Addiction
The final item of business is a members’ business debate on motion S4M-05128, in the name of Kenneth Gibson, on the origins of addiction. The debate will be concluded without any question being put.
Motion debated,
That the Parliament highlights the Adverse Childhood Experience study, The Origins of Addictions, which bridges a relationship between adverse childhood experiences, including childhood sexual abuse, and the development of addiction problems in later life; understands that the American study analysed 17,000 adults and discovered that the compulsive use of nicotine, alcohol and injected street drugs increases proportionally to the intensity of adverse life experiences during childhood, whereby the risk of becoming an injected drug user increased as much as 46-fold when compared with no exposure to adverse experiences; notes the significance of the Addictions Psychology Audit by NHS Greater Glasgow and Clyde, which found that 49% of patients receiving counselling had suffered from childhood sexual abuse; acknowledges the dependency of addictions for survivors of childhood sexual abuse in which resorting to drugs or alcohol often allows survivors to escape from the horrific and traumatic memories and flashbacks, and believes that addiction services and psychological support would treat addiction more effectively as an experience-dependent and not just a substance-dependent condition.
17:02
I thank the MSPs from all parties who signed my motion to enable this debate to take place. I also thank Anne Macdonald, the Scottish Association for Mental Health, Health in Mind and colleagues from the cross-party group on adult survivors of childhood sexual abuse, who have assisted my preparation and were keen to highlight an issue never before debated in the Scottish Parliament. I am pleased that CPG members are in the gallery and that MSP CPG colleagues will take part in the debate.
The Scottish Government estimate of the number of people aged 15 to 64 years old with problem drug abuse in Scotland in 2009-10 was 59,600. That may be an underestimate as it is difficult to evaluate an often hidden population. The national health service also estimates that around 9 per cent of men and 4 per cent of women show signs of alcohol dependence and with nearly one in four Scots smoking cigarettes, addiction is a chronic problem for many.
Addictions can be defined as persistent, compulsive dependence towards a behaviour or substance. They are often beyond an addict’s self-control and he or she may be unable to distinguish between want of a substance and the need for it. Often addicts are portrayed as people whose bad life choices have led them into addiction and on some occasions that is indeed the case. There is a sense that problems are self-inflicted and there is a lack of sympathy towards individuals who are perceived as being responsible for their own addiction. However, addictions have many causes: biological, social or psychological.
The direct cause has not yet been definitively discovered; if it had been, perhaps many in Scotland would not now face a battle against drugs, alcohol and tobacco. Biological factors such as the brain’s orbital-frontal cortex, which can differ between addict and non-addict, and predisposed genetic components are recognised. For example, seven genes have been identified as predisposing an individual to smoking, including variants in nicotine receptor genes, which also predict the success of nicotine replacement therapies. Social causes include addictive substance availability, peer and family pressure when those people have addictions, and social deprivation.
Psychological and physiological dependency, leading to addiction, can take myriad forms—from gambling to drug abuse. Strong evidence supports the predisposition of adverse experiences to drug, alcohol and tobacco abuse. It is, therefore, important to acknowledge that addiction is often an experience-dependent condition rather than just substance dependent. That should underpin the treatment approach and, ultimately, improve the likelihood of recovery.
Psychological causes involving the experience-dependent aspect of addictions often include traumatic adverse experiences in childhood leading to an increased likelihood of someone developing addictions in later life. A major component of such adversity is childhood sexual abuse. A study that was published in the French journal Annales Médico-psychologiques highlighted the connection between people being the victims of rape or sexual abuse in childhood and their developing addictions. The study explained that rape is a risk factor for post-traumatic stress disorders and addictive behaviours including alcohol abuse, drug use, repeated suicide attempts and eating disorders. Another study that was published in the Journal of Traumatic Stress in 2003 found victims of rape to be 13.4 times more likely to develop two or more alcohol-related problems and 26 times more likely to have two or more serious drug-related problems. Those results strengthen the connection between adverse experiences and addictive behaviours.
According to the National Society for the Prevention of Cruelty to Children, nearly 18,000 sexual crimes against children under 16 were recorded in England in 2010-11, which is almost certainly an underestimate due to underreporting. There is no reason to suggest that, as a proportion of the population, Scottish figures would be very different. The NSPCC also published a report in 2011, “Child abuse and neglect in the UK today”, for which more than 6,000 children, young adults and parents were interviewed. The shocking findings were that one in six children aged 11 to 17 had experienced sexual abuse and that 34 per cent of victims did not report the abuse to anyone.
The severe trauma that is suffered by survivors of childhood sexual abuse makes them vulnerable to addictions, and teenagers with alcohol and drug problems are 18 to 21 times more likely to have been sexually abused. Dean X, a survivor, said that to blot out “stuff from my past”,
“Every day of my life ... I was taking drugs ... drinking every day from when I woke in the morning ... I took cocaine to work; valium to bring myself back down and I was drinking”.
Gordon Y used alcohol to blank out the memory of abuse, too. He said:
“I was alcoholic ... every time people asked I would run a mile, wouldn’t even speak to them. I didn’t associate it with what happened in the past. I just ... felt that I couldn’t understand the different feelings going on, telling myself I wouldn’t trust anyone else, the toll it was taking on my body”.
Anger, promiscuity and dissociation from emotions such as love and empathy are also symptomatic in many addicted survivors.
The links between adverse experiences and the development of addictions must be understood in order to recognise and manage effectively an addict’s condition. It is imperative to investigate the source of an individual’s addictions including, in far too many cases, sexual abuse when young—abuse that has damaged their self-esteem and self-confidence and that has led them to believe that addictive and destructive behaviour can help them to escape past nightmares. The link between childhood adversity and addiction must be acknowledged by prevention initiatives. It is important to consider the two components that are involved in the patient’s condition: the adverse experience and the addiction. Treatment should integrate the two components, as treatment for the addiction can be effective only when the underpinning experience that caused the addiction is treated. That approach will greatly improve the chance of recovery.
The Substance Abuse and Mental Health Services Administration, a branch of the United States Department of Health and Human Services, proposes two models to adopt in treating survivors of child abuse and neglect for their addictions. The integrated model addresses dual diagnosis whereby both substance abuse and childhood abuse are treated simultaneously within the same programme. The concurrent model involves substance abuse treatment with appropriate referrals being made to mental health services for treatment of the childhood abuse. In both models, teamwork between the counsellor who is delivering addiction support and the mental health practitioner who is supplying physiotherapy for the childhood abuse is essential for a successful outcome.
Addiction and counselling services in Scotland offer a very high standard of care to patients. Nevertheless, it is important for services to recognise addictions as experience-dependent conditions and to adapt treatment appropriately. A recent audit of the addictions psychology caseload by NHS Greater Glasgow and Clyde found that 49 per cent of patients who were receiving counselling had suffered childhood sexual abuse. Improved links with the British Psychological Society Scotland and psychologists working with survivors of childhood sexual abuse were made as a direct result of the study.
Treatment for the survivors of childhood sexual abuse with addictions is very complex, and identifying the link is essential to ensuring appropriate treatment. Services in Scotland need to develop a more trauma-informed service, as neglecting addiction as an experience-dependent condition will impair the success of any treatment. I ask the minister, in responding to the debate, to advise the chamber what progress has been made so far and what steps will be taken to ensure that traumatic experiences are properly taken into account in the treatment of addictions.
17:09
I congratulate Kenneth Gibson on securing this important debate. The adverse childhood experiences study, “The Origins of Addiction”, confirms the correlation between addictions in adulthood and adverse childhood experiences, including childhood sexual abuse.
Those of us who are members of the cross-party group on adult survivors of childhood sexual abuse are only too aware that drink and drug addiction resulting from the trauma of childhood sexual abuse and the impetus to drown or block post-traumatic symptoms such as flashbacks and nightmares have been a huge issue for many years. Despite that, it has been hard to get those individuals recognised centrally on the drug and alcohol agenda. Many of those addicts are parents who have been abused, which not only causes general problems with parenting but means that they tend to be locked in addiction, and fail, time after time, to stay off their addiction. In turn, that raises child protection issues.
Meanwhile, there is a continuous and escalating financial cost to the state and voluntary sector of providing services in an attempt to cope with males and females with those problems. In some respects, we are merely throwing good money after bad because many front-line public services are not geared to deal with childhood sexual abuse. The motion highlights why. Quite simply, addiction would be treated more effectively if addiction services and psychological support treated it
“as an experience-dependent and not just a substance-dependent condition.”
In other words, the approach recognises that the root cause of some addictions is an unconscious but compulsive use of materials such as drugs and alcohol in an effort to block out adverse prior life experiences, the majority of which have been concealed by the individual as a result of shame, secrecy or social taboo.
In effect, in the absence of other alternatives for help with and respite from their trauma, survivors of childhood sexual abuse self-medicate using alcohol, tobacco and drugs in order to seek short-term relief to enable them to escape from their horrific and traumatic memories and flashbacks.
In 2009, the Equal Opportunities Committee inquiry report on female offenders in the criminal justice system revealed a significant correlation between childhood abuse leading to substance abuse and offending in adult life. Open Secret in Falkirk, a community-based organisation that provides support services for survivors and their families, has done some excellent work with offenders. The provision of the right services for childhood sexual abuse survivors, delivered in the right way, at the right time, has positive outcomes: it reduces the demand on other services and it is a significant contributor to lowering adult recidivism and offending, including violent offending, in Scotland. That is why Stop It Now! Scotland, the national programme for the prevention of child sexual abuse, delivers basic information on child sexual abuse and existing services throughout the prison population in Scotland.
Most childhood sexual abuse cases remain unreported and undetected because prevention has not been prioritised. Being serious about tackling the root causes of the alcohol and drug addiction of adult survivors of childhood sexual abuse not only shows a longer term and informed determination to create a positive lasting change but is an excellent example of where targeted preventative spend can make a huge difference.
Again, I congratulate Kenneth Gibson on bringing the motion to the chamber this evening. I hope the minister, in responding, takes on board the points raised, particularly about preventative spend.
17:14
I congratulate Kenneth Gibson on securing this members’ business debate on the extremely important issue of the causes of addiction and our attitudes to it. The Scottish Government has introduced a number of key initiatives, including the road to recovery programme, which is the country’s first cohesive approach to tackling drug misuse, but addiction remains a huge problem in Scotland. NHS Greater Glasgow and Clyde’s addiction services alone are responsible for delivering addiction treatment and care services for 12,000 clients, and delivering such services costs the NHS millions of pounds a year.
For too long, the common response from the public in Glasgow to the public health challenges that are faced in relation to addiction and its accompanying costs to individuals, their friends and families has been to say that that is just the Glasgow way and is part of who we are as Glaswegians, with our sick man of Europe tag. The approach has been more or less to leave it at that, deal with the issue as it arises and not look at the root causes. It remains the case that for many of Glasgow’s public health issues the silver bullet is to tackle the underlying deprivation and poverty, but that is a debate for another day.
That is why I was very interested in the work that Mr Gibson’s motion mentions on the relationship between adverse childhood experiences and addiction. The study in question took place over two years and involved 17,000 participants. Each participant completed a confidential survey that contained questions about childhood maltreatment and family dysfunction, and gave details of their current health status and behaviours. The survey covered experiences such as emotional, physical or sexual abuse, emotional or physical neglect and growing up in a household where someone was an alcoholic, a drug user, mentally ill or suicidal, where the mother was treated violently or of which a member was imprisoned during the patient’s childhood.
Information on any adverse childhood experiences was combined with the result of the patient’s physical examination to form the baseline data. Less than a third of the participants reported zero ACEs. When ACEs were reported, the link between them and addiction was found. As the number of ACE conditions increases, so do the chances of being a user of street drugs or of having problems with tobacco or alcohol abuse.
The research found an interesting parallel with the problem of addiction being the solution to a much deeper problem—that is, one of the ACE conditions. That is why it is far more detrimental to addicts’ recovery to believe that their behaviour and subsequent addiction are always the result of poor life choices rather than what they often are—a mask to cover underlying issues.
The masking link was further explored in research that was conducted by Sarah Nelson of the centre for research on families and relationships at the University of Edinburgh and supported by Health in Mind. For that research, a number of interviews were conducted with male survivors of childhood sexual assault. More than half the survivor group became addicted to drink or drugs in their teens and a quarter were addicted before they reached their teens. Half the group also experienced another addiction, such as a gambling addiction, compulsive eating, sexual addiction, compulsive self-harm or workaholism.
One young ex-prisoner used drugs
“to get rid of my problems”—
other members have described that—and
“to make my problems go away. They never did, they just disappeared for ten, fifteen minutes, half an hour, an hour, a day.”
Another person said:
“I know I used to drink ... to forget it all”.
In talking about his addiction to food and his sexual addiction, one person said:
“I think subliminally I wanted to make myself unattractive ... And then because I felt fat and ugly and horrible because I was putting on weight, I would think, right, I’ll go out and try and test anybody to see if they’ll have sex with me or not.”
All the participants talked about their troubled and addictive relationships with alcohol, drugs, sex, food or work. The common theme is that such relationships are a mask to stop them thinking about what happened to them as children, which is where the origins of their addiction lie.
Not everyone who has an addiction has had a traumatic experience in their childhood, but having an adverse childhood experience substantially increases the likelihood of addiction in later life. For that reason, we must continue to work to ensure that our children are safer than ever before from avoidable harm. If children grow up with a parent in prison, they must be given support from a young age to help them to deal with that in a less destructive way. Safe spaces must be provided for children where they can bring issues of emotional, physical or sexual assault to people who will be able to help them. We must continue to champion the work that is done in the third sector across Scotland by organisations such as Children 1st and the NSPCC.
As well as trying to prevent an ACE from manifesting itself as an addiction in adulthood, it is important to change how we view addiction, so that we move to a system where we empathise with a person’s experience and do not just judge them for the choices that they have made without considering what the underlying causes of their choices might have been.
17:19
I join other members in congratulating Kenny Gibson on securing a debate that is incredibly important in bringing a number of highly significant issues to the Parliament’s attention.
I have listened with great interest to those who have participated in the debate. As those members will be aware, “The Origins of Addiction” report raises a number of very complex issues. Ultimately, it shows that there is a clear link between early childhood experience and negative outcomes in adulthood. I am sure that we all share the goal of finding better ways to address those issues. In doing so, we must treat the problems that come about as a result of early childhood experiences more effectively, but we must also—as several members have said—focus on prevention, so that those problems do not occur in the first place. The early years of a child’s development are one of the most important times at which to start that prevention process.
As a Government, we have made it clear that we have a simple but ambitious aspiration for Scotland to be the best place in the world for children to grow up. For our children to become the successful, confident and effective individuals our nation needs, we must nurture every element of their wellbeing.
We know that early childhood experiences have lifelong effects on cognitive and emotional development and that chronic, unrelenting stress in early childhood, whether caused by neglect or repeated abuse, can be toxic to the development of a child’s brain. We also know that children are more likely to experience some form of mistreatment between birth and three years of age—16 out of every 1,000 children experience that. I am sure that all members would agree that that should not be tolerated.
Our children have the right to be cared for and protected from harm and to grow up in a safe environment in which their needs are addressed quickly and effectively. Their wellbeing and safety are key priorities for this Government. To ensure that that is the case, we must support the practitioners who work in the field to address such issues and to provide a safe environment.
I will give a few examples of the work that we are doing to support that work. The “National Framework for Child Protection Learning and Development in Scotland 2012”, which was published in November, sets out the necessary skills for all staff and volunteers who come into contact with children to keep them safe. We have published Scotland’s first national risk assessment toolkit for child protection, which will help professionals to better identify concerns among vulnerable children. In addition, we are taking action to ensure that child sexual exploitation in Scotland is detected, dealt with and ultimately prevented.
We also have stronger arrangements for preventing children from being exposed to individuals who perpetrate such offences. The Protection of Vulnerable Groups (Scotland) Act 2007, which came into force in 2011, introduced a new membership scheme for people who work with vulnerable groups that allows Disclosure Scotland to act much more promptly when new information is received that indicates that someone might pose a risk to vulnerable groups.
Looking to the future, we recently consulted on proposals for the children and young people bill, which aims to provide real and sustained long-term benefits to children and their families. The bill will seek to embed partnership working in our services to ensure that the design and delivery of services are centred on a child’s whole wellbeing and that, ultimately—in the context of this evening’s debate—services are better able to prevent the horrors of sexual abuse and to act more quickly to identify and support victims when it occurs.
We must also continue to work with the whole of society as it is right now. As part of our commitment to the health and wellbeing of adult survivors of childhood abuse, we launched Survivor Scotland, our national strategy for childhood abuse, in 2005. We have raised awareness of childhood abuse, supported training for front-line staff and provided services for survivors with an investment of £5 million since 2007. We have also agreed to extend the time to be heard model since its successful pilot in 2010 to all institutional care residents through a national confidential forum. We consulted on proposals for the forum and will take those forward this year through the provisions of the proposed victims and witnesses bill. That will offer survivors an opportunity to talk about their experiences as children in care and have those experiences acknowledged.
We also need to ensure better support for individuals who are addicted to alcohol or drugs. Through our national drugs strategy, the road to recovery, we aim to tackle drug use by focusing on recovery, acknowledging that individuals have a range of needs to be addressed, including the underlying causes to which members have referred tonight, and ensuring that individuals have a say in their treatment and their path to long-term sustained recovery, whether it be clinical or psychological.
However, recovery only starts with the ambition for a better life. When an individual reaches out for help, it is crucial that they get the right help at the right time, because it is a crucial milestone in their life. Addiction services in Scotland are undergoing redesign to focus on the whole person and their journey to recovery. To support that, we have invested a record £30 million via NHS boards in alcohol and drug partnerships, to provide front-line drug services and offer support to those who require it. We have also provided £39 million to ADPs to deliver local alcohol strategies in line with local need and priorities. We also reduced treatment waiting times to a maximum of three weeks for more than 90 per cent of the people who started drug and alcohol treatment within the period of referral between July and September 2012.
Alongside that, we created a network of alcohol and drug partnerships to deliver appropriate health and social care services at a local level, taking account of local needs and individual circumstances.
All that will support individuals to become contributing members of society once again.
In drawing my remarks to a close, I emphasise the importance of this very complex issue. I fully acknowledge the link between early childhood experience and the negative outcomes in adulthood that are clearly highlighted in “The Origins of Addiction” report. I firmly believe that addiction can be treated more effectively as an experience-dependent condition, not just as a substance-dependent condition. We can do more in this area, and we are determined to do more to stop people being damaged by substance misuse.
I am grateful to Kenny Gibson for bringing this debate before Parliament. Knowing Mr Gibson, I know that he will continue to pursue the issues outwith the chamber.
Meeting closed at 17:28.