals, but even humans raised in conditions where there is inadequate social stimulation develop bizarre self-stimulatory and even selfabusive activities, such as head banging, biting on their skin, pinching themselves until they bleed, or rocking repetitively. That is, being in need of physical contact with others, when this contact is insufficient, children and young animals will engage in repetitive and sometimes abusive self-stimulatory activities. So great is the need for stimulation that when it is lacking they supply it to

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themselves in an inappropriate manner. Generally this self-stimulation is abusive as if the infant were punishing itself for being unloved (p. 265).

This literature is in line with the findings found in this study; that it is important for children to feel accepted and loved by their parents. Therefore, if a child does not feel accepted inside their home; it stands to reason, the child will seek acceptance outside the home. It basically boils down to the simple point; all human beings need love and acceptance. Ultimately if the child doesn’t receive the necessary love and acceptance, they develop self-abusive behaviors. The researcher agrees that substance abusing behaviors carried out in adulthood is simply another form of self-abusive activities.

Finding 7: Exposure to drug/alcohol use.

All of the participants discussed their exposure to drug or alcohol use, for the very first time. Despite all of the negative factors which have influenced their overall development; there was not one participant who was unable to recall their first time drinking alcohol or getting high. Due to the severity of their exposure to traumatic events in childhood, some participants were unable to recall their exact age when their exposure to child abuse occurred. Some participants were only able to recall, an age range of when the abuse occurred (in childhood). However, not one participant was unable to recall in vivid detail, the circumstances surrounding their first exposure to drugs or alcohol. Some participants’ initial exposure happened inside the family home. They either had parents or older siblings who engaged in drug or alcohol consumption. This often resulted in them sneaking a sip of a parent’s beer or stealing an older siblings’ marijuana joint, to smoke it with their own friends. Nevertheless, despite the route taken it became quite

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clear in the data analysis; exposure to drugs and alcohol was a significant factor in individuals developing problems with substance use in adulthood. Additionally, the data revealed the exposure to drugs and alcohol centered around socialization with peers.

None of the participants admitted to getting high alone in isolation, especially at the beginning of their experimentation phase with drugs and alcohol. Every one of the 20 participants discussed their exposure to drugs and/or alcohol always involved another person, regardless of it being family member or friend. Some participants discussed their exposure involved watching older siblings or parents consume drugs and alcohol. Their family exposure to observing drug use; inevitably peaked their own curiosity about using drugs or alcohol. Many participants talked about wanting to “imitate” their parents or older siblings’ consumption of drugs or alcohol. Therefore exposure to drugs or alcohol became a major contributing factor, leading substance users down the path to addiction.

According to the literature, a longitudinal study conducted in 1992 showed of 1462 participants, 429 youths were offered alcohol, 395 were offered tobacco, and 50 youths were offered cocaine or an opportunity to smoke crack (Crum, 1996). This further validates the data obtained in this research regarding a young persons’ exposure to drugs/alcohol involves others (including peers and/or family members).

Finding 8: Paths to addiction.

Each of the participants discussed their individual journey down the paths to addiction. Addiction was a crucial factor in this research about adult substance use.

Substance users shared various accounts of their unique experiences related to their individual paths into addiction. Some substance users reported initially, the path to

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addiction was not easily recognized. It became pretty clear to the researcher, that many of the participants lacked insight into addiction (prior to being impacted). Therefore, all warning signs were ignored, due to a lack of knowledge on the participants’ part. For example, some participants spoke of receiving multiple DUI’s before realizing their drinking had become problematic. Other participants reported experiencing multiple arrests in attempts to purchase narcotics. However, these negative consequences never indicated the substance user’s consumption of drugs and/or alcohol had become problematic (for them). Participants who were addicted to heroine discussed the negative side effects of attempting to discontinue their heroine use via the ‘cold turkey’ method.

These individuals reported, it was only after experiencing the physical withdrawal symptoms of heroine use, that they realized their substance use was no longer recreational; their consumption of heroine had crossed over into the path of addiction.

The consistent theme throughout the interview process, involved the substance user’s attempt to have fun. From the data analysis emerged the idea, of routines being established in the process of getting high. Drug use was an opportunity to be accepted by like-minded peers, engaging in a common activity (drug use), sharing resources, increasing sexual activity and repeating the cycle of chasing the drugs all over again.

Once this pattern became established in the individuals life, addiction to substances was the end result. According to the National Institute on Drug Abuse, “by the first grade, or earlier, children show temperament and behavior traits that are powerful indicators of the inclination to use and abuse drugs in their teenage and adult years” (1992, p.1).

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Finding 9: Substance user being in denial despite negative consequences.

Each of the participants reported their initial denial about developing an addiction problem, despite their many negative consequences. The participants all disclosed stories around the negative experiences they endured while deep in their addiction. In the substance use community, there is a term known as “hitting rock bottom.” It is during this phase of addiction, the participants relived their painful experiences of suffering the negative consequences resulting from their habitual substance use. Participants spoke at length about the ‘costs’ associated with their substance use. These costs had relatively little to do with money per se. However, they more detailed the physical and emotional losses associated with their substance use. Some participants discussed losing gainful employment, losing wives/husbands, losing homes and rental properties. In some extreme cases, participants discussed the physical loss of life, they experienced when a friend died, as a result of drug overdose. In essence, these participants relived some very traumatizing events which were a direct result of their use of substances. However, despite experiencing these negative consequences, the substance users remained in denial about the development of their problem with substance use. They continued to engage in habitual substance use, without the ability to reflect on the associated negative costs. The participants recounted, once they hit rock bottom there was no place left to go, except up.

Rock bottom is a very individual and unique experience to each person. Therefore, the factors which contributed or led the substance user to be at an all-time low in their lives often went unnoticed. Participants discussed the physical consequences included losing large amounts of body weight over time, resulting in a look of deprivation and malnourishment. Other participants discussed experiencing medical problems including

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asthma, heart problems and other physical ailments. Some participants showed the researcher, the impact habitual substance use had on their dental hygiene. Participants smiled to display, missing or rotten teeth, as a result of their continued substance use.

One participant showed how her front teeth had been eroded into an arch, resulting from a continued pattern of smoking the crack pipe. This participants smile, literally looked like her two front teeth, were carved around the shape of the pipe. The participant shared a picture from her earlier years prior to drug use with the researcher, to serve as a comparison of the damage her crack use had on her dental health. Although, the participants were able to disclose in vivid details the negative consequences they endured as a result of their substance use problems; this was initially not enough to make them discontinue their substance use. Therefore, the overall theme emerged, resulting in the substance users’ denial of a substance use problem, despite their many negative consequences. The literature indicates there are three common defense mechanisms used by patients to resist change. “The first defense mechanism is denial- the addict believes he is truthful but is not, the second is rationalization- the addict provides good reasons instead of the true reasons for his use and the third is projection-the addict places blame for use on someone else” (Gillig, 2007, p. 48).

Finding 10: Substance user doesn’t know who to trust.

The participants all reportedly struggled with an uncertainty of knowing, whom they could trust. Substance users struggled with factors regarding, who to trust vs. who not to trust. The participants reasoned that part of their inability to identify trustworthiness in others; stemmed from their exposure to childhood abuse, neglect

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and/or trauma. The participants had been exposed to pain and hurt at an early age within their families of origin. Therefore they developed a certain kind of ‘paranoia’ if you will, about who they felt could be trusted. Some participants explained using marijuana and cocaine, can heighten paranoia in some individuals. This factor coupled with their past exposure to abuse, made determining who was trustworthy, even more difficult to determine. Other participants shared their accounts of going to visit their mother (or other family members) and being confronted with their physical decompensation and disheveled appearance, as evidence of having a substance use problem. Therefore, it was obvious to outsiders (who were sober), the user was obviously in need of professional help. Yet, when the substance user returned to their circle of get high buddies, they would ask a fellow substance user, whether the family member’s assessment of their appearance was accurate? The fellow substance user would then provide a conflictual account of the severity of the participant’s substance use problem. This usually resulted in the participants struggling with a decision regarding, who to believe? The participants did not know whether to believe their mother saying, “Boy you look a mess, go get yourself some help” or their get high buddy saying, “man you look cool, let’s go half on another bag of dope.” This ambivalence around trust seemed to permeate all relationships, experienced by the research participants. Some participants even discussed the importance of knowing who their enemies were, whenever they engaged in substance use. Participants repeatedly reported the role of lying, stealing, cheating and manipulation played in the substance users’ attempts to obtain more drugs and/or alcohol.

Therefore, trust is a key factor that many participants struggled with while actively using drugs and alcohol. Other participants reported struggling with their own decision making

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skills during active substance use. They questioned whether or not their own thinking, could be trusted. The lines of appropriate boundaries, moral values and socially acceptable behaviors all seem to become compromised in the process of actively using drugs and alcohol. People, who would normally be trustworthy, become suspicious characters once they have been identified, as someone who regularly uses substances.

Participants talked about the need to determine whether or not a person could be trusted, to repay money borrowed at a previous get high session. Participants talked about how charming and manipulative fellow substance users become, when they are craving a fix from their respective drugs of choice. Male participants felt the trust factor was especially true regarding female substance users. Male participants discussed the manipulation skills female participants used; in flirtation, sex and charm to manipulate them into providing more drugs or more money for the female substance users. This theme of ambivalence around trust issues seemed to be prevalent in all of the research participants. The literature affirms that “addiction (whether to drugs or alcohol) chemically changes a person’s brain. I mean seriously chemically and structurally changes it. And it is these brain changes that make it impossible for your loved one to change their behaviors when drinking or drugging because the brain controls everything a person thinks, feels, says and does� (Fredericksen, 2013, p.1). The substance user has literally altered their brain through the course of their addiction, therefore impacting their ability to form trusting relationships.

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Finding 11: Substance users seek help.

All of the participants reported their individual decision to seek help for their substance addiction. For each participant, there came a point in their active use of illicit substances, (when only they could decide) whether they were tired of existing in a substance induced haze everyday of their lives. Each participant experienced unique individual circumstances which resulted in their desire to make a change from their previous lifestyle of regular substance use. Participants talked about living life in a dark fog or cloud and becoming emotionally numb to the pain their substance use was causing not only them, but their loved ones as well. Female participants talked about the unintentional pain they caused their children and family members, as a result of their continued substance use. Some participants disclosed near death experiences while actively participating in substance use on a regular basis. They talked about going into bad neighborhoods and avoiding flying bullets, all in an attempt to obtain more drugs.

Participants talked about getting to the point, where they were performing sexual acts/favors for other people in order to obtain money or drugs. Some participants actually talked about being on drug binges for days and weeks at a time. Upon resurfacing from the dope house, they discovered a close family member or friend had died while they were on their drug binge; therefore, no one was able to locate them and/or notify them about their loved ones’ demise. Participants spoke of being incarcerated due to drug charges and missing a loved one’s funeral as a result. These and many other factors played into the individual participant’s desire to seek substance abuse treatment. The researcher must be clear; the path to seek help was unique for each participant. Some participants went to NA/AA support groups to get clean and sober.

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Other participants entered into inpatient substance abuse treatment programs. Some participants used their spirituality and faith; by increasing church attendance and involvement, to help them overcome their substance use problems. Some participants attended intensive out-patient substance abuse treatment programs. Regardless of the particular path chosen by the individual participants, they each made a decision to seek help to stop their habitual substance use problems. The literature reports there were 1.8 million people in 2012 who sought treatment for substance abuse. The Substance Abuse and Mental Health Services Administration reveals “of those people, 701,147 people needed help for alcohol, yet 45% were struggling with the use of alcohol plus another drug. The remainder listed illicit or prescription drugs as their primary problem” (2017, p. 1). The researcher needs to note there are multiple factors which impact a substance users’ decision to seek treatment. However, a formal substance abuse treatment program is not the only option available to achieve sobriety. Some people use self-help groups like NA/AA, or churches and spiritually based programs. Despite the substance user’s individual preference in how to seek help, there are multiple options available to them.

The key factor is, the substance user makes a conscious decision to improve the overall quality of their lives, by seeking help for their addiction and changing their past behaviors.

Finding 12: Substance user re-entry into society.

All of the participants discussed their personal experiences around reintegration back into society, after achieving sobriety. This re-integration was the result of being released from incarceration or being discharged from substance abuse treatment, upon

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successful completion of the program. Regardless of the path taken by the individual participant to re-integrate back into society; the participant experienced increased levels of anxiety and fear when attempting to navigate life soberly without the further use of drugs or alcohol. Participants discussed the conflicting emotions which seemed to become unthawed, after years of substance use which left their emotional state frozen in a position of self-centeredness. Participants discussed having to make amends for all the terrible things they had done while under the influence of drugs and alcohol. Participants had demonstrated a lack of concern for family members and loved ones while they were partying and using drugs/alcohol. Now, the participants were sober and for the first time in many years (in some cases) had to experience the consequences of their drug seeking behaviors; especially as it related to family members they had lied to, stolen from and manipulated out of money to support their drug use. Female participants spoke of the difficulty they experienced with their children upon returning home from treatment.

Participants were confronted with mistrust by their kids and other family members.

People in general did not trust the participants’ commitment to achieving sobriety as sincere. Many participants spoke of the need to ‘prove’ themselves as trustworthy to loved ones. Other participants who had been incarcerated for extended periods of time due to their substance use habits; experienced culture shock upon reintegration back into society. Participants spoke of the changes which had taken place in society, while they were incarcerated. One participant recalled being unaware of cell phones being in existence, upon his release from prison. Therefore, when he got on the bus, he saw people talking to themselves (really on cellular headphones), he was terrified.

Additionally, he did not see the other bus passengers holding anything in their hands, but

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yet they were talking! He also recalls sitting next to a passenger and mistakenly thought the passenger was talking to him and he responded inappropriately. The bus passenger informed the participant, “He was on the phone.” Other participants disclosed feelings of rejection they experienced from loved ones after being discharged from substance abuse treatment; nevertheless, they had no family member willing to allow them to reside inside their homes, due to previous substance using behaviors. This often resulted in participants having to reside in half-way houses or sober living environments.

Regardless of the particular discharge setting the participant found themselves facing upon reintegration back into society, it was an extremely anxiety provoking and fearful experience for them. The participants’ anxiety filled emotions had to be handled, in addition with trying to maintain their sobriety, by avoiding relapse back into substance use. This last phase of the grounded theory model, proved challenging to participants.

Additionally, reintegration back into society is a necessary step, in a participants’ road back to recovery from drugs and alcohol. There appears to be a gap in the literature regarding the specific factors substance users face upon re-integration back into society, upon successful completion of substance abuse treatment. However, there appears to be much more literature available, regarding a person’s re-integration back into society upon release from a correctional facility. This leaves room for future research to be conducted, relative to the obstacles and barriers faced by substance users’ upon completion of drug treatment.

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Experts’ Evaluation of the Model The researcher conducted three exit interviews with experts in the field of substance use and addiction, prior to the conclusion of this study. This was done in an attempt to assess the usefulness of the model and its’ face validity. All three experts gave their permission to be cited in the study. The interviews of Mrs. Carr and Ms. Hartfield took place in their offices of the Illinois Division of Alcohol and Substance Abuse located in downtown Chicago. The interview of Director Theodora Binion took place in her home. All three experts were recruited from their places of employment. The researcher approached each participant individually to request their participation in the study. All three experts agreed to participate in the research and were given a ten dollar gift card from Target for their participation. The researcher presented each expert with a questionnaire during their individual interviews. Each questionnaire which was presented to the expert participants consisted of five questions. The five questions were designed to obtain the experts professional opinion and feedback about the model developed in this study. The five questions were as follows: 1.

Can I have your permission to cite/quote you directly in my dissertation?

2. Based on your experience, are there any parts of the model that seem unclear?

3. Based on your experience, are there any parts of the model that don’t seem to fit the overall narrative or are there misfits?

4. Based on your experience, is this model consistent with your understanding of how children who are abused/neglected/ and traumatized journey down the path to addiction?

5. How would you rate the overall usefulness of this model?

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See Appendix E for a complete example of the expert questionnaire.

As the interviews were conducted, the researcher simultaneously audio recorded them. After the interviews were completed, the researcher uploaded the audio files to a transcription service. After the transcriptions were completed, the researcher listened to the audio recordings while reading the transcripts and making corrections to any errors on the hard copy. Upon successfully proofreading the transcripts, the researcher began to analyze the data obtained from the experts and integrate their recommendations into this study.

Mrs. Lakeisha Carr.

The first expert participant was Mrs. Lakeisha Carr who has worked in the field of addictions for the past 10 years. The researcher had no prior relationship or association with her. Mrs. Carr has functioned as a program monitor for the State of Illinois Division of Alcohol and Substance Abuse. Mrs. Carr had an opportunity to evaluate the grounded theory model developed in this study and provided her professional feedback to the researcher. She indicated this model was clear in conceptualization, as presented by the researcher and also agreed, based on her experience, that the model was consistent with her understanding of how children who are abused/neglected and traumatized; ultimately journey down the path to addiction. Mrs. Carr rated the model as very useful, in her understanding of children who are exposed to childhood abuse, neglect and trauma, later developing problems with substance abuse in adulthood. Mrs. Carr’s professional recommendation was to make sure that the genetic component of a substance user’s family history be included alongside environmental factors. It is her professional

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opinion, the genetic component of an individuals’ make up, is equally important with the environmental factors. According to Mrs. Carr, I believe there is also a genetic component; where even if a child might not be raised by a parent, like, let’s say they are raised by their grandmother. The grandmother has a good healthy environment but father is in the streets, mom is in the streets, and she is not exposed to them using, she still has a higher risk of being addicted to drugs, to me, because there is a genetic component to it (2017).

Mrs. Carr did not find any other recommendations or changes necessary to the model presented from this research.

Ms. Carolyn Hartfield.

The second expert participant was Ms. Carolyn Hartfield who has 26 years of experience in the field of addiction. The researcher also had no prior relationship or association with her. Ms. Hartfield has functioned as a recovery support specialist for the Illinois Division of Alcohol and Substance Abuse for the past 16 years. Ms. Hartfield indicated the grounded theory model presented in this research was clear and consistent, with her understanding of how children who are abused/neglected or traumatized journey down the path to addiction. Ms. Hartfield rated this model as useful in her field of addiction recovery. Ms. Hartfield did not recommend any changes to the model.

However, she verbalized her professional opinion regarding the participants’ reintegration back into the community. She wanted to make sure the researcher understood, “substance users have skills but they need to be made aware of them prior to reintegration.” Ms. Hartfield also shared another professional opinion regarding the

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people who work in the field of addictions. It was her belief that many professionals have pre-conceived notions about the substance users’ lack of skills when they are actively using substances. She believes this to be especially true, if substance users are court ordered to treatment. Ms. Hartfield stated, “Many professionals think if a substance user is mandated (court ordered) to treatment, the substance user does not want to change.” Ms. Hartfield strongly disagrees with this idea. She shared her experience in the field of addictions regarding treatment agencies. It is her professional opinion, “that many treatment agencies tend to group all substance users in one category; these professionals need to keep their pre-conceived ideas about the individual substance users to themselves and ultimately deal with substance users as individuals!”

Ms. Theodora Binion.

The third expert participant was Ms. Theodora Binion who has 25 years of experience in the field of addictions. Like the other experts, the researcher had no prior relationship with her. Ms. Binion functioned in the role of the Director for the State of Illinois Division of Alcohol and Substance Abuse for 12 years prior to her retirement last year. She also served as the Director for the State of Illinois Division of Mental Health simultaneously for three years prior to her retirement. Director Binion indicated the model was clear and conceptually relevant to the field of addiction. However, she had concerns about the small sample size of 20 substance using participants. Her initial impression of this study was the sample size needed to be larger in order for it to be generalized to the substance use community. Director Binion indicated the model developed from this research could be useful. However, she firmly believed there are

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some limitations to the generalizability of this model. She strongly believes there is a predisposal factor at work, in some substance users’ propensity to develop an addiction to substances. Director Binion also shared another professional opinion about the limitations of this study. She was concerned the model did not account for resiliency factors that some substance users possess, while others do not. She shared an example of a substance user who achieved sobriety without going to treatment; instead the substance user may have used church and their religious beliefs to achieve sobriety. Director Binion also discussed the implications of an individual substance user’s motivation to achieve and maintain sobriety, could be very different across socio-economic classes.

She gave an example of some wealthy doctor or lawyer, living in Wilmette (an affluent suburb) being more motivated to change their substance using behaviors, because they have more at stake and ultimately more to lose than another substance user who lives in a poverty stricken community. She further believes poverty is such a big factor for many substance users. Therefore, it is her professional opinion that, “there are greater adverse consequences to substance abuse in some populations.” Overall, Director Binion believed the grounded theory model developed in this research could be useful in potentially treating substance users. However Ms. Binion believes, “If we only think of substance abuse as a physiological or psychological problem, we miss the boat; we have to address the issue of substance abuse/addiction being a physical disease.” Director Binion believes this model has the potential to be useful in treating addiction, but further research is needed to account for additional factors including poverty, resiliency and predisposition to substance abuse.

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The Researcher’s Assumptions Prior to Conducting this Study The researcher made two assumptions prior to the beginning of conducting this study. The two assumptions are as follows;

Assumption #1.

Abuse and neglect experienced as a child increases the likelihood that such a child will develop substance use as an adult. The researcher’s assumption was based on the premise that any type of childhood abuse, neglect and/or trauma will impact subsequent developmental phases.

It is this researcher’s findings based on the data obtained in the interviews, that this assumption is true. Children, who experienced exposure to childhood abuse and/or neglect, are at increased risk for developing substance use problems in adulthood. All twenty of the participants of this study experienced exposure to childhood maltreatment.

Consequently, each of the participants later developed a problem with substance use in adulthood.

Assumption #2.

Depending on the severity, exposure to childhood trauma will increase the likelihood that such a child will develop substance abuse as an adult, because any traumatic event experienced will impact subsequent developmental phases.

It is this researcher’s finding based on the data obtained in the interviews, that this assumption is true. Participants of this study discussed the traumatic experience, of losing their mother to death in early childhood. These participants openly reported the

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death of their mother’s, became a turning point in their early childhood development.

The loss of nurturing and affection previously provided by their mothers’ had an overwhelmingly negative impact on their subsequent developmental years. The participants reported an overall change in their personality and their compassion level for other people, severely decreased. Growing up without a mother, made the participants feel unloved and unwanted by surviving parents (usually fathers). Therefore, the participants report they lost a desire to impart love to others (especially the surviving parent). The lack of a mother’s love and guidance often left the young child adrift without direction and guidance from another invested adult. Sometimes, older siblings attempted to step in and fill the void created by their mother’s death. However, the participants of this study indicated a sibling can never fill the void of a deceased parent.

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Chapter 6

Conclusion and Recommendations

Implications for Social Work The research in this study has large implications for the field of social work. The findings indicate there is a connection between childhood exposure to abuse, neglect and/or trauma and developing substance abuse problems in adulthood. Therefore as clinicians, this information can prove extremely helpful in identifying children who could be potentially at risk, for developing substance use problems in later developmental years. Additionally as clinicians, there is a constant increase in the patients who present for help with substance abuse problems. Social workers need to be informed of the etiology of not only the problems with addiction, but also the contributing factors children experienced in their early developmental years. Social workers need to understand that each patient who presents for help is struggling with multiple factors, before they even reach the path to addiction. Therefore, social workers should be equipped to support and provide emotional attunement to these patients. Social workers also have to handle the emotional problems which lay dormant in each person, prior to the crisis that prompts them to seek professional help. Ultimately, the social worker is charged with not only dealing with the presenting problem, but also the problems from

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childhood which was never addressed (professionally). Overall, the social worker needs to understand the impact childhood abuse, neglect, and/or trauma may have, on an adult struggling with substance abuse problems. Therefore, the greatest implication for the field of social work is the importance of future research being needed, to understand the multiple factors confronting individuals struggling with addiction.

Theoretical and Clinical Implications The research conducted in this study has provided insight into the childhood factors; which may contribute to an adult, developing substance use problems in adulthood. The participants have consistently revealed their childhood exposure to abuse, neglect and/or trauma during their early developmental years; have directly or indirectly, impacted their decision to use illicit substances. Although, some participants of this study lacked insight, into the exact reasons for their problems with substances; they all agree their exposure to childhood abuse, neglect and/or trauma during their early developmental years impacted their self-worth, self-esteem and ability to handle psychosocial stressors. According to Kohut, an infant’s development follows from the caretaker’s capacity for providing empathy/affective attunement with her child. This empathy is at the essence of an individual’s self-cohesion (1996). Therefore, if a child grew up in an environment where they were exposed to repeated episodes of childhood abuse, neglect and/or trauma; these children essentially did not develop the self-cohesion, necessary to develop adequate coping skills in later developmental phases (including adulthood). If children did not receive adequate nurturing and guidance through their early developmental years, it impacted their later development into adolescence, as well

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as adulthood. As previously discussed in the major findings of this study; the participants’ early exposure to childhood maltreatment impacted later developmental phases in their life. Additionally many participants of this study revealed some form of insecure or disorganized attachment, in their early developmental years. Therefore, the researcher observed a pattern amongst substance user participants displaying problems with forming secure attachments in adulthood. Therefore, it serves to reason, substance users who experienced childhood exposure to abuse, neglect or trauma, also suffered from problems in forming secure attachments in their early childhood development, according to Attachment Theory.

Some participants believe they would have experimented with drugs and alcohol merely because of the environment they grew up in. While other participants believe, it was the feeling of acceptance they received from fellow substance users, which encouraged their continued substance use. Additionally, the euphoria they experienced, resulting from their particular drug of choice, helped propel them into a path towards addiction. The participants also discussed their need to escape, their painful childhood memories of abuse, neglect and/or trauma. While their exposure to childhood abuse, neglect, or trauma, are certainly not the only factors, which impacted their desire to use and ultimately become addicted to substances. They consider their exposure to adverse childhood experiences to be a major contributing factor in their problems with addiction in adulthood.

Their maltreatment resulted in them developing a faulty coping system in childhood.

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Therefore, in adulthood, they struggled with affect regulation, transition states and mentalization. Their failure to develop the ability to mentalize as adults is in direct response to their inability to mentalize as children. A majority of the participants talked about using drugs as their coping mechanism. They emphatically stated, without drug use, they did not cope with life at all. Their desire to seek drug treatment and achieve sobriety; was basically their first attempt to cope with life in adulthood (prior to addiction), without numbing themselves to the realities they were being confronted with on a daily basis. According to E. J. Khantzian’s, “Self-Medication Hypothesis (SMH), a psychoanalytically informed theory of substance addiction that considers emotional and psychological dimensions, substance addiction functions as a compensatory means to modulate affects and self-soothe from the distressful psychological states” (2003, p. 518).

The literature supports the finding that individuals who abuse substances, struggle with handling their own affective states. This inability to regulate their affective states can be traced back to childhood abuse, neglect and/or trauma according to the literature.

According to Christopher Bollas, affect regulation is achieved as a result of the infants’ earlier experiences of the object (1987). This implies the painful reality these children experienced in their early developmental years; caused a rupture in the abused child’s psychic development. For example, a participant who reported repeated sexual abuse by her father, could not develop the ability to regulate her own affective states because of the sexual abuse and trauma, she suffered on a repeated basis, at the hands of her own father.

If the father did not provide the necessary functions in order for the child to develop a cohesive sense of self; this would leave the child struggling in later developmental phases. Participants lacked feelings of self-worth and self-esteem in their earlier years.

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Therefore, this feeling of worthlessness continued into their adulthood. These feelings of inadequacy were compounded if the other parent in the home, failed to provide much needed protection, to the abused or neglected child. Therefore, this child grew up with no sense of value within the family system. This was further compounded in adulthood after exposure to substances occurred. While attempting to numb their painful affective states, the participants also suffered the double trauma of rejection by family members/friends following their addiction to substances. Once compounded by the negative consequences related to the substance user’s negative behaviors; ultimately the participants went further into their addiction, because their current feelings of rejection only reactivated the childhood memories of abuse, neglect or trauma. Frenchy, a female participant in the study put it this way, “Why didn’t they value me”? All people in life want to feel valued by someone close to them. Children, who suffered exposure to childhood abuse, neglect, and/or trauma did not feel valued within their families of origin. Therefore, they grew up with feelings of inadequacy. Once they became engaged in regular substance using behaviors, this only heightened their sense of being marginalized by the people closest to them (family/friends). Overall, children who experienced any type of maltreatment in childhood are at risk for developing substance use problems in adulthood.

Validity The researcher was able to develop a grounded theory model based on the interviews of the participants of this study. As a result, the model was presented to three experts in the field of addiction. These experts had an opportunity to examine the model developed in this grounded theory study for a face validity check. The experts based on

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their years of experience in the field all agreed the model was valid based on their professional understanding of addiction. The experts all verbalized their understanding of the factors which contribute to a child’s exposure to abuse, neglect and/or trauma; can ultimately have by impacting a person’s decision to engage in the consumption of alcohol and illicit substances. The model developed in this research was rated useful by two of the expert participants and rated very useful by one of the expert participants. According to Hammersley, “validity represents accurately those features of the phenomena that is intended to describe, explain or theorize” (1987, p.73). Based on the data obtained in this study and the interviews with three expert participants; this grounded theory model is valid based on the findings of this study.

Limitations The research conducted in this study was based on a qualitative method of inquiry. Therefore, the findings are not generalizable to society as a whole. This is largely in part due to the subjectivity of the participants and the researcher. Additionally, the sample size of 25 participants was inadequate, to generalize to the larger population of substance users. Another limitation of the study was the small mix of diverse ethnic groups who participated in this study; was not adequate to make findings which could be used across all ethnicities. Additional factors which may have impacted the findings of this study did not include factors such as: resiliency, poverty, and/or or intergenerational factors were not explored in this study. Therefore, additional research is needed to gain a more comprehensive view of the additional factors which may play a role, in people developing a problem with substance abuse in adulthood.

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Researcher’s Reflections The researcher is pleased with the overall grounded theory model which was created from the data analysis of this study. The research questions initially sought, in this inquiry were answered, based on the findings of this research. The grounded theory model developed in this study appears to be a useful place to start comprehending the factors which impact people struggling with addiction to substances in adulthood.

Additionally, the model will be helpful in the researcher’s future efforts; to effectively understand and treat the population of people who struggle with addiction to substances.

Additionally the researcher’s knowledge, that this population endured such painful and traumatic experiences during childhood, will always make the researcher remember the importance of being non-judgmental and more compassionate towards people struggling with addiction to illicit substances. The researcher feels it was an honor to be given the opportunity to sit with these 25 participants, as they shared their lived experiences relative to their exposure to childhood abuse, neglect and/or trauma. The information obtained in the interviews was very personal and sensitive in nature. The researcher was moved by the experiences the participants shared during their individual stories and the level of honesty they disclosed, will forever be a life changing experience as a novice researcher and a senior clinician. This experience has increased the researcher’s desire to conduct future research on this topic.

Implications for Future Research This study has only scraped the surface of the multiple factors, which may contribute to someone developing a substance use problem in adulthood. However, the

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data indicates there is a strong relationship between childhood exposure to abuse, neglect and/or trauma and the development of a substance abuse problem in adulthood. This research concluded with the development of an emerging theoretical model. Hopefully, this research will encourage other professionals in the field to continue investigating, the phenomenon of adult substance use and its’ relationship to early exposure to childhood abuse, neglect and or trauma. Any further research should explore the recommendations of Director Binion; there needs to be further study on the impact of resiliency among the substance users’ population, along with an inquiry into the role of poverty among this group. According to Dr. Alan Leschner, Director of NIDA he indicates determining “the exact relationship between child abuse and drug abuse is exceedingly difficult given the role that variables such as poverty, family dysfunction, the level of social support for victims, or the child’s gender and age play” (1998, p. 1). The current gap in the literature leaves much room for further exploration into this subject matter.

Conclusion The data collection and data analysis conducted in this study proved to be a very rich source of data. The participants shared their lived experiences from their exposure to childhood abuse, neglect and/or trauma; relative to developing a problem with substance abuse in adulthood. The experiences provided by the research participants, shed much light on the painful experiences these individuals suffered at the hands of their parents, during their early childhood development. Their childhood experiences were traumatic at the very least. These young children experienced maltreatment in various forms of abuse: including verbal, physical, emotional and sexual abuse. These atrocities were

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unimaginable for any child to endure (especially on a repeated basis). Additionally these young children suffered neglect including being left home alone to fend for themselves and younger siblings, without food or clothing. As if these painful experiences were not enough; these young children also suffered various forms of traumatic experiences and some included complex trauma. Overall, the researcher has one professional recommendation for anyone working with the population of substance abusers; these individuals need to be treated with the utmost respect. Professionals should be extending an additional dose of compassion, to this population. Substance users have more than likely experienced the depths of hell in their childhood; they also took a second trip back to hell, during their addiction. As helping professionals, there needs to be no judgment or condemnation against this group of people. Instead, professionals should extend them extra empathy because of their fight and determination to survive, despite growing up in hell. Not to mention they have been living in hell, for a significant part of their adulthood (as a result of their addiction)!

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Appendix A Sample Script for Substance Abusers

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Appendix A Sample Script for Substance Abusers Upon receiving phone calls from interested parties, the researcher will provide an overview description of the research by verbalizing the following script. “My name is Teresa Glaze-Shields and I am a clinical social worker conducting research in partial fulfillment of my dissertation. I am conducting research about adult substance abusers who have experienced some form of childhood abuse, neglect or trauma. I would like to interview you at a later time established by both parties to discuss your life experiences.

The interviews will last approximately 1 hour to 1 hour and 30 minutes. There may be a need to contact you for a future follow-up interview (later on in the research process).

You will be compensated for your time by participating in the research. I will provide $10-$15 gift cards from Wal-Mart as compensation. I will offer $15 gift cards to actual substance abusers and a $10 gift card to family members and experts. If at any time you feel that you want to discontinue participation, you may drop out at any time with no penalty. You will still be given the incentive for participation regardless of completion in this study. The informed consent forms will be discussed and signatures will be obtained from participants. Confidentiality will be discussed and the participants will be informed that their identities will be protected at all times during the research. Their true identities will never be disclosed in the research process.� Participants will be informed that their identifying information will be removed from all notes. If a tape recording device is allowed for the interview, the participant will be informed, the recordings will be erased once the transcription is completed. If the participants agree to participate and the

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appropriate consent forms have been signed, the researcher will schedule individual interviews with the participants to begin gathering data.

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Appendix B Sample Script for Family/Friends of Substance Abusers

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Appendix B Sample script for family/friends of Substance Abusers Upon receiving phone calls from interested parties, the researcher will provide an overview description of the research by verbalizing the following script. “My name is Teresa Glaze-Shields and I am a clinical social worker conducting research in partial fulfillment of my dissertation. I am conducting research about adult substance abusers who have experienced some form of childhood abuse, neglect or trauma. However, I am also interested in the views and opinions of family members and friends impacted by the behaviors of adult substance abusers close to them. I would like to understand from their perspective the ways in which substance abusers have made an impact on their life. I would like to interview you at a later time established by both parties to discuss your life experiences. The interviews will last approximately 1 hour to 1 hour and 30 minutes.

There may be a need to contact you for a future follow-up interview later on in the research process. You will be compensated for your time in participating in the research.

If at any time you feel that you want to discontinue participation, you may drop out at any time with no penalty. You will still be given the incentive for participation regardless of completion in this study. The consents will be discussed and signatures will be obtained from participants. Confidentiality will be discussed and the participants will be informed that their identities will be protected at all times during the research. Their true identities will never be disclosed in the research process.� If the participants agree to participate and the appropriate consent forms have been signed, the researcher will schedule individual interviews with the participants to begin gathering data.

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Appendix C Interview Guide for Family Members

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Appendix C Interview Guide for Family Members

1. Tell me a little bit about yourself.

2. Tell me a little about the person you would like to talk about who is substance user and also, talk about your recollection, their experiences of abuse, neglect and/or trauma as a child.

3. What was it like in the household for _______ growing up?

4. Can you tell about ______’s parents or caregivers?

5. How do you know that _______ was abused, neglected and/or traumatized as a child?

6. Tell me a little about _______’s substance use.

7. What kind of drug do they use?

8. How often do they use it?

9. What kind of consequences has _____ experienced because of their drug use?

10. Do you have a good relationship with ______? Please explain.

11. How has ______’s drug use affected your relationship with him/her?

12. Are you surprised that _____ grew up to be a substance user? If yes, Why?

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Appendix D Interview Guide for Substance Users

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Appendix D Interview Guide for Substance Users

1. How do the participants remember their developmental experiences that include abuse and neglect or trauma?

2. Tell me about what it was like growing up in your home.

3. Tell me about your parents or caregivers.

4. How were you treated as a child?

5. How were you disciplined as a child?

6. How do you think about these past experiences?

7. When you recall these experiences how do you feel?

8. Do these feelings play into your desire/need to use substances?

9. What other types of things play into your desire to use substances?

10. As an adult, what purpose does the use of substance serve?

11. Have you ever tried to quit before? If Yes, why didn’t it work?

12. What has made it difficult in your adult life to not use substances?

13. If you had not been abused, neglected or traumatized as a child, do you think your life would be different today? If yes, how do you think it would be different?

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Appendix E Expert Questionnaire

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Appendix E Expert Questionnaire 1. Can I have your permission to cite/quote you directly in my dissertation?

Yes No If No, what should I call you? _____________________________

To start, I’m going to explain the model to you. I’ll from one major concept to the next and I’ll illustrate the cases from my study.

2. Based on your experience, are there any parts of the model that seem unclear?

Yes No If Yes, which parts?___________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ __________________ 3. Based on your experience, are there any parts of the model that don’t seem to fit the overall narrative or are there misfits?

Yes No If Yes, which parts?___________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ __________________ 4. Based on your experience, is this model consistent with your understanding of how children who are abused/neglected/and traumatized journey down the path to addiction?

Yes No If No, how is your understanding different?________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ __________________

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5. How would you rate the overall usefulness of this model?

1 –Very useful 2-Useful 3-Somewhat useful 4- Not currently useful If expert made recommendations for changes, ask them if they would be willing to review a redraft and explanation of the new model. Yes/No

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Appendix F Substance Abuse and Victimization Survey Questionnaire

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Appendix F Substance Abuse and Victimization Survey Questionnaire

ID#_______ Introduction My name is Teresa Glaze-Shields. I am a Doctoral student at The Institute for Clinical Social Work. The purpose of this survey is to gather information about people who are recovering from substance abuse and also have a history of childhood trauma.

Instructions Please circle the number that best represents your response. Please select one response only to each question.

What is your gender?

1...................... Female 2......................... Male 3……………………….Other 1. I am ______ years old.

2. Race __________________ 3. Marital status ______________ 4. Education level 1. Have you ever been the victim of physical or emotional abuse?

1............... Yes 2................. No If yes, how old were you when the abuse started? ___ years old

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2. Were you ever neglected as a child?

1............... Yes 2................. No If yes, how old were you when the neglect started? ___ Years old 3. Have you ever used illegal drugs or alcohol?

1............... Yes 2................. No 4. If yes, how old were you when you started using illegal drugs or alcohol? ____ years old 5. Have you ever witness anyone abuse or neglect a child?

1............... Yes 2................. No 6. Did your mother/father/caretaker humiliate or ridicule you during childhood?

1............... Yes 2................. No 7. Did your mother/father/caretaker yell at your during childhood?

1............... Yes 2................. No

8. Did your mother/father/caretaker make you feel like a bad person while growing up?

1............... Yes 2................. No

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9. Did you ever receive physical spankings, punches or hits from parents/caretaker during childhood?

1............... Yes 2................. No

10. Were you ever sexually abused or violated during childhood?

1............... Yes 2................. No

Please fill in the blank with your most appropriate response, to each question below.

11. What is your drug of choice? ______________________________________ 12. How often do you consume drugs or alcohol? _________________________ 13. How strong is your substance abuse dependency?

Very strong____________________ Strong________________________ Neutral_______________________ Weak________________________ Very Weak____________________ 14. Have you ever suffered any negative consequences related to your drug use? ______________________________________________________________

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15. Do you know what contributing factors led you to use drugs/alcohol? ______________________________________________________________ 16. Do you know the factors which trigger your desire to use drugs/alcohol? ______________________________________________________________

Thank you for participating in my survey. Your participation will help me accomplish my educational goals. Please return all completed surveys and consent forms to Teresa Glaze-Shields upon completion.

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Appendix G Individual Study Screener

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Appendix G Individual Study Screener Pseudo Name: _____________________ Introduction I’m now going to collect a survey from you. The purpose of this survey is to help me screen you for my study.

Instructions Please place a check next to the response that best represents you. There are no right or wrong answers.

1. What is your gender? ____ Female ____ Male ____ Other: ________________________ 2. I am _____ years old.

3. My race is: ____ Asian ____ Black ____ White ____ Other: _________________________ 4. My ethnicity is: ____ Hispanic or Latino ____ Not Hispanic or Latino 5. My marital status is: ____ Married ____ Common law ____ Domestic partnership ____ Divorced ____ Separated ____ Single ____ Other: ________________________

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6. My education level is: ____ Less than high school ____ High school diploma ____ GED ____ Some College with a high school diploma or GED ____ College degree ____ Other: _______________________ 7. Have you ever been the victim of physical or emotional abuse? ____ Yes ____ No If Yes, how old were you when the abuse started? _____ years old 8. Were you ever neglected as a child? ____ Yes ____ No If Yes, how old were you when the neglect started? _____ years old 9. Have you ever used illegal drugs? ____ Yes ____ No If Yes, how old were you when you started using drugs? _____ years old 10. Have you ever used alcohol? ____ Yes ____ No If Yes, how old were you when you started using alcohol? _____ years old 11. Have you experienced any negative consequences as a result of your drug or alcohol abuse? ____ Yes ____ No

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If Yes, please describe: (If No, possibly not a good candidate for the study) ________________________________________________________________________ ________________________________________________________________________ ____________ 12. What is your drug of choice? _________________________________________ 13. How often do you consume drugs? ____________________________________ 14. How often do you consume alcohol? ___________________________________ 15. How strong is your substance abuse dependency? ____ Very strong ____ Strong ____ Neutral ____ Weak ____ Very weak 16. When you were a child, did you ever witness someone being abused or neglected? ____ Yes ____ No If Yes, how old were you when you witnessed this? _____ years old 17. Did your mother/father/caretaker frequently humiliate or ridicule you during childhood? ____ Yes ____ No 18. Did your mother/father/caretaker frequently yell at you during childhood? ____ Yes ____ No 19. Did your mother/father/caretaker make you feel like a bad person while growing up? ____ Yes ____ No 20. Did you frequently receive physical spankings, punches or hits from parents/caretakers during childhood?

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____ Yes ____ No 21. Is there any other type of abuse you experienced that you’d like to share with me? ____ Yes ____ No If Yes, please describe: ________________________________________________________________________ ________________________________________________________________________

End of survey – thank the participant. If you automatically feel they are a good fit, invite them to be participant in your study and set up an interview time and place. If not, tell them based on how they responded to the screening questions, it does not sound like they would be a good fit for your study. You may offer them a summary of the results of your study at study completion. If they want this, get their email or mailing address.

Name: ______________________________________ Address: ____________________________________ City: ________________________________ Zip code: ____________________ Email: _________________________________________

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Appendix H Family Study Screener

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Appendix H Family Study Screener Pseudo Name: _____________________ Introduction I’m now going to collect a survey from you. The purpose of this survey is to help me screen you for my study.

Instructions Please place a check next to the response that best represents you. There are no right or wrong answers.

1. What is your gender? ____ Female ____ Male ____ Other: ________________________ 2. I am _____ years old.

3. My race is: ____ Asian ____ Black ____ White ____ Other: _________________________ 4. My ethnicity is: ____ Hispanic or Latino ____ Not Hispanic or Latino

5. What is your relationship to the substance user? ____ Family (Please identify relationship) ______________________ ____ Friend ____ Other: ____________________________

6. How often has the substance users’ addiction impacted your life? ____ A great deal

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____ A moderate amount ____ Occasionally/Sometimes ____ Almost never ____ Never 7.

How many years has your friend/family member struggled with addiction? ____ Years

End of survey – thank the participant. If you automatically feel they are a good fit, invite them to be participant in your study and set up an interview time and place. If not, tell them based on how they responded to the screening questions, it does not sound like they would be a good fit for your study. You may offer them a summary of the results of your study at study completion. If they want this, get their email or mailing address.

Name: ______________________________________ Address: ____________________________________ City: ________________________________ Zip code: ____________________ Email: _________________________________________

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