The day a story about three major opioid manufacturers winning in court plastered my Facebook newsfeed, a picture of my niece when she was fourteen showed up in my memories.
In the picture, she stands in front of a mural of an ocean scene with a lighthouse that was supposed to be inspirational; that's where the group home staff insisted we take pictures of the children we visited. Krystal was genuinely happy in the picture. She knew I drove two hours each way to see her, and at the time I took the photo, no one else had done that. Nothing she could do with her blonde hair or baggy red sweatshirt could make her look older; she was one of the youngest kids at the facility.
When I shared that picture, she was somewhere in a cycle of jails, shelters, and rehabilitation facilities that dominated her adult life. But today was the first time Facebook reminded me of the image since those bright blue eyes closed forever, and she was found face down in a ditch, blonde hair forming a veil around her frame.
The official cause of death was an overdose.
Understanding our pernicious problem: Drug abuse crisis in America
I was nine when Nancy Regan proposed we end the crack epidemic and, by extension, other illegal drug abuse, by "just saying no.” it seemed as good a solution to the problem as any.
Throughout the 1990s, occasional voices explaining that the people most likely become addicted to drugs, and stay addicted, were people who had experienced abuse as a child and/or suffered mental illness occasionally rose through the din. But the "just say no" and "arrest people left and right" answers were much simpler to make into sound bytes.
Amazingly, people still use illegal drugs and drug abuse continues to be a pernicious problem of our society.
The ACE Study breakthrough
In 1999, I was doing a final paper for my sociology classes. I came across a paper entitled "Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study."
It was recent and reiterated everything I'd heard, read, and seen. I intuitively understood the connection between child abuse, drug abuse, addiction, and many other things.
The ACE Study documented the scope of child abuse as much more significant than anyone else had. Using self-reports, principal investigator Dr. Vincent Felitti reported that ⅔ of middle-aged, middle-class people in his sample had experienced at least one life-altering childhood trauma.
When I cited the ACE study in a preliminary draft of my paper, my professor simply couldn't believe I was interpreting it correctly. He was a kindly, gentle man, and I decided it would be kinder to remove the citation than to walk him through the study.
A few years later, I married into Krystal's step-family. Like many abuse survivors, the idea of having my own family had a magnetic draw. If I could fill it with other children like me, so much the better. Krystal fit the bill; her father was abusive to his partners (Krystal's mother and subsequent partners), and he had his part in alcohol and drug abuse. Krystal's mother was emotionally abusive; she lived in a house where there wasn't always food, power, or a working phone. Krystal never felt valued or protected at her mother's house; she never felt safe anywhere.
On her 13th birthday, her mother gathered Krystal's possessions into a garbage bag, drove her to her father's house, and said, "I can't handle her anymore." A few months later, her father went to jail, his girlfriend sent Krystal back to her mother's house, and her mother placed her in the group home.
A straightforward way to kill the pain
The ACE study proved that ten childhood traumas caused many negative health consequences. Subsequent research showed some of the neurological and cellular mechanisms for that. Brains that grow when a child is regularly afraid for their life are optimized to prioritize short-term survival and comfort. Brains wired for fight-or-flight crave calming; brains wired for disassociation crave stimulation and intensity.
And there's an even more straightforward way to explain it all: ACEs hurt.
Being physically hurt. Being emotionally hurt. Being unprotected (which feels a lot like being unloved, the ultimate hurt). Watching a partner endanger a parent's life, which feels like a threat against your own life and an act of hatred from the victimized parent because how can they not realize it's killing you to watch this? It hurts.
Watching a parent's ability to love and teach and parent get subsumed by a drug or a mental illness is an agony. It's agonizing at the moment; it's agonizing to reflect on it minutes or decades later.
The loss of love, guidance, moments that make you feel normal, and opportunities to feel connected to the people you most need a connection to are incredibly painful.
There are countless ways to try and cure pain; drug abuse—consuming chemicals designed to do so is perhaps the most straightforward.
Ironically, the behavior that Krystal's mother cited as most intolerable, that she used to justify placing her into foster care, was dabbling with marijuana.
Why do people abuse drugs? Drug abuse causes in the intergenerational cycle of trauma
The ACE study forever laid to rest the cruel debate about which kinds of child abuse, maltreatment, and trauma are worse; all ten of the ACEs, individually and in combination, contributed identically to adverse adult outcomes.
This study also broadened our understanding of how poor outcomes, like criminal-justice involvement, addiction, poverty, etc, are passed through the generations. In other words, this is the intergenerational cycle of trauma and its consequences.
Effects and dangers of drug abuse
Childhood trauma and drug abuse are closely related. It can look like this:
Heroin-addicted parents subject a little girl to physical abuse, sexual abuse, and physical neglect (she doesn't consistently have food and supervision, and she has very little access to medical care). She now has an ACE score of four. She grows up committed to breaking the cycle of abuse and dysfunction. She gets pregnant and stays with the baby's father, even though he's abusive. She struggles with depression and finds painkillers and alcohol are good ways to cope with it. And while she refuses to hit her children, she relies heavily on screaming, fear, and humiliation to make her children obey her, which constitutes psychological abuse. So, while trying to be a better mother, she has bestowed upon her children the same ACE score she has.
Krystal always wanted to do things her way. Like me, like so many of us, she craved healing through starting a family. Like her mother, she chose a violent man addicted to drugs as the patriarch. His violence worsened her mental illnesses and her substance abuse. She bounced from jail to friends' couches to shelters. There is no way her babies could have felt safe. And she knew it; she knew it was her fault that child after child was winding up in foster care; Kyrstal hated herself for it, and to deal with the hatred, she used more drugs.
How does drug abuse affect families?
Since child abuse became a public policy issue in the 1970s, we've viewed it as a “kids vs. parents," "good vs. bad" problem.
Parents who bestow ACEs on their children don't do it because they're evil; it's mostly pain and trauma all the way down, the wounded wounding the vulnerable.
Krystal's mother was a poster child for this. She wasn't a monster, she loved Krystal and her other kids. She had trouble bonding with the children of someone who treated her violently,a known issue among domestic violence survivors. Her next partner wasn't a wellspring of empathy and understanding. And based on a thousand little things she mentioned, I don't think her first 18 years were all that great. Divesting yourself of a child is not normal; it is simply not something parents do unless they're parenting through many scars. She was doing the best she could, but it wasn't good enough from Krystal's perspective.
Supporting wounded parents and preventing child abuse
As child abuse became a public policy issue, researchers learned how to prevent it. Not through the criminal justice system, not through federal child protective systems, but by supporting wounded parents long-term.
A suite of programs collectively known as Maternal Home Visiting Programs work by pairing isolated, stressed and likely traumatized new mothers with a professional who supports them. These programs do many valuable things like lift mothers from poverty and lower maternal mortality.
They also prevent abuse. Maternal Home Visiting Programs break the cycle.
I came across the ACE study in college because I was trying to understand why the world knew how to prevent child abuse before I was born and didn't. The college lauded me for my paper, but I didn't have an answer then, and I don't have one now. I know that 20 years ago, when I started educating legislators about these programs, they kept a stranglehold on funding, ensuring no more than 5% of eligible families received them. I know those numbers haven't changed. I know Krystal wasn't able to enroll with any of her babies.
How to control and prevent drug abuse in America? It’s all about the pain
Krystal lived with me briefly after group home before returning to her mother. She was the first one who told me that heroin was supplanting crystal meth as the predominant drug in her hometown.
As time passed, reporters, sociologists, and documentarians verified her observation in rural Pennsylvania and across the country. “The Opiate Crisis," as we now know it, was primarily responsible for over 100,000 deaths in 2021.
Yes, some big corporations did horrible things and should be held accountable. But proximity to drugs or drug dealers doesn't cause addiction, and at least 75% of people addicted to opiates didn't get addicted through legal prescriptions—people in pain turning to a chemical designed to treat pain; that's predictable.
The opiate crisis supplanted the methamphetamine crisis, which superseded the crack cocaine crisis. And I can’t guess the next chemical de jour that hurt people will choose as a treatment for their pain. But I know there will be one; this isn't about the chemical; it's about the pain.
Why do we want to stay trapped in an eternal cycle of abuse?
As long as we ignore the best tool for breaking these cycles of intergenerational trauma, we will have more traumatized children. And more traumatized adults. More people seeking to treat pain with chemicals designed for that purpose. More hurting people who are desperate to withdraw from the world in fear or destroy it in their rage.
Krystal's three children are in foster care. Foster care is a badly broken system with atrociousoutcomes, but at this point, efforts to fix it are like rearranging seating on the Titanic. Their lives are requisition orders for poppy seeds to be planted in a distant land. Or requisition orders for bullets, either aimed at themselves or the cruel world in which they dwell. Their names are likely to spend years on waiting lists for SSI, SSD, and public housing because being broken in a thousand places doesn't lend itself to gainful full-time employment.
I still try to educate legislators about how crucial it is to invest in the Maternal Home Visiting programs that prevent childhood trauma. I can tell them that I watched the requisition order for the current batch of poppy seeds get generated and that their failure to support these programs ensures another set. Sometimes it works.
But we like simple answers.
We want short-term projects.
We like hating bad guys.
We like to judge.
And, when we do, it ensures more pain and lives trapped in an eternal cycle of abuse.
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