What lies within us are all the experiences, interactions, emotional styles, physicality, nervous system responses, generational memories, styles of behavior, values and beliefs of our primary caregivers – our families.

As more and more studies come forth indicating that addictive disease is a brain disease, that the chemistry of the person with the primary disease is not “normal” and often may have been abnormal even before the drug or alcohol use, one can begin to ask the question, “What’s going on?” What about the genetics? Is the fact that addiction occurring in multi-generational families is totally related to genes that are not functioning properly? If so, how does this start? Who is “patient zero”?

Let us begin to ask some new questions. What, for example, is the impact of trauma in a family on the genetic makeup of its members? Can it change in one or two generations? What is the impact on the central nervous system, the chemistry? Can it be possible that addiction in a family member can have a traumatic impact on other members of the family – the spouse, the parents and the children?

So here, I believe, is the main question. There are some of the most talented people one can imagine — intelligent, caring, compassionate — treating those afflicted with the primary disease of addiction. However, in not making treatment and therapy easily available to those people with the secondary impact of addiction, are we almost guaranteeing that this affliction will go on to the next generation?

Most practitioners who work with treatment and recovery have experienced the simple fact that the alcoholic/addict is much easier to convince to attend 12-step, self-help meetings — often daily — than to convince family members to attend 12-step, self-help meetings related to co-dependency, once a week.

This is the fiction that we live with: “I’m not the person with the problem. If he/she gets better, I’ll be fine. The problem with me is you.” Perhaps the biggest fiction is, “The children are not affected; they are fine, and there is no need to talk to them. We’ll tell them that daddy/mommy is away working or visiting”. Children always know what is happening in a family; what they are often unable to do is articulate their knowing. However, they know and they also know that it must be bad because no one is talking about it to them; no one is helping them to understand and find language to talk and be comforted. So they learn to comfort themselves, they learn to be afraid of things not spoken; they learn to become hyper-vigilant, super-quiet or super-good. They know. Emotionally, they know. Physiologically, they know. The next question is in what way this might affect not only their adult lives, but also the lives of their children.

Psychological stress (trauma) is a type of damage to the psyche that occurs as a result of a traumatic event or series of events. The heightened arousal of a child’s primary caregiver signals danger to the child. Without knowing what is wrong, they nevertheless begin to physiologically imitate the nervous system responses of their parents.

With increasing levels of stress (or trauma) we begin to see some signs of insecure attachment. Secure attachment is a form of affect regulation. Damage may involve physical changes inside the brain and to brain chemistry, which damage the person’s ability to adequately cope with stress.

With exposure to trauma as a child, a person may re-experience the trauma and try to avoid trauma reminders. Often, the person is completely unaware of what is happening and begins to engage in disruptive or self-destructive coping mechanisms.

The brain uses epinephrine to execute autonomic and neuroendocrine responses, serving as a global alarm system. The autonomic nervous system provides the rapid response to stress known as the fight-or-flight response. The interactions between the mental state, nervous and immune systems can impair developmental growth in children, which later alters their perceptions of, and reactions to, stress.

The trauma associated with addiction in a family is similar to a bomb going off in a room. Everyone is hit, but the family identifies only one member as the problem. Whether that one person recovers or does not recover, the family still has the autonomic trauma responses.
Since the other co-dependent family members believe the only problem is the identified “problem one”, no one seeks help. Each member in the family goes on to create their own families based on unhealed trauma.

“Childhood adversity, stemming from abuse, parental loss, witnessing of domestic violence or household dysfunction is a major cause of poor mental and physical health. One major consequence of early adversity is a markedly increased risk for substance use, abuse, and dependence“ (Chapman, ET. Al. 2004, Dube et al, 2003; Felitti, 2002).

From a Harvard Medical School study, we now have new information about stress on children.
“Under non-addictive states, the nucleus acumbens receives input from a number of brain regions, including the hippocampus and the prefrontal cortex. These inputs serve to modulate the response of the nucleus accumbens in a manner that is controlled, flexible, and contextually relevant. Following stress exposure, this system is less well modulated. Hippocampal gating of cortical inputs is reduced. Moreover, the prefrontal cortex inputs respond more selectively to drug-conditioned cues which is a vital critical factor leading to relapse.” 1

This study goes on to explain that with this loss of flexibility, the ability to experience stress relief easily, access pleasure and the simple joy of the world around us is significantly reduced… until a person with this brain state encounters a drug, such as alcohol, or other drugs (including some medication). At this point, the individual experiences relief, euphoria and relaxation, never before realized. This becomes the euphoric recall that presents itself in times of real or imagined stress. The negative consequences after the drug use are not stored in the same manner.

When we look at family members who have not developed the primary addiction, we frequently see patterns of behavior intended to soothe, relax and give pleasure. These behaviors have a similar impact as drugs to the addict. They work for a short while then need to be repeated….over and over and over. These behaviors include: shopping beyond one’s means daily or several times a week; Internet addiction; gambling; sexual compulsion; control issues; work that excludes balance; serial monogamy – always needing new relationships and the chemistry that goes with them; and food addiction of all kinds, such as compulsive overeating to starving oneself to binging and purging.

A study unrelated to addiction but of major importance was first introduced by Dr. Lars Olov Bygren, a preventive-health specialist who is now at the prestigious Karolinska Institute in Stockholm. He is a pioneer in the study of epigenetics, which is looking at how one’s environment and choices can influence your genetic code and that of your children – not over several generations, but immediately. We have always believed that the choices and circumstances of our lives might negatively impact our brains or bodies, but wouldn’t change our genes, our DNA . Now it appears that “stressors can activate epigenetic marks, modifying histones or adding methyl groups to DNA strands. These changes can turn genes on or off and may affect what gets passed down to your offspring. If you overstimulate genes for, say, obesity or a shortened life span, your kids can inherit these overactivated sequences. That could mean a lifetime of battling unfavorable gene expression”. 2

What can we do to begin to affect a change and not simply treat symptoms? Families need help as intensively as does the family member with the primary disease. Children need to be involved. Children are always involved in the problem; we need to involve them in the solutions.

Open up conversations appropriate to their age level and begin to teach them ways to become healthy, relieve stress, talk about whatever is bothering them, listen to what they are saying carefully and respond. The Betty Ford Center in California has a program, at an extremely reasonable rate, for children and a stand-alone program for co-dependents. Neither of these programs requires that one have a family member in treatment. There may be other similar programs around the country as well.

We need to focus and develop mechanisms to help families over a period of time – not just a week or weekend, but extended therapeutic intervention and training. If more interventionists included intensive family work – education; skills training; directing to treatment when possible; Al-anon and Alateen, over a period of months, we might begin to make some changes to this multi-generational affliction. Some have started doing this work – more is necessary.

1 From Neuroscience and Biobehavioral Reviews, a review of “Desperately driven and no brakes: Developmental stress exposure and subsequent risk for substance abuse”. By Susan L. Andersen and Martin H. Teicher, from a study of Developmental Biopsychiatry Research Program, McLean Hospital/Harvard Medical School, Belmont, MA

2 From “Why Your DNA Isn’t Your Destiny”, Time magazine, January 2010, by John Cloud, Vol. 175, No. 2

Today, I feel that I am providing treatment to the grand children and great grandchildren of these early patients.  Addictive disease is like a bomb going off in a room; everyone is hit with flying fragments of the addiction bomb.  With each generation that passes, the trauma increases but unfortunately, trauma and the impact on the brain often does not become a part of treatment.  Our population in treatment today very frequently have dual disorders; personality disorders, major problems with anxiety, depression, stress and anger, process addictions such as eating or restricting, gambling, shopping, internet and pornography, and most of all post traumatic stress disorder.

We have understood for many years that addiction runs in families and that the genetic sensitivity sets family members up to have this disease themselves much in the same manner as other chronic disorders and/or diseases in a family.  What we have not looked at enough until lately, are those family members who are not born with this genetic sensitivity but still develops the disease of addiction.  I am suggesting that an additional reason that this disease runs in families is the stress and trauma that children experience growing up in a family with addiction.  Even the adult children of alcoholic/addicts, who do not have addiction, may have developed patterns of emotional behavior that can negatively impact their children, and set up the brain for drug addiction.   Trauma, which causes a stress reaction, is often created when one or both parents (or primary caregivers) have addiction, mental health issues and/or rage issues.  The children of this stress or trauma often do not know they have been impacted and tend to believe they will be “OK” if they leave and create their own families.  Trauma has been shown to change the structure and chemistry of the brain.  These children then pass on to their children both the trauma and the fragmented intimacy issues they developed as children.

Expressions of trauma include;  emotional detachment including dissociation or “numbing out”, dissociation leading to a person seeming emotionally “flat”, preoccupied, distant, or cold, super controlling, hyper vigilance and anxiety and sleep problems.  The brain uses epinephrine to execute autonomic and neuro-endocrine responses serving as a global alarm system.  The autonomic nervous system provides the rapid response to stress known as the flight-fight-freeze response.  The interactions between the mental state, nervous and immune systems can impair developmental growth in children, which later can alter their perceptions of, and reactions to stress.

Anxiety is the response of the organism to a threat, real or imagined.  Objective manifestations include increased responsiveness, restlessness, and autonomic nervous system changes such as increased heart rate and blood pressure.  There are important differences between acute anxiety and chronic anxiety.  Chronic anxiety often strains or exceeds an individual’s ability to adapt to it.  Chronic anxiety is fed by a fear of what might be.

All human beings have a primal drive towards pleasure and away from pain.  With a brain that is anxious, depressed, always in “alert” mode for some un-named danger, the initial effects of a drug, alcohol, marijuana, opiates or cocaine, give the user an initial euphoria not previously experienced.  This experience is recorded in the limbic system as a “good thing”.  Away from pain, towards pleasure.  Memory of past trauma or traumas is quieted, hyper-arousal is, for the moment, quieted, and fear recedes.  The most natural thing would be to repeat the experience of drug taking to re-experience the relief of stress symptoms

Now, with one alcoholic with four children, we may have 2 of the children with addiction; perhaps one genetically sensitive and one whose brain changes are the result of the stress of living with the uncertainty and fear of an alcoholic parent.

Only a small percentage of people with addiction receive treatment.  When they do go to treatment, they receive on average 28 days of treatment and then return to the same environments from which they came. We now know that not much changes in the brain in 28 days, that we need 90 days to be of real help.  In the last 5-7 years, there has been an explosion of information regarding addictive disease as a Brain Disease!  However, even in the face of new information, most of us are using the model of emotional/behavioral approaches to treatment.   I am not saying this is wrong but I am saying that before applying emotional behavioral solutions, we need to TREAT THE BRAIN-FIRST.

We have for many years asked people to sit and listen to lectures and sit in process groups while they work on written assignments.  There is nothing wrong with this approach but we need to first help the brain and body to heal for this approach to be effective.

People with anxiety have developed a changed manner of breathing in a shallow way.  They are continuously breathing in a manner that deprives the brain of necessary oxygen.  In addition, they often use food for comfort with extremely high levels of sugar, which increases blood pressure, causes the body to work twice as hard and can have a harmful effect on the brain.  Their diets often don’t contain necessary nutrients and they often take very few, if any, supplements for brain building.  It is almost impossible for a person to learn and apply what they have learned with a brain that is anxious about the loss of the chemicals it has learned to rely on, while simultaneously experiencing the pain of withdrawal and post acute withdrawal.

The Three Legged Stool for Brain building

In addition to traditional treatment these are the activities that help the brain begin to heal in a significant manner.

First, clients need to detox from not only the addictive chemicals that brought them to treatment but also from sugar and caffeine.  The diet needs to be only extremely low on the glycemic index, but fresh food instead of frozen or canned.  Items such as potatoes, white breads and flour, sweets of any kind, should be removed from the daily diet.  All items with caffeine should be removed.

Second, the use of an exercise designed to help clients learn to breathe from the belly and practice some form of aerobic breath needs to be a part of a daily regimen.  At Malibu Beach Recovery Center, we use yoga and a very special style of yoga breath three times daily in addition to traditional treatment methods.  Whatever a facility designs around teaching breathing, it is central to helping to heal the brain.  Because this is a dramatic change for the body, resistance to this exercise should be expected.  The body will fight what it is not used to.  It is possible to achieve an aerobic workout through breath work alone which means that even people with physical challenges can participate.  Closing the day, the use of meditation is extremely helpful.

Third, we can all become more knowledgeable in the use of amino acids and natural supplements that provide amazing help for the brain to heal itself from the assault of stress and chemicals used over many years.  There are so many good authors of help in this area.  I recommend starting with books by Julia Ross, “The Mood Cure” and Dr. Hyla Cass,  “8 Weeks To Vibrant Health” and, “Natural High” but there are many good books on this subject.  Supplements are something a physician, working with clients in treatment will want to be in charge of as they should be used with careful diagnosis and monitored in the early stage of treatment.

I have been calling this unique approach of supplements, yoga and yoga breath and low glycemic diet, “A SPA FOR THE BRAIN”.   In my thirty plus years of working in the field of addiction, I have never seen such vibrant health as is produced by this “three legged stool”.