Our bodies and brains are like radio antennae, gathering information from our environment. Our brains and bodies respond to every experience by creating or releasing chemicals and hormones. Experiences create connections and networks in our brains to predict and respond to similar experiences in the future. Depending on the foundation of past generations and early childhood development, we find solutions to address our underlying needs. Depending on the environment we are in, we build neural pathways in our brains that lead to behavior that fits well within this environmental context. We learn solutions for survival in this environment. Patterned repetition of positive, supportive relationships—along with skill building—can wire our brains for socially acceptable success or a cycle of negative outcomes and even early death (Brown et al., 2009).
In this article, I will discuss brain development, adverse experiences, and effective methods to foster resilience in adolescents who have experienced trauma.
An understanding of basic brain networks and human development is the ideal place to start. When children are growing in their mothers’ wombs, the earliest stages of development begin. Imagine a building that is being newly constructed—instead of starting construction on firm cement that has been poured, leveled, and measured very carefully, imagine a foundation of uneven sand with rocks that is being built on a sloping hill. Anything that is built on these two foundations will either be strong and sturdy or somewhat weak and vulnerable. Children are very similar in that the earliest development of their brains and bodies is the foundation for the rest of their lives.
In the womb, babies are surrounded by liquids and chemicals produced by their mothers. Some of these liquids provide nutrition and chemicals that babies need to grow in a healthy matter. However, when mothers experience stress or significant discomfort, their bodies produce chemicals that may be damaging to the developing children. Chemicals that are present in the womb include oxytocin, cortisol, adrenaline, and dopamine. In small doses these chemicals are necessary and harmless, but in large and frequent doses, these chemicals can have a negative impact on the physical and chemical development of babies’ brains. It is important for pregnant mothers to avoid exposure to what is called “toxic stress.” It is also important for the people around pregnant mothers to do their best to maintain a calm, supportive environment.
According to the Center on the Developing Child at Harvard University (2021), there are generally three levels of stress that we experience: positive, tolerable, and toxic. Positive stress is an experience that may cause some discomfort, but is easily manageable. It may cause a slight increase in heart rate and elevated hormones such as cortisol. An example might be going to a doctor’s appointment at a new location. A mother’s body may produce some cortisol that helps her focus on following directions in order to make it to the appointment on time. This level of cortisol would not have an effect on developing children. The concerning level of cortisol occurs during toxic stress.
Toxic stress occurs when mothers experience strong, frequent, or prolonged adversity, such as intimate partner violence. These experiences can cause elevated levels of cortisol and adrenaline that lead to negative effects on developing brains. Studies have shown an increased risk for autism, affective disorders, and decreased cognitive ability in children whose mothers experienced toxic stress during pregnancy (March of Dimes, 2015).
You may have heard about “adverse childhood experiences,” or ACEs. In 2019 in California, the governor appointed the state’s first Surgeon General and that office has made educating people about the impact of toxic stress and ACEs its number one priority (DelFavero, Chhean, Tewarson, Haldar, & Hockenberry, 2021). A landmark study in the late 1990s showed that ACEs have a profoundly negative impact on children over their lifespan (Felitti et al., 1998). This study became known as “the ACE study” and it has been the cornerstone for advancing the evidence that childhood experiences not only have an emotional effect, but behavioral and physical effects as well.
The work started at a Kaiser Permanente preventative medicine obesity clinic in San Diego, California. Some participants did exceptionally well, while others started to do well and then simply dropped out of the program. These particular patients confounded the doctors. Some of the patients were three hundred pounds overweight, lost one hundred pounds, but then dropped out. The principal physician, Dr. Vincent Felitti, decided to do hundreds of face-to-face interviews to try and unravel the mystery. He examined all of their medical history and found no abnormalities. Then an accident happened.
Dr. Felitti (2004) was asking the same routine of questions, but suddenly misspoke. He intended to ask, “How old were you when you were first sexually active?” but instead he asked, “How much did you weigh when you were first sexually active?” The patient responded that she was only forty pounds and she was only four years old when she was first sexually active. The patient disclosed that she had experienced sexual abuse by her father at that very young age. Dr. Felitti recalls that he had only had one other instance of reported incest in over twenty years of practicing medicine.
He continued his interviews and heard a surprisingly high occurrence of childhood sexual abuse. Of the next almost three hundred patients he and his colleagues interviewed, most of them also disclosed childhood sexual abuse. Dr. Felitti concluded that eating was not the problem for the patients in the obesity clinic, and neither was weight—eating was a solution to their problem. His conclusion was that food soothed their anxiety, fear, anger, or depression. These adults used food similar to others who may use alcohol, tobacco, or methamphetamine: to decrease upsetting and unpleasant emotions. This led to the larger ACE study.
Over seventeen thousand patients completed a survey in which they were asked questions about their experiences as children. Three categories of childhood adversity began to take shape: abuse, neglect, and household dysfunction. Within these categories, ten experience types were discovered as common and related to health problems throughout the lifespan. The ten ACEs that were categorized were as follows (Felitti et al., 1998):
Dr. Robert Anda from the Centers for Disease Control and Prevention (CDC) was involved in the ACE study and was overwhelmed by the amount of suffering. He was surprised at the multiple traumas they discovered individuals were experiencing as children (Felitti et al., 1998). Yet this was only the beginning.
The patients were then followed for fifteen years and medical information continued to be gathered from them. Unfortunately, they found that the more ACEs children have, the more likely they are to experience chronic illnesses such as heart disease, chronic obstructive pulmonary disease (COPD), depression, and cancer (Felitti et al., 1998; Felitti, 2004). The most significant finding was related to those patients who had an ACE score of four or more.
Patients who had marked “yes” on the ACE survey in more than four categories experienced significantly higher rates of disease and even early death. Compared to patients who reported zero ACEs, patients who had four or more ACEs had a 240 percent greater risk of hepatitis, were 390 percent more likely to have COPD, and had a 240 percent higher risk of sexually transmitted infection (Felitti et al., 1998; Felitti, 2004). There are other significant effects the researchers noticed as well.
People with four or more ACEs were twice as likely to be smokers, twelve times more likely to have attempted suicide, seven times more likely to report alcoholism, and ten times more likely to report injecting “street drugs.” Additionally, male children with ACE scores of six had a forty-six-fold (4,600 percent) increase in the likelihood of becoming injection drug users at some point in their lives (Felitti, 2004). These behaviors fall into the category often described as “health-risk behaviors” and are the main focus of this article. Furthermore, individuals with six or more ACEs die nearly twenty years earlier on average than those with no ACEs. The reason behind these negative outcomes is related to the hormones previously discussed that affect growing babies during pregnancy and developing brains in early childhood.
Toxic stress during pregnancy and childhood releases hormones that physically damage children’s developing brains and have a lasting impact on their overall health. The impact on the developing brain may put children at risk for learning difficulties, emotional problems, developmental issues, and the aforementioned long-term health problems. Negative childhood experiences that are “built” on an already uneven foundation affects relationships with adults and other children as well as the actual development of the brain.
The human brain continues to develop until the age of twenty-five (NPR, 2011). The experiences we have as children wire our brains for prediction of safety or threats in our environment. The more positive and safe experiences we have, the more our brains statistically predict that current experiences are also positive or safe. However, the more negative, threatening experiences we have, the more our brains statistically predict negativity or threats. Our brains create our understanding and perception of the world around us based on these early interactions. If our childhoods included exposure to adults who were engaging in health-risk behaviors, we are more likely to predict safety in similar situations as opposed to threat or danger.
Adolescents are at a unique period when they will need to make decisions about situations they have not experienced before. This lack of experiential knowledge, especially partnered with peer pressure, may lead to decisions that are considered socially unacceptable. More specifically, the prefrontal cortex—the thinking network of the brain that plays a major role in logic, future thinking, and reasoning—is not fully developed. Youth experiencing adversity during this developmental period may also view substances as an outlet or coping mechanism to deal with the adversities they face in their lives. In our current time, with a worldwide health pandemic, growing racial tension, and political upheaval, there are additional ACEs that researchers are beginning to discuss along with the original categories of abuse, neglect, and household dysfunction.
Returning to our metaphor, adolescence can be seen as the middle floors in our building. The foundation will certainly have an impact on these middle floors. If the foundation is shaky, these floors might also be uneven. If there are problems (i.e., adversities) on these middle floors, they will have an effect on the next floors that are built as well. Furthermore, up to this point we have not even discussed the blueprints for this building. Genetics and epigenetics also play a role in the development of health-risk behaviors and patterns of behavior such as addiction and substance use. It is well known that physical characteristics, such as hair color or eye color, are passed on from parent to child. This is known as “genetics,” or the blueprints for the building. Intergenerational substance use and addiction are also in the blueprints for each of us.
“Epigenetics,” however, is defined as “factors beyond the genetic code” and literally means “above the gene,” as “epi-” is Greek for “on” and “genetics” refers to genes (“What is,” 2021). Studies of epigenetics, mostly in rats and mice, have shown that responses to the environment can also be passed on from one generation to the next. In one study, rats were given an electric shock when they were exposed to the smell of a cherry blossom (Dias & Ressler, 2013). They learned to predict or expect the electric shock whenever they smelled cherry blossom, even when no shock occurred. This fear response was not only passed on to the rat pups of the next generation, but also to the rat pups of the generation that followed. In essence, the grandpups of the original rats had a fear response to the smell of a cherry blossom passed down in their genetic code.
Epigenetics may be able to explain why some adolescents who did not grow up around substance use end up using or abusing substances and others do not. It is quite possible that behavioral responses may skip a generation because there were no environmental factors that turned on the gene of alcohol or drug abuse. This may also explain the high rates of substance abuse in populations or cultures which have experienced a multitude of adversities. Adversity coupled with peer pressure and the need to cope with adversity can easily lead to addiction and substance abuse.
The reality that all this science and research leads us to is that addiction is a developmental disorder similar to autism, attention deficit hyperactivity disorder (ADHD), or even dyslexia (Szalavitz, 2016). Our genes are the basic foundation built upon during pregnancy and the first five years of our lives. If our grandparents and parents experienced adversity, that will impact us and our developing brains. If we experience adversity during childhood, that will also impact us and our developing brains. All these environmental and biological realities may lead us to seek out solutions to meet our needs—solutions labeled by our current culture as “substance abuse” and “addiction.”
Dopamine, adrenaline, oxytocin, amphetamine, cortisol, THC, nicotine, cocaine, testosterone . . . these chemicals could be arbitrarily chosen and labeled as “good” or “bad.” They all have an effect on our brains at varying degrees and varying doses. The first key strategy for helping adolescents is to take the time to increase awareness of the needs that are being met by risky behaviors or the use of chemical substances and address those needs, instead of simply utilizing whatever the current solution is.
The second strategy is to rewire the brain, through repetition, to statistically predict safety instead of threat. This can only be done through relationships with other people in our environment.
Strategy three involves examining the words we use about our emotions and behaviors—as well as those we use about ourselves and our environment—and learning new ways to describe them.
The fourth and last strategy is assisting adolescents in honing their ability to make decisions. This not only assists in the healing of trauma, but also provides a source of self-esteem.
Let us take a more in-depth look at these strategies.
As previously mentioned, the first strategy is to look deeper at underlying needs that are not being met and find new ways to address them. One of our current “solutions” to address substance use in adolescents is to interrupt access to the particular substance they are using.
Nicotine is a prime example. Nicotine is a stimulant that provides a boost of energy and increases heart rate and blood pressure. Nicotine also acts as a smooth muscle relaxant that helps people feel calm and relaxed. Simply taking away cigarettes from adolescents will not address their underlying need for that increased heart rate and blood pressure, or for that calm and relaxed feeling. A brisk jog or other forms of cardio exercise can quickly increase heart rate and give a boost of energy similar to the boost from nicotine. Other ways of increasing blood pressure include eating salty foods or using a supplement like vitamin B-12. There are also behavioral aspects of smoking that can be addressed as well.
The second key strategy for helping adolescents is to retrain or rewire the brain. In this specific example of smoking cigarettes, the rituals and repetitive actions related to most smokers has been built, developmentally, over time. To be effective, the new strategy must include changes in the normal routine around this activity. It will be valuable to walk through the feelings and actions associated with the behavior leading up to smoking, during smoking, and after. Fortunately, adolescent brains are still growing and should be easily retrained for different behaviors.
Develop a plan for the instant adolescents feel or hear the thought of wanting a cigarette. What was going on prior to the thought? What are some alternatives? For the first few days, allow the behavior to play out in order to understand and examine it. Then make small changes in the behavior and repeat the process. Remove any judgment or shaming about the behavior, as this is also connected to the release of chemicals in the body and brain. Provide as much positive feedback as possible. All of these seemingly small changes will eventually rewire the brain for predicting a different outcome and engaging in the desired behavior change.
We are social creatures and are greatly affected by our environment, so it stands to reason that the most effective way to change behavior is through relationships. Having a sponsor or mentor can make changes in behavior more effective and last longer. Developmentally, many of our predictions of safety and security were created and repeated in the earliest years of our lives. The process for changing behavior is the same. For most people, positive reinforcement is more effective than negative reinforcement or punishment. Peers or trusted adults will be another major support in changing behavior, as they were likely involved in the development of the behavior in the first place.
The third strategy revolves around language. Language and the words we use about ourselves, our relationships, and our environment are interwoven into our perceived experiences. Examining the words we use about our behaviors may help us understand our thoughts and feelings about those behaviors. Do we use negative words about ourselves and others we are related to? What kinds of words do we use to talk about our environment and the impact it has on us? Do we feel like we are victims of bad luck with no control over the outcomes we experience, or do we see ourselves as playing an important role in deciding and defining who we are?
An exercise that is helpful is building emotional granularity. According to Barrett (2017), developing emotional granularity involves learning new words and ways to describe our emotions and the emotions of others. Many of us grew up learning a very limited list of emotions—angry, sad, happy. However, these are large categories of emotion that do not accurately describe how we are feeling. Understanding and using words like “blissful,” “ecstatic,” or “elated” to describe positive feelings helps us fine-tune our response to our environment. This is effective for negative words as well.
When adolescents say they “feel like crap,” they could be helped to understand the difference between feeling “crappy” and feeling “disappointed” or “discouraged.” Increasing adolescents’ ability to understand what they are thinking about a particular situation in more detail can open up the possibilities for potential solutions. If they can understand that they are feeling discouraged, the solution may be to find a different strategy to tackle the problem they are facing or ask someone else for help in solving the problem. If they get stuck simply “feeling crappy,” their brains may predict that the solution to feeling crappy is to get high and forget about the problem altogether.
The last strategy adolescents can build upon is their ability to make decisions. As previously stated, the more experiential knowledge we gain, the better our brains become at statistically predicting the outcome. Walking adolescents through this process is assisting them in building another skill. They will not only receive the benefit of your positive reinforcement and encouragement, they will also learn a new skill and foster the sense of accomplishment that builds self-esteem. This is healing trauma, this is the solution to breaking the cycle of intergenerational substance use and toxic stress, and this is building resilience.
Ideally, we would live in a world in which everyone is safe from harm and abuse. Since this is not our reality, the next best thing to do is reduce the amount of adversity children experience during pregnancy and during their earliest years of life (i.e., harm reduction). The one thing we do have control over, as adults who interact with adolescents, is our ability to help reshape their brains.
Every interaction you have with another human being is important. Our brains are predictive tools that keep track of interactions and experiences in order to respond (Barrett, 2017). The more positive, safe, and supportive interactions we have in our lives, the more our brains will be wired to predict safety. The more negative, threatening, abusive interactions we experience, the more we will come to expect the same. This ultimately shapes our behavior as well as the way we treat our children and others we interact with.
When we experience loss, abuse, or any other forms of adversity, our brains and bodies respond with chemicals, hormones, and the wiring of our brains to predict similar experiences in the future. Adolescent brains built on uneven foundations will find solutions to address their underlying needs. Depending on the environment they are in, they will build connections in their brains that we can help direct in a socially positive direction. Patterned repetition of positive, supportive relationships—along with skill building around decision making—can wire their brains for socially acceptable success instead of continuing the cycle of negative outcomes and even early death.
Jason Williams, MS, has a master’s degree in psychology and has worked in the field of children’s mental health and foster care for eighteen years in Fresno, California. He is a cofounder of Brain Wise Solutions Group, Inc. and a certified trauma-informed care trainer in partnership with the Community Resilience Initiative (CRI). Williams is highly involved in bringing resilience-based and trauma-informed care to Fresno County and is on the leadership team for the Fresno County Trauma and Resilience Network.