I have been doing a number of trainings for domestic violence advocates over the past few months and I have found myself challenged by my own attitudes and beliefs in regards to why women stay in abusive relationships or why they continue to drink or use drugs when they have so much to lose. The more thought I put into it, the more I realized that the reasons for both are quite similar.
After meeting with a client the other day about some ongoing problems she is having with neighbors, an advocate asked me why, even though the woman is clean and sober, she continues to have difficulties staying out of trouble. This woman had been through a couple of extended inpatient treatment programs and is currently in the process of rebuilding her life after leaving her relationship for a second time. There are children involved and the woman had done a lot of work to be able to regain custody of her children after she ended her drug use. Remarkably, she is staying clean and sober and she appears determined to succeed in staying away from her abuser.
I told the advocate that the unfortunate issue for a lot of women who become clean and sober is that their economic circumstances force them to return to the same type of neighborhoods in which they previously engaged in drug use. Their priorities have changed. They want to be mothers. They want to be safe and they want to be sober. However, they may not have the resources, as single women with children, to move beyond a low income neighborhood. For this same reason, a woman with children may choose to return to her abuser or become involved with a new man. Financially, she just can’t do it on her own.
For many women who have grown up in homes where abuse was an ongoing occurrence, the idea of being able to move out and beyond her circumstances may seem to be an insurmountable task. There may be little evidence in her life that things can get better.
In a world where 85% of women who are in treatment for drugs/alcohol have been physically (including sexually) we may instead wonder what is her motivation for staying clean and sober. To have to live with the ongoing pain that comes from childhood abuse or ongoing domestic violence may result in self medication of that pain with any means possible. A number of women become addicted to pain or anxiety medications that were prescribed to them after seeking medical attention for injuries due to abuse.
There is a lot of stigma that surrounds women with children who abuse drugs. It is a common idea that a woman who uses drugs or alcohol either neglects or provides inadequate care for her children. This is not necessarily so, but the shame and guilt that surrounds a woman who self medicates can often be a trigger to ongoing use even after entering a recovery program. Judgment comes in many forms, but self judgment is the hardest. No matter what we may think, it is still harder to be her than we can ever imagine.
In severe cases, there may be a lot more going on than we can imagine. The long term effects of significant childhood and ongoing adult trauma can make it very difficult for a survivor to make decisions that increase safety and sobriety. Often there are human service workers or family members who become frustrated with clients who seem to be stuck, who seem defiant or manipulative, or resistant to treatment or court recommendations. The reasons for this perceived resistance have more to do with past trauma than being manipulative or defiant.
Neuroscience has found that under extreme stress the brain goes into flight or fight mode. For victims of long term or severe abuse the brain remains in that mode for a long period of time. The doing center of the brain (the amygdale) becomes flooded with adrenaline and cortisol and the thinking area of the brain (the frontal cortex) shuts down in order to allow the doing center to take action to be safe. Over the long term, it is like pressing on the gas and brake pedals at the same time. The abuse survivor is working completely from a place of self preservation. As human services workers who want to be able to help, we find this frustrating and forget that even though we are not the abuser the person still has no reason to trust us. In fact, it may be child service workers, therapist, police officers, parents, teachers, and others who let the victim down in the past and may have made her situation even worse. In addition, she may have found that the only thing that can calm down the intense emotions she is experiencing may be a drug.
This information is not to justify a survivor’s drug use. It is more of an explanation as to why trauma informed treatment programs are so necessary. Mental health and substance abuse treatment programs that do not address the issues via a trauma informed approached are less likely to meet the needs of their clients and help them maintain true recovery.
Most mental illnesses have roots in of trauma that triggered an ongoing reaction to the world that may seem maladaptive to the rest of us, but for the survivor it has become the only way to feel safe in the world. Anxiety and panic disorder, Post Traumatic Stress Disorder and substance abuse disorders have their roots in unresolved trauma. The person has lost their sense of safety in the world and remains hyper-vigilant against any further trauma. I heard a statement the other day that I am going to start carrying with me as a credo in promoting trauma informed treatment. “If we can start addressing the trauma that occurs in a child’s life, we may someday be able to reduce the DSM (Diagnostic and Statistical Manual used to diagnosis mental illness) to a pamphlet.”
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