Mike Miller tells his personal story of how adverse childhood experiences impacted his life, how they impact men and masculinity in general and how these themes have informed his clinical work.

When I entered treatment for the second time in June 2003, I knew I had a big problem with drug use as there were consequences in every aspect of my life. I had no friends to turn to; I’d burned every bridge as I was unable to uphold my end in any relationship. My financial situation was bleak. Healthwise, if I didn’t have heroin I went into opiate withdrawal within a matter of hours. The anxiety, depression and loneliness I experienced was overwhelming. At times I didn’t know if I could carry on, or if I even wanted to. I was 32 years old and my life was not how I had imagined it. When I was younger I’d been an honour roll student, captain of sports teams, sponsored skateboarder and snowboarder and always knew that I could be successful at whatever I chose. Now I was homeless, penniless and on the brink of hopelessness. It was clear that drug use was taking its toll on my life.

What I didn’t identify was that I was also a survivor of trauma. Nobody had ever used that term, especially not in relation to my substance use. I’d been through a lot of difficult situations during my 20 years of using substances, but they were easy enough to rationalise or explain away. It never occurred to me that any of those things would have a long-term impact on my life, or might actually contribute to my substance use, my inability to stay employed, my relationship problems or beliefs that I held about myself or the world. At that time if I was asked what I knew about trauma I most likely would have identified it as childhood sexual abuse, a plane crash or being in a war zone, but not any of the things I had experienced. They were just ‘normal’.

When I entered the treatment facility, I knew I had to stop using substances and I was committed to doing so. I stayed in treatment for an extended period of six months, participated well and followed all instructions, including transitioning to a secondary care facility for a further four months. This facility was a 12 Step (AA) based centre and all interventions were designed to shine a light on my problematic substance use through a 12 Step lens, while providing me with a safe environment. They didn’t have any credentialed or accredited therapists and there was nobody educated beyond 12 Step peer support. This meant we didn’t look at anything that could have been underpinning my addiction, including any sort of trauma, or any processes beyond the substance use. That was 16 years ago and during that time I’ve not returned to substances, but in the subsequent years I struggled with what I now know to be trauma responses, other than substance use.

I wish I knew then what I know now about trauma. If someone had joined the dots for me about how abandonment by my father after my parents separated when I was 6 years old influenced how I acted in relationships with others, my ability to trust and let people in and my self-esteem, I may have been able to have healthier relationships. As I couldn’t trust people, I wasn’t able to be honest with others about what I was experiencing - the anxiety, the fear, the lack of confidence and feelings of unworthiness - or ask for help.

Another factor was that growing up in the 1970s and 1980s, I received messages about how men ‘should’ behave. Messages like “don’t be weak”, “boys don’t cry”, “man up”, “feelings are for girls” and similar. So there I was, scared, anxious, self-conscious to the point of obsession and ashamed of feeling those things, thinking it made me weak or that there was something wrong with me. That’s when substances entered the picture. I remember the first time I drank at 12 years old feeling immediate relief from all those things.

So the socialisation that men are subjected to, including the messages they receive about not becoming vulnerable for fear of being judged as weak or less of a man, contributes to and supports addiction. Further, trauma has a direct correlation to poor health outcomes, including substance use, as evidenced by the Adverse Childhood Experiences (ACE) Study. The ACE Study asked a series of questions about childhood experiences, such as “Were your parents ever separated or divorced?”, and “Did you often feel that no one in your household loved you or thought you were special or important?” The more questions that participants responded yes to, the worse their health outcomes were, including a much greater incidence of substance use. In 2004, Vincent J. Felitti, MD wrote in his paper, The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study, “The ACE Study compares adverse childhood experiences against adult health status, on average a half-century later. Our overall findings presented extensively in the American literature, demonstrate that adverse childhood experiences are surprisingly common, though typically concealed and unrecognised. Adverse childhood experiences still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction and mental illness. Adverse childhood experiences are the main determinants of the health and social wellbeing of the nation.”

With respect to addiction he wrote, “In our study of over 17,000 middle-class American adults of diverse ethnicity, we found that the compulsive use of nicotine, alcohol, and injected street drugs increases proportionally in a strong, graded, dose-response manner that closely parallels the intensity of adverse life experiences during childhood.” Felitti concluded by saying, “Our study of the relationship of adverse childhood experiences to adult health status in over 17,000 persons shows addiction is a readily understandable although largely unconscious attempt to gain relief from well-concealed prior life traumas by using psychoactive materials.” What it shows is that traumatic experiences, whether we acknowledge them as traumatic or not (and with the socialisation men are subjected to, they most likely do not, or will not talk about it if they do), have long-term, negative health implications, including a much higher risk of substance use, correlated to childhood experiences. This is what treatment needs to address.

Today, I’m a Certified Substance Abuse Therapist, Certified Clinical Trauma Professional, EMDR (Eye Movement, Desensitisation and Reprocessing) Therapist and Clinical Programme Director at Reach, the men’s treatment programme at The Cabin Chiang Mai. We’ve designed and implemented a programme that addresses all the things I wish were addressed in my treatment episodes. Reach is gender-responsive, trauma-informed and evidence-based, so that we can provide the best treatment available to address all the presenting problems men with addiction face, not just substance abuse or behavioural issues.

Mike Miller, Clinical Programme Director at Reach, the new men’s treatment programme at The Cabin Chiang Mai