Adverse Childhood Experiences Increase the Risks for Developing Major Depression and Substance Use Disorder in Older Adults: Implications for Addiction Therapy
Review of “Kim, Y., Kim, K., Chartier, K. G., Wilke, T. L., & McDonald, S. E. (2021). Adverse Childhood Experience Patterns, Major Depressive Disorder, and Substance Use Disorder in Older Adults. Aging & Mental Health, 25(3), 484-491. Available at https://www.tandfonline.com/doi/abs/10.1080/13607863.2019.1693974?journalCode=camh20”
Background
Multiple studies document how adverse childhood experiences (ACEs) rewire a child’s brain and alter the neural networks. The changes are toxic, profound, and enduring. The changes impact a person’s thoughts, feelings, and responses (Herzog and Schmahl, 2018) and color their physical and emotional lives for long afterward. The findings of the study under review provide evidence that ACEs increase the risks for developing major depressive disorder (MDD) and substance use disorder (SUD) in older adults.
SUD therapy must be tailored to an individual’s unique situation. It must not only address physical symptoms but also the underlying causes of the disease. The treatment mode(s) adopted should identify the emotional triggers of addiction and help individuals change their perceptions and thought patterns and alter their destructive behavioral responses and coping mechanisms. It is thus critical that psychotherapists and counselors get to the exact root cause of the SUD. They should keep in mind the findings of the present study and investigate if their older patients have a history of ACE(s).
The trauma of an ACE is deep-seated, and the resulting changes in the neural networks mean that an individual’s problematic coping mechanisms get embedded in the limbic system. It is that region of the brain that learns and holds on to responses that it believes is essential for survival, such as fight-or-flight responses. These responses are difficult to unlearn, and therapists and psychologists should plan treatment likewise.
Study
Using data from the National Epidemiologic Survey on Alcohol and Related Conditions III, researchers investigated if there was any association between past-year SUD based on DSM-5 criteria and the incidence of ACEs in older adults. The study sample comprised 11,386 older adults aged 55 and above.
The researchers carried out a latent class analysis (LCA) of ACEs. LCA is a person-centered approach that attempts to identify sub-groups of individuals with similar characteristics within a heterogeneous population. They identified these four classes: High Adversity, Low Adversity, Child Abuse, and Parental Substance Use. The intent was to find out if different ACE classes showed different rates of SUD.
Major depression is an independent risk factor for developing SUD (Conway et al., 2006). So, another variable in the study was past-year MDD. Researchers investigated if there was an association between ACEs, SUD, and MDD and whether SUD was mediated by major depression.
Results
Subjects in the High Adversity, Child Abuse, and Parental Substance Abuse classes were more likely to have SUD than those in the Low Adversity class. Those in the High Adversity and Child Abuse classes were likely to have MDD than those in the Low Adversity class. Major depression was believed to have contributed to the development of SUD in those in the High Adversity and Child Abuse classes.
Therapy Implications
Sometimes it is easy to miss a history of ACE in an older patient unless you ask specific questions.
Usually, patients do not believe there is a link between their childhood traumatic experiences and their present SUD diagnosis. Time may mellow the memory of or the rage surrounding an ACE in an older person. Even if they are unconsciously carrying the negative mental imprints of the incident, they believe they have moved on from the incident. So, they do not mention it to their therapists.
Sometimes patients deliberately conceal specific incidents from their childhood for fear of bringing shame on their family members.
The younger family members of older patients may not be aware of the ACEs that their loved ones had experienced. If the spouse or the partner of the patient has moved on and siblings and other contemporaries are not around, therapists may never learn about the history of ACE.
The evidence presented in the current study should encourage therapists and counselors to explore the ACE perspective. This knowledge can help practitioners focus on the real root causes of the SUD during behavioral therapies, such as CBT and Rational Emotive Behavior Therapy (REBT), and maximize therapy success.
References:
Herzog, J. & Schmahl, C. (2018). Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in Psychiatry, 9(420). DOI: 10.3389/fpsyt.2018.00420
Conway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006). Lifetime Comorbidity of DSM-IV Mood and Anxiety Disorders and Specific Drug Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67(2), 247-257. Available at https://pubmed.ncbi.nlm.nih.gov/16566620/
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