Does Adoption Cause Substance Abuse?

By Regina Walker 11/29/15

As National Adoption month comes to a close, The Fix looks into the links between childhood trauma, adoption and addiction.

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“Assume that all children who have been adopted or fostered have experienced trauma.” - from the American Academy of Pediatrics pamphlet, “Helping Foster and Adoptive Families Cope with Trauma.” 

One of the most well-established facts in modern addiction medicine, and in modern addiction research, is that there is a direct link between early childhood emotional and/or physical trauma, and an increased risk of addiction and substance abuse issues in adult life. Many studies have shown this correlation, and its factuality is no longer in dispute. While there is certainly a genetic basis to addiction, genes by themselves are not destiny and as a rule, even if there is a genetically determined greater risk of addiction in an individual, it usually takes some early life stressor to trigger addictive behavior. This is a tricky subject because there are always the extreme cases—like a person who is adopted, and has what looks on paper like an idyllic childhood thanks to devoted adoptive parents, but has a genetic predisposition to addiction and eventually falls prey to addictive behavior despite all the best support their adoptive parents can provide.

At the same time, there are those individuals (at the other end of the bell curve) who, despite the undeniable trauma of separation from birth parents and exposure to an indifferent or even abusive foster or adoptive parent situation, somehow manage to avoid the trap of addiction, and make stable and safe lives for themselves as adults.

Perhaps there's an interesting question to ask ourselves: Is adoption, in and of itself, traumatic? And if so, what can be done to recognize the risk this poses to those at risk for substance abuse and addiction problems, and head off those risks before they become unmanageable?

First, let’s take a look at the question of whether or not adoption is inherently and necessarily traumatic. Here, the data is unsurprisingly very varied, with many opinions but not very much in the way of actual verifiable data. For instance, we have the views of Dr. Nancy Verrier.

Nancy Newton Verrier, Ph.D, is the author of the popular and controversial book, The Primal Wound. Published in 1993 and described as “the adoptee’s bible,” The Primal Wound seeks to clarify the effects of separation from the birth mother on adopted children by exploring pre- and perinatal psychology, attachment, bonding and loss. Dr. Verrier states, "I believe that the connection established during the nine months in utero is a profound connection, and it is my hypothesis that the severing of that connection in the original separation of the adopted child from the birth mother causes a primal or narcissistic wound, which affects the adoptee's sense of Self and often manifests in a sense of loss, basic mistrust, anxiety and depression, emotional and/or behavioral problems, and difficulties in relationships with significant others.”

The problem is that Verrier’s book has also been described by some as an out-and-out anti-adoption book, and it contains some assertions that, attention-getting as they might be, seem awfully difficult to verify and even impossible in principle to verify. Sarah Saffian is the author of Ithaka: A Daughter’s Memoir of Being Found, and writes on the subject of adoption for Slate.com. In an email exchange in Slate’s Book Club, she discusses another book on adoption—Barbara Melosh's Strangers and Kin: The American Way of Adoption—and in that email she mentions her incredulity at noting that Dr. Verrier at one point asserts that “when adopted babies and toddlers cry . . . it means that they are mourning their birth mothers.” It goes without saying (or it should go without saying) that babies and toddlers pretty much universally cry and that to ascribe such a specific meaning to such a common—even ubiquitous—behavior seems on the face of it, absurd.

And yet, Verrier’s book, which Saffian is comfortable characterizing as an outright anti-adoption book, continues to be popular and is even described by some as a “bible” for adoptees. Saffian goes on to note that Melosh writes (Melosh is an adoptive parent) about the intriguing fact that among the adoptive parents that Melosh got to know, there was “an a priori consensus that all adopted parents long for reunion.”

So what does actual data tell us? Well, let’s take a look at one. There is, for instance, a study conducted in 2001 at the University of Minnesota, Minneapolis, which looks at the risk for a reported suicide attempt in adopted offspring vs. non-adopted offspring. At first, the data looks conclusive—the study, with lead author Margaret A. Keyes, Ph.D, found that in the populations studied there was about a fourfold greater risk of a reported suicide attempt in adopted offspring. Yet in the study’s conclusion, Dr. Keyes, while noting the study’s interesting results, also cautions against reading too much into them.

“The risk of suicide attempt associated with adoption may be due to various influences. von Borczyskowski et al., confirmed that Swedish adoptees carry a higher burden of heritable risk for suicidality, that is, biological parents’ substance abuse, suicidal behavior, and psychiatric illness explained one-third of increased risk of suicide attempt in domestic adoptees. Factors unique to relinquishment by a biological parent (e.g., early trauma, institutional care, attachment issues) may also elevate risk for suicidal behavior later in life. . . adoptees were further distinguished from non-adoptees by moderately large differences on family discord and smaller differences on academic disengagement. Adoptees did not evidence significantly more substance use disorders or MDD symptoms and showed no difference on personality scales.”

And Keyes has also commented, in discussing the study, “The majority of adoptees are psychologically healthy. With elevated risk, we are talking about a very small number of people."

Another study by Dr. Keyes, also published in the Archives of Pediatric and Adolescent Medicine found that adolescents adopted as infants were twice as likely as non-adoptees to be diagnosed with externalizing disorders such as attention-deficit/hyperactivity (ADHD) and oppositional defiant disorder. Though this statistic is jarring, Dr. Keyes stated, "In the past, many people suggested that adopted children were seen in mental health settings more often than other children because of a referral bias." Dr. Keyes theorized that “adoptive parents might be more likely to seek professional help because they tend to be better educated, have more economic resources, and they have had experience with accessing social services during the adoption process. If this were the case, it could in part explain the increased number of diagnoses in this population.” So here again, there is nothing to specifically suggest that adoption taken apart from other factors is itself inherently traumatic, and therefore inherently a risk factor for addiction later in life.

A study published in the Archives of General Psychiatry, found adopted children whose biological parents had a drug problem, are more likely to abuse drugs themselves.

Kenneth S. Kendler, M.D., of Virginia Commonwealth University, and his team set out to find the relationship between genetic factors, environmental factors, and drug abuse. (In simple terms, the nature vs. nurture question.) In other words, are children who they are raised to become? Or are children who their genetic factors make them?

The study focused on 18,115 children who were born in Sweden between 1950 and 1993. The study also looked at their biological and adoptive relatives and the researchers used information about drug abuse from legal, medical, and pharmacy records. They also used information from health databases and national registries. 

Dr. Kendler remarked, “Risk for DA (drug abuse, --RW) in adopted children is increased by a history in biological parents and siblings not only of DA but also of alcoholism, major psychiatric illness and criminal convictions. Risk for DA in adopted children is increased by disruption in the adoptive parent-adopted child bond by death or divorce but also by a range of indices of a disrupted adoptive home environment and deviant peer influences such as parental alcoholism and sibling drug abuse, respectively.”

The researchers concluded that, “Adopted children at high genetic risk were more sensitive to the pathogenic effects of adverse family environments than those at low genetic risk. In other words, genetic effects on DA were less potent in low-risk than high-risk environments.”

It would seem, then, convincing-sounding but unproven narratives about how adoption might be inherently traumatic aside, that there is in fact little to no sound evidence to support the notion that adoption alone, taken as an event apart from all other influences, is either traumatic, or poses a greater risk of issues with substance abuse or drug addiction. Insofar as factors that can be associated with adoption may come into play—instability or abuse in the adoptive family, for instance, or neglect as a result of issues in the logistics of adoption and foster home placement—there may be an increased risk of emotional trauma, and therefore substance abuse issues. But this is merely to say, that when it comes to substance abuse risk, adopted children in adolescence and adulthood are placed at risk because of a complex interaction of many different factors, including genetics and environment.

In other words, they’re just like the rest of us.

Regina Walker is a regular contributor to The Fix.

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