For the past decade I have been working with adults who are struggling with all sorts of addictions and behavioral compulsions. It is well documented that adoptees are at high risk for addictive disorders, and quite often I find myself working with people who are adopted or who have spent some time in foster care. This significant connection is a crucial one that deserves thoughtful investigation.
We know that as addiction progresses, systems in the brain associated with decision making and inhibition become “hijacked” and changed (Volkow, 2003). Prior to these brain changes, I believe that the root cause of addictive behavior in many cases — and especially in the cases of those adopted or fostered — lies in a deeply embedded pain. Often I have found in my work with adoptees pre- and post-recovery that there is a deep feeling of inner turmoil, disconnection, low self worth, and overwhelming fear and anxiety. I believe what leads my adopted or fostered clients into addiction or compulsive behavior often stems from the suppression of inner pain. Sometimes this is a pain recognized, but sometimes this buried pain is not so clear. Substance abuse can be thought of as an attempt at a solution to the inner turmoil rather than the cause of it, as it can help to numb pain and keep it lodged within. The problem with this is that keeping the pain blocked prevents us from experiencing the growth we need to become our best selves.
All adoptees and those raised in foster care certainly know turmoil. At some point in their earliest experiences they were immersed in it. It has been my observation, in my years working with adoptees who are in recovery from addiction, that very early pain — a pain which is often not remembered visually — is still present, often rearing its head once the numbing has ceased. If the person continues to ignore the pain, eventually it will force itself out, causing havoc in their lives as they try to navigate the world in sobriety.
While one may not have these visual memories of early traumatic experiences, one’s bodily systems, including the brain, remembers the pain. Nancy Verrier, author of “The Primal Wound: Understanding the Adopted Child,” coined the term “Separation Trauma” which she believes occurs when the baby is separated from the biological mother. If this occurs at birth or around this time, the baby is removed from the mother’s heartbeat, her voice, her scent and their mother-infant bonding chemical, oxytocin (Verrier 2003). Adoptees may also have additional developmental trauma through neglect and abuse in their birth homes before they are taken from their parent(s) and put into foster care. A child who is moved to a busy orphanage might additionally experience neglect, crying out for care and receiving little or none. Again, this is early trauma — pain — that may not be really remembered or recognized as adults.
A few years ago a TED Talk came out that many in the addiction field floated around via social media or email. It was journalist Johann Hari discussing his theory of addiction. This theory is based on the idea that addiction is the opposite of connection. Humans want to connect; some would say it is what we are here to do. When our ability to connect to each other is wounded, we become connected to relationships with other things — drugs, alcohol, shopping, gambling, lust — instead of people. Years of studies that have focused on attachment and bonding, (J. Bowlby, 1982/1969,1973), have found that children who have had early experiences in which they did not know if their needs would be met, or knew that their needs probably would not be met, are at risk to develop issues with attachment and connection later in life. In addition to having a history of trauma and possible struggles with attachment, adoptees who have little or no information around their pre-adoption history (both genetic and personal) may feel a deep gap in the fullness of their identity, further complicating their ability to connect to others. Based on my clinical experience, I believe that connection difficulties are a key factor underlying the battle between adoptees and addictive behavior.
One of the greatest obstacles of processing and eventually healing pain is the denial and suppression of the truth of that pain. When we deny or suppress, it may feel safer. At times, we are not even aware we are suppressing. But… eventually, especially once abstaining from drugs and alcohol, those difficult feelings will fight their way out somehow. Our culture often encourages us to suppress. For example, many adult adoptees have described hearing the following narrative throughout their lives: “Your birth mother/parents wanted to give you a better life and then you were adopted into a family that could give you that better life and who loves you. You should be grateful.”
This narrative is often really true, and it is not uncommon for adoptees to share a strong loyalty to this version of events. But, there is so much more to this story. There is a deeper, more complicated truth that lies beneath this simple sweet tale that is sometimes really hard for adoptees to talk about or even get in touch with emotionally. It has been my experience that given time — perhaps years — into recovery from addiction, it is almost inevitable that issues stemming from experiences with early trauma and difficulties with attachment will be a strong focus in therapy for the adoptee.
Parents and friends of adoptees can help support healing by giving the adoptee, ideally from an early age, opportunities to explore their adoption story in a deeper way. Their feelings will be validated when they are allowed to talk about the complexities of their history and given opportunities to discuss their pain. Adoptee-to-adoptee connection is irreplaceable. Much like the magic that comes when two people in recovery from addiction connect, when adoptees can talk about these issues, they can start to heal and feel understood.
Good outpatient or inpatient treatment for adoptees who are attempting recovery from substance abuse in particular must have a strong focus on both connection and on allowing inner pain to be recognized, maybe for the first time, and in a safe way. Fortunately, the best practices today in addiction treatment largely fall in line with this standard and include a large social component, whether in the form of support groups, therapy groups, or a focus on outside recovery 12-step groups. Exposure to these social settings, trauma- and grief-informed therapy, as well as an ongoing longer-term relationship with a therapist who understands issues around adoption and attachment are the keys to a good recovery.