Childhood sexual abuse (CSA) has seemed at the forefront of many news items recently and increasingly out there in the public domain. The statistics quoted in the UK are 1 in 4 women and 1 in 6 men are survivors, higher in other countries such as the USA. Indeed, most of our addiction clients tend to present with underlying trauma, many as a result of CSA. So as clinicians and treatment providers how do we deal with this epidemic in terms of numbers and the resultant increased disclosures and presentations?

1. Numbing the Pain
Childhood Sexual Abuse
and Addiction
#CSANumbingThePain
ICAAD, Wednesday 8 May 2019

2. Disclosure statement
● Lou Lebentz and Clarinda Cuppage are presenting
independent of any financial compensation
● Permission has been granted from the Charity One in
Four for inclusion of material from the Survivors’
Voices awareness project, freely available in the
public domain.

3. What’s our outcome for you today?
• Increase awareness and recognition of the scale of
childhood sexual abuse (CSA)
• Understand CSA in the context of Adverse Childhood
Experience (ACE) studies & increased risk to vulnerability
• Improve understanding of the neurobiology of trauma and greater
awareness of symptoms of CSA
• Greater insight into supporting disclosure and when to work with
survivors during recovery
• Information about referral and support for survivors and
professionals working with them.

4. CSA statistics
• 1 in 4 young people experience a form of CSA by 18
(Finkelhor et al, 2013)
• Minimum 15-20% of girls & 7-8% of boys experience CSA
(Centre of Excellence of CSA, 2017)
• Only 1:8 come to the attention of the authorities in childhood
(Children’s Commission, 2015)
• There are an estimated 11 million adult survivors of contact and non
contact abuse in the UK (Radford et al, 2011)
• 53% of women & 27% of men in prison report experiencing
emotional, physical or sexual abuse in childhood. (Ministry of Justice, 2012)

5. CSA in the news

6. Current state of CSA in addiction
• CSA prevalence within addiction not routinely
recorded in the UK
• 268,390 people were in contact with drugs and alcohol
services 2017 to 18 (Public Health England, 2018)
• Anecdotal estimates vary considerably:
• 80-90% of women, 60% of men in rehab for addiction
experienced childhood sexual abuse
• CSA in recovery - opportunity to stabilise, signpost and to
work.

7. Clarinda Cuppage
Survivors’ Voices
Project Coordinator, Counsellor

8. Why did we do this?
• Approximately 25% of clients tell us about substance
use issues
• Many people with addictions are unaware their trauma
is connected to their using
• Many people in the 12 step fellowships are survivors,
but not necessarily seeking support for CSA
• To give survivors of CSA their voice and for their voice
and their experiences to educate and inform others.

9. What did these survivors tell us?
• “I walked around continually ensuring that no one really
saw or knew the ‘pervert’ that lived within me….Drugs, alcohol
and separation from normal society seemed a natural hiding
place and for many years worked.” Piers
• “From an early age I was abused by my father……The child is
suppressed and manipulated and becomes an object of
shame, a feeling which possesses them all their lives” Martin
• “My story is difficult to hear. I don’t want to hear it myself. I
don’t want it to be about me. I don’t want it to be true. Better to
have no story than to have mine.” Thomas

10. Lou Lebentz
Psychotherapist,
EMDR Clinician
Founder @ The Voyage

11. Adverse Childhood Experiences
(ACE) study (1998)
• Research demonstrates adverse events in
childhood contribute to long-term health
• 28% of study participants reported physical
and 21% reported sexual abuse
• 40% of original sample experienced two or
more ACEs, 12.5% four or more
• Cumulative ACE score is correlated to
health, social, behavioural problems,
including substance abuse across lifetime.
Physical Abuse
Sexual abuse
Emotional abuse
Physical neglect
Emotional neglect
Mother treated violently
Household substance abuse
Household mental illness
Incarcerated household member
Parent separated or divorced

12. ACEs - How did you score?
https://www.rwjf.org/en/library/infographics/the-truth-about-aces.html

13. Adverse childhood
experiences and addiction
The 1998 study found people experiencing more than
four adverse childhood experiences (ACEs) are:
• seven times more likely to become addicted to alcohol
• 10 times more likely to be at risk of intravenous drug
addiction
• 12 times more likely to have attempted suicide.

14. The neurobiology of trauma

15. Left and right hemisphere

16. Hippo and amy

17. Trauma and CSA reactions
• Fight – Flight – Freeze - Flop (submit) - Friend (attach)

18. Window of tolerance
With thanks to Christiane Sanderson and One in Four

19. Trauma Effects
Trauma Reaction/Triggers Trauma Abstinence
Trauma Arousal or
Pleasure
Trauma Shame
Trauma Blocking Trauma Repetition
Trauma Splitting Trauma Bonding
Betrayal Bonds by Patrick Carnes

20. Trauma and CSA reactions
• Central Nervous System – on high alert, states of fear, panic, anxiety,
dissociative rage, sensory overload, inability to filter stimuli
• Hypo-arousal, shutting down unable to feel anything or Hyper-arousal,
overloaded, constantly activated
• Dissociation (mental flight) from day dreaming, going blank, numbing or
zoning out to severe memory loss and disconnection from body. Range
of dissociative disorders

21. Trauma reactions (cont)
• Survival system activated - outside of conscious awareness
and control
• Internal cascade of chemicals, amygdala high alert (preparing for
emergency), hippocampus
• Sympathetic Nervous System – preparing for flight or fight, ‘quick and
dirty’, accelerator
• Parasympathetic Nervous System – rest and digest, conservation, freeze
response, brake, disengagement
• Trauma remains on-line – high level of fear, relaxation is difficult
• Traumatic memories, fragmented memories.

22. Symptoms associated with CSA
• Flashbacks, nightmares, avoidance of memories
associated with trauma
• Overwhelming feelings of fear, anger, shame, horror –
mood swings and negative feelings about self, others and
the world
• Feelings of detachment, loss of interest in significant
activity, lack ability to experience positive emotions, or
feeling numb

23. Symptoms associated with CSA
• Symptoms can lead to self-medication, self-harm,
anxiety disorders etc.
• Trust and attachment issues, huge impact on
relationships (avoidance/anorexia)
• Confusion over sexual identity, impact on sexuality
• Shame, self-blame, negative self-belief

24. Shame
With thanks to Christiane Sanderson and One in Four

25. Plus the shame of addiction

26. So how do we deal with it?

27. Phased approach to treating CSA
Healing stage: stabilisation
• Safety (internal and external)
• Grounding/resources
• Psychoeducation/triggers
Healing stage: processing
• Re-storying, attributing blame, recognition, loss, emotional expression
• Affect Tolerance
• Finding a voice
Healing stage: integration
• Healthy relationships and boundaries
• Sense of agency/self-identity • Power and control
• Post-traumatic growth
From Herman and Rothschild

28. • Making the link between CSA and trauma
• Understanding what happened to then, not what is
wrong with them
• Recovery through connection
• Access to specialist services
• Post traumatic growth.
What helps survivors who are
also addicts?

29. Understanding people with CSA
• CSA Trauma reactions - impact on mental, physical health,
and relationship problems
• Many survivors unaware of links between behaviour and abuse
• Survivors often experience confusion and fear, which can lead to
misdiagnosis and misunderstanding
• Effective therapeutic support is critical to long-term understanding
of CSA
• Frontline workers can improve their understanding of CSA to
respond to survivors more empathically

30. Understanding people with CSA
• Fear of emotional intimacy with clinician
• Perpetrator may still be in their close environment
• Using avoidance strategies still?
• Unhelpful responses to their disclosure
• The desire to protect others from stigma and distress
• Wanting quick fixes – recovery takes time!

31. What our project found helpful?
• Greater understanding of the link between
CSA and addiction - within services
• Trauma support services/centres where survivors are
educated about the impact of CSA and trained in self-
management of trauma symptoms
• “It’s been hugely important for me to know that I am
not alone, and there are professional organisations,
charities and voluntary groups offering support.”

32. Survivors’ stories in the room

33. In hindsight
• What else would have helped and when?
• Any other thoughts on how to best deal with disclosure?
• When to approach the trauma?
• Any other points or comments you’d like to make?
• Any thoughts from the audience?

34. How can we all build links?
• Survivors Trust (www.survivorstrust.org)
• NAPAC (National Association of People Abused in
Childhood) Helpline and signposting organisation
0808 801 0331 www.napac.org.uk
• One in Four (www.oneinfour.org.uk)
• Survivors UK (www.survivorsUK.org.uk)

35. Keep in touch:
Lou Lebentz
www.loulebentz.com
www.thevoyageprogramme.com
07789 866922
lou@lebentz.com
Clarinda Cuppage
www.oneinfour.org.uk
07773 282862
clarinda@clarindacuppage.com

36. Bibliography
Alcohol and drug treatment for adults: statistics summary 2017 to 2018. Public Health England (2018)
Bradshaw, J. (2006) Healing the Shame that Binds You
Carnes, P. J. (1998) The Betrayal Bond: Breaking Free of Exploitative Relationships
Children’s Commission, (2015) Protecting children from harm: A critical assessment of child sexual abuse in the family network in England and priorities for action
Cozolino, L. J (2002) The neuroscience of psychotherapy: Building and Rebuilding the Human Brain
De Young, P. A (2015) Understanding and Treating Chronic Shame: A relational/neurobiological approach
Finkelhor, D. et al (2014) Lifetime Prevalence of Child Sexual Abuse and Sexual Assault Assessed in Late Adolescence, Journal of Adolescent Health (2014) Vol 55 (3), pp 329-333
Felitti, V. J. et al (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experience (ACE)
Study. American Journal of Preventive Medicine 14 (4).
Fisher, J.(2017) Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation
Hampden-Turner, C. (1981) Maps of the Mind
Herman, J, (1992) Trauma and Recovery
Kelly, L. and Karsna, K. (2017) Measuring the scale and changing nature of child sexual abuse and child sexual exploitation. Centre for expertise on child sexual abuse
Larncer, D. (2014) Conquering Shame and Codependency. 8 Steps to Freeing the True You.
Lodrick, Z. (2010) Victim guilt following experience of sexualised trauma: investigation and interview considerations. The Investigative Interviewer. Issue 1
Le Doux, J (1996) The Emotional Brain
Levine, P. (1997) Waking the Tiger
Prisoners’ childhood and family backgrounds. Results from the Surveying Prisoner Crime Reduction (SPCR) longitudinal cohort study of prisoners. Ministry of Justice (2012)
Research Series 4/12
Parnell, L. (2013) Attachment-Focused EMDR: Healing Relational Trauma
Radford, L. et al. (2011) Child abuse and neglect in the UK today. London: NSPCC
Rothschild. B, (2000) The body remembers: The psychophysiology of trauma and trauma treatment
Siegel, D. J. (2003) Healing Trauma: Attachment, Mind, Body and Brain
Numbing the pain: Survivors’ voices of childhood sexual abuse and addiction. www.oneinfour.org.uk (downloadable)
Sanderson, C. (2015) Responding to survivors of child sexual abuse: a pocket guide for professionals, partners, families and friends. One in Four.
Sanderson, C. (2013) Counselling Skills for Working with Trauma: Healing from Child Sexual Abuse, Sexual Violence and Domestic Abuse (Essential Skills for Counselling)
Van der Kolk, B. (2014) The Body Keeps the Score: Mind Brain and Body in the Transformation of Trauma