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What is Recovery?

An essay on the subject of “What is Recovery” raises, for me, the question of what is Addiction. Since everyone of us has an idea, our own idea, of what Addiction is, we'll also have our own answer to “What is Recovery?”

Since we don’t have agreement in our field on what Addiction is, I doubt that we can come up with an easy agreement on what recovery is. I could just tell you my definition of both but my goal is not for us to have a debate over which we can come to a resolution. My goal is that we all look at ourselves and how we got to this question. It may be, that after examining ourselves, we may choose to change the question we ask.

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Why Are Adolescents Violent?
Feature Articles - Adolescents
Written by James Garbarino, PhD   
Friday, 11 July 2008
How can we best approach the question, “Why are adolescents violent?” To do so effectively, we need a perspective on human development that begins with the realization that there are few hard and fast simple rules about how human beings develop; complexity is the rule rather than the exception.

Rarely, if ever, is there a simple cause-effect relationship that works the same way with all people in every situation. Rather, we find that the process of cause and effect depends upon the child as a set of biological and psychological systems, set within the various social, cultural, political and economic systems that constitute the context in which developmental phenomena are occurring.

This insight is the essence of an “ecological perspective” on human development as articulated by scholars such as Urie Bronfenbrenner. It is captured in these words: If we ask, “Does X cause Y?” the best scientific answer is almost always, “it depends.” It depends upon all the constituent elements of child and context, such as gender, temperament, cognitive competence, age, family, neighborhood, society and culture. Consider the following:

• The amount of infant babbling predicts childhood IQ in girls, but not in boys (Maccoby et. al, 1965).
• About 10 percent of children are born with a temperament that is prone to becoming “shy.” However, this predisposition can be overcome in most children with strong, supportive and long-term intervention (Thomas & Chess, 1977).
• Abused children who exhibit a pattern of negative social cognition were found to be eight times more likely to develop problems with antisocial aggressive behavior than were abused children who exhibited positive social cognition (Dodge et. al., 1995 ).
• On average, “unconditional maternal responsiveness” at three months of age is a predictor of “obedience” at 12 months of age; but at nine months of age is not (Maccoby et. al. 1965).
• While visits from nurses to the homes of expectant mothers was effective in reducing child abuse in first time births to single mothers (from 19 percent to 4 percent among a high risk sample), this effect did not occur in homes where an abusive male was present (Olds et. al., 1997).
• The correlation between poverty and infant mortality is influenced by neighborhood factors, being “higher than would be predicted” in some areas and “lower than would be predicted” in others, depending on the degree to which prenatal services are accessible (Garbarino & Kostelny, 1989)
• A study comparing the United States and Canada found that the correlation between low income and child maltreatment was higher in the United States than in Canada (Garbarino, 1995).
• Native Hawaiians see the goal of child rearing as producing an interdependent person while most Americans are seeking to create rugged individualists. For example, Hawaiian mothers place a high value on infants sleeping with parents, whereas most Americans discourage the practice (Garbarino & Ebata, 1983).

This ecological perspective is frustrating: we all would prefer a simple “yes or no” to the question “does X cause Y?”; however, reality is not obliging on this score. In general, it is the accumulation of risks and assets in a child’s life that determine developmental progress, not the presence or absence of any one negative or positive influence.

For example, Arnold Sameroff’s classic study (Sameroff et. al., 1987) included eight risk factors. Among these risk factors were parental characteristics, such as educational level, mental health status, absence and substance abuse; and family characteristics, such as economic status, race, maltreatment and number of children.

The results indicated that the average IQ scores of children were not jeopardized by the presence of one or two risk factors. Since research indicates that what matters for resilience is that children reach an “average” level of cognitive competence (about 100), it is highly significant that children with zero, one or two risk factors averaged 119, 116 and 113, respectively. However, with the presence of four or more risk factors, IQ scores declined significantly into the dangerous range (averaging 90 with four risk factors and 85 with five).

According to Sameroff’s research each risk factor alone wasn’t significant; rather, it was the accumulation of risk factors that accounted for the differences. The same is true with regard to developmental assets. Competing with the accumulation of risks are the number of developmental assets in a child’s life and the components of resilience. Research conducted by the Search Institute (Benson, 2001) has identified 40 developmental assets — positive characteristics of family, school, neighborhood, peers, culture and belief systems. As these assets accumulate, there is a decline in the likelihood that a child or adolescent will be engaged in antisocial violence — a 61percent chance for kids with zero to 10 assets, as opposed to a 6 percent for kids with 31 to 40 assets. This accumulation of assets predicts resilient response to stress and challenge.

For example, if we ask, “Does absence of a parent produce long lasting negative effects?” the answer is, as it always is, “It depends.” Once we know what else a particular child is facing — whether it be poverty, parental substance abuse, child abuse, racism, or too many siblings — we can move closer to “yes, probably” or “no, probably not.”

One important influence on the developmental impact of these contingencies is always the temperament of the child. Each child offers a distinctive emotional package, a temperament. Each child shows up in the world with a different package of characteristics: some are more sensitive, whereas others are less so; some are very active, whereas some are lethargic. Why are these differences important? One reason is that they affect how much and in what direction the world around them will influence how they think and feel about things. 
What one child reasonably tolerates, may be highly destructive to another child. What will be overwhelming to one child will be a minor inconvenience to another. Knowing a child’s temperament goes a long way toward knowing how vulnerable that child will be in the world, particularly in extreme situations. Thomas and Chess’s classic research on temperament in the United States reported that while about 70 percent of “difficult” babies evidenced serious adjustment problems by the time they entered elementary school; for “easy” babies the figure was 10 percent (Thomas & Chess, 1977).

Most children can live with one major risk factor; few can handle an accumulation of them. Getting from a generalized “it depends” to a more specific assessment of the likely fate of any child lies in accounting for all the elements of accumulated risk factors, developmental assets and temperament, to determine the odds of success or failure.

Although it is defined in numerous ways, resilience generally refers to an individual’s ability to stand up to adverse experiences; to avoid long term negative effects; or otherwise, to overcome developmental threats. Many of us know a child whose life is a testament to resilience. The concept of resilience rests on the research finding that while there is a positive correlation between specific negative experiences and specific negative outcomes, in most situations a majority (perhaps 60 to 80 percent) of children will not display that negative outcome (Garbarino, 2008). All children have some capacity to deal with adversity, but some have more than others and are thus more “resilient,” while others are more “vulnerable” in difficult times. However, some children face relatively easy lives while others are forced to face mountains of difficulty with few allies and resources.

Resilience is not absolute. Virtually every child has a “breaking point” or an upper limit on “stress absorption capacity.” Kids are “malleable” rather than “resilient,” in the sense that each threat costs them something. If the demands are too heavy, the child may experience a kind of psychological bankruptcy. Moreover, in some environments virtually all children demonstrate negative effects of highly stressful and threatening environments (Tolan, 1996). African-American adolescent males studied faced the combination of highly dangerous and threatening low income neighborhoods, and low resource/high stress families. None was resilient at age 15 — when measured during a two-year period as neither being more than one grade level behind in school nor having sufficient mental health problems, so as to warrant professional intervention.

Resilience, in gross terms, may obscure real costs to the individual. Some children manage to avoid succumbing to the risk of social failure as defined by poverty and criminality, but nonetheless, experience real harm in the form of diminished capacity for successful intimate relationships. Even apparent social success — performing well in the job market, avoiding criminal activity and creating a family — may obscure some of the costs of being resilient in a socially toxic environment. The inner lives of these children may be fraught with emotional damage — to self-esteem and intimacy, for example. Though resilient in social terms, these kids may be severely wounded souls.

Why are adolescents violent? The simplest answer is this: they are violent because as children they did not learn to successfully use non-violent strategies for meeting their needs and responding to emotions like anger, frustration and fear. Of course, most adolescents — indeed, most human beings of any age — are capable of violent behavior. The success of military training in producing soldiers who are capable of lethal violence “on command” is evidence of that. However, adolescent violence starts in childhood.

Virtually all children express aggressive behavior in infancy and early childhood, so the real issue is not “how do children become aggressive?” but rather, “why do some children continue to be aggressive and thus set the stage for becoming violent teenagers?” Research reveals that the two principal processes that control the developmental pathway for aggression in childhood are: the ideas a child learns about aggression (“cognitive structuring”); and the experiences a child has in situations where aggressive behavior is modeled and reinforced (“behavioral rehearsal”) (Tolan & Guerra, 1998).

Some children receive consistent messages, such as “don’t hit,” that reduce the legitimacy of aggression, whereas others receive messages that legitimatize aggression, such as “fight back when attacked,” and “aggression is successful.” Similarly, some children observe parents, siblings and peers resolving conflict non-aggressively while others observe abuse and fighting.

Mapping patterns of cognitive structuring and behavioral rehearsal goes a long way toward understanding why some kids arrive at adolescence with a high level of aggressive behavior. Virtually everyone who commits an act of violence believes it is justified — at least at the time of committing the act. All this helps explain why boys have traditionally engaged in more physical aggression than girls. Girls have been taught “girls don’t hit” and were generally excluded from situations where they could practice being physically aggressive, whereas boys were taught “boys do hit — it’s just a matter of learning who, when and where to hit” — and were welcomed into situations where physical aggression is normal (most notably, competitive sports). These same processes help explain why the gap between boys and girls in the matter of physical aggression is narrowing, as girls are told and shown that “girls do hit” and have a chance to participate in settings where they can practice being physically aggressive.

The ratio of girls’ to boys’ participation in high school sports changed in the past 30 years from 1:32 to 1:1.5 (Garbarino, 2006). This may help explain these findings: the ratio of male to female arrests for assaults changed in the last 20 years from 10:1 to 4:1; and research on the effects of televised violence on aggressive behavior in children shows that in the 1960s, girls, who were immune to the effect, now show the same effects as boys (Garbarino, 2006).

Conduct disorder

The kids most at risk from bringing a pattern of serious childhood aggression into adolescence are those who have developed a chronic pattern of bad behavior and violating the rights of others. These are the kids who might be described as meeting the criteria for what mental health professionals call “conduct disorder.” Research reveals that the odds of a child developing conduct disorder are increased by abuse and having lower levels of social information processing. Examples of poor social information processing may include: being hypersensitive to negative social information and oblivious to positive social information; having very limited ideas of alternatives to physical aggression as a social tactic; and believing that aggression is a successful social tactic.

Knowing this, what conclusions can parents draw? The first conclusion is that no matter how effective, motivated and attentive any of us is as a parent, our children go to school with kids who are prone to behave violently — some of whom have access to lethal weapons. There are kids — mostly boys — in every school who have developed patterns of aggressive behavior; established internal states in which they see themselves as victimized by peers and society; and whose emotions and moral judgements have become harnessed to their aggressive rage. If they reach a crisis state, and if weapons are available, these youth can readily make the transition to murder. Knowing how these kids reach this point and being aware of what we can do to reclaim them, empowers us to reduce the odds that they will commit acts of lethal violence.

Preventing violence early on

The second conclusion is that the problem of lethal youth violence usually starts from a combination of early difficulties in relationships that are linked to a combination of difficult “temperament” and negative experience. Every parent knows children come equipped with different temperaments: some are sunny and easy; others are stormy and difficult. Some children are easy to parent; others are very challenging. Some are so difficult that no “normal, average” parent will be able to succeed without expert professional advice and support. When it comes to developing patterns of aggression, some of the difficulties lie in being impulsive, emotionally insensitive, having a high activity level, being of less than average intelligence, and being relatively fearless.

These temperamental problems do not spell doom, however. What matters is how well the parenting and educational experiences of these children meet the challenges posed by their difficult temperaments. Of special concern are two patterns. The first is a pattern of escalating conflict in the parent-child relationship, in which parent and young child get caught up in mutually coercive and aversive interactions. The second is a gradual process of emotional detachment arising when parents and teachers abandon these children by withdrawing from them in the face of their negative behavior. 

These patterns increase the odds that these vulnerable children will become increasingly frustrated and out of sync as they meet up with the challenges of paying attention in school. In a culture likes ours, in which there is such intense cultural imagery that legitimizes and models violence, this emotional abandonment is particularly dangerous. Parent education, starting before children are born and continuing through until adolescence, is crucial for preventing violence.

Once they are “lost” this way, they tend to form into aggressive and antisocial peer groups that build negative momentum throughout childhood and into adolescence. This can be avoided. For example, research by Sheppard Kellam and his colleagues demonstrates that if the first grade classroom is well organized and provides clear messages about behavior, aggressive boys are reclaimed and their aggressive behavior tamed (Kellam et. al., 1994). If the classroom is chaotic, these boys form negative peer groups and their problems with aggression intensify.

My own effort, Let’s Talk About Living in a World With Violence, has demonstrated its ability to reduce aggression among third graders when used by a teacher who is comfortable dealing with issues of aggression and who integrates these concerns (and the program materials) into the general classroom curriculum (Garbarino, 1992). Children whose difficult temperament and experience put them on track for problems with aggressive behavior, need help from parents and teachers to learn to manage their behavior. Teachers need special skills and a high level of motivation to create classroom environments that prevent violence.

Research demonstrates that patterns of aggression start to become stable and predictable by the time a child is eight-years-old. Unless we do something to intervene, children identified as aggressive at this age will tend to be aggressive 30 years later (becoming adults who are violent in their families, get involved in fights in the community, and drive their cars aggressively).

Child abuse — its role in aggressive behavior

The third conclusion is that the most common pathway to this pattern of aggression at age eight is for temperamentally vulnerable children to be the victims of abuse and neglect at home, and as a result, to develop a negative pattern of relating to the world in general. This maltreatment can be both physical abuse (beatings) and psychological abuse (rejection).

The resulting negative pattern has four parts: 1) hypervigilance to the negatives (such as threatening gestures) in the social environment around them; 2) oblivious to the positives (such as smiles); 3) a tendency to respond aggressively when frustrated; and 4) concluding that aggression is successful in the world.
According to research by psychologist Kenneth Dodge and his colleagues, this negative pattern is the most potent link between a child being the victim of maltreatment and developing a pattern of chronic bad behavior and aggression (what will be diagnosed by mental health professionals as “conduct disorder”) (Dodge et. al., 1995). Being abused produces a seven-fold increase in the odds of developing conduct disorder. About one-third of these children with conduct disorder will eventually become violent, delinquent youth (and about 90 percent will go on to demonstrate some serious problem in adulthood). In juvenile prisons, typically about 80 percent will have shown this negative pattern (Garbarino, 1999). Child abuse prevention is the cornerstone of preventing lethal youth violence.

Social toxicity

The fourth conclusion is that troubled kids will be as bad as the social environment around them. I have identified this as the issue of “social toxicity,” the presence of social and cultural “poisons” in the world of children and youth, to which troubled kids — both boys and girls — are especially susceptible. Just as asthmatic children are most affected by air pollution, so “psychologically asthmatic” children are most affected by social toxicity.

The glorification of violence on television, in the movies and in video games is part of this social toxicity; and it affects aggressive kids more than others. The same is true for the size of high schools. Academically marginal students are particularly affected in a negative way by being in big schools (with more than 500 students grades 9-12). The availability of drugs and guns is another example. Mobilizing community leaders, parents, professionals and youth themselves, can provide a rallying point for improving the social environment. Where gangs operate and vulnerable kids live in a “war zone,” the social environment can draw many kids into patterns of severe, even lethal violence. Detoxifying the social environment of children and youth is essential to protect them from the problem of lethal violence.

Spiritual crisis

The final conclusion is that at the core of the youth violence problem is a spiritual crisis. Human beings are not simply animals with complicated brains. Rather, we are spiritual beings who are having physical experiences. This recognition directs our attention to the multiple spiritual crises in the lives of violent adolescents. They often have a sense of “meaninglessness,” in which they are cut off from a sense of life having a higher purpose. By the same token, they often have difficulty envisioning themselves in the future.

This “terminal thinking” undermines their motivation to contribute to their community and to invest their time and energy in schooling and healthy lifestyles. Finally, they often have lost confidence in adults to protect and care for them. This leads them to adopt the orientation of “juvenile vigilantism.” A teenager says, “If I join a gang I am 50 percent safe; if I don’t join a gang I am zero percent safe.” The point is that adults don’t enter into the equation.

Non-punitive, love-oriented religion institutionalizes spirituality and functions as a buffer against social pathology, according to research reviewed by psychologist Andrew Weaver (Weaver et. al, 1998). On the other hand, the shallow materialist culture in which we live undermines spirituality and exacerbates these problems. One way to deal with these issues is to have schools join with community leaders to embrace the national character education campaign, as developed, for example, by psychologist Thomas Lickona (2004). Character education offers all positive elements within a community a focal point for its actions. It provides a framework in which to pursue an agenda that nourishes spirituality.

Over the past 25 years there has been a doubling of the percentage of children and youth who have mental health and developmental adjustment problems that are severe and chronic enough to warrant professional intervention, according to the research of psychologist Tom Achenbach (Achenbach & Howell, 1993). The spreading problem of youth violence is related to this larger development. Dealing with it will require both a broadly-based prevention perspective on community life, and a conscious focus on dealing humanely and effectively with troubled aggression children in childhood, lest they fall in line to proceed down the pathway to youth violence.

James Garbarino, PhD holds the Maude C. Clarke Chair in Humanistic Psychology and is Director of the Center for the Human Rights of Children at Loyola University Chicago. In addition to authoring several books, he has undertaken missions for UNICEF to assess the impact of the Gulf War upon children in Kuwait and Iraq, and has served as a consultant for programs serving Vietnamese, Bosnian and Croatian children.

References

Achenbach, T.M., & Howell, C.T. (1993). Are American children’s problems getting worse? A 13-year comparison. Journal of American Academy of Child and Adolescent Psychiatry, 32(6), 1145-1154.
Benson, P.L. (2001). Developmental assets. In J.V. Lerner & R.M. Lerner (Eds.), Adolescence in America: An encyclopedia. (pp. 208-217). Santa Barbara, CA: ABC-CLIO.
Dodge, K.A., Pettit, G.S., Bates, J.E., & Valente, E. (1995). “Social information-processing patterns partially mediate the effect of early physical abuse on later conduct problem.” Journal of Abnormal Psychology 104: 632-643
Garbarino, J. (2008). Children and the dark side of human experience: confronting global realities and rethinking child development. NY: Springer Publishers.
Garbarino, J. (1992). Let’s talk about living in a world with violence. Chicago: IL: Erikson Institute.
Garbarino, J. (1999). Lost Boys: Why our sons turn violent and how we can save them. New York: Anchor.
Garbarino, J. (1995). Raising children in a socially toxic environment. San Francisco: Jossey-Bass Publishers.
Garbarino, J. (2006). See Jane hit: why girls are growing more violent and what we can do about it. NY: Penguin Press.
Garbarino, J., & Ebata, A. (1983). The significance of ethnic and cultural differences in child maltreatment. Journal of marriage and the family, 45(4), 773-783.
Garbarino, J. and Kostelny, K. (1989). The human ecology of infant mortality: neighborhood factors. Chicago: Erikson Institute.
Kellam, S. G. Rebok, G. W. Ialongo, N and Mayer. L. S. (1994). The course and malleability of aggressive behavior from early first grade into middle school: results of a developmental epidemiology-based preventive trial. Journal of child psychology and psychiatry and allied disciplines. 35 (2) 259-281.
Lickona, T. (2004). Character matters: How to help our children develop good judgment, integrity, and other essential virtues. New York: Touchstone.
Weaver, A. et al. (1998). An analysis of research on religions and spiritual variables in three major mental health nursing journals. Issues in Mental Health Journals, 19, 263-276.
Maccoby, E.E., Dowley, E.M., Hagen, J.W., & Degerman, R. (1965). Activity level and intellectual functioning in normal preschool children. Child Development, 36(3), 761-770.
Olds, D., Eckenrode, J., Henderson, C. R. Kotzman, H. Powers, J, Cole. R. Sidora, K. Morris, P, Pettit, L. and Lickey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: 15 year follow-up of a randomized trial. Journal of the American Medical Association, 278, 637-643.
Sameroff, A. Seifer, R. Barocas, R. Zax, M. and Greenspan, S. (1987). Intelligence quotient scores of 4-year-old children: social environmental risk factors. Pediatrics, 79, 343-350.
Thomas, A., & Chess, S. (1977). Temperament and development. New York: Brunner/Mazel Publisher.
Tolan, P. (1996). How resilient is the concept of resilience? The Community Psychologist, 29, 12-15.
Tolan, P., & Guerra, N. (1998). What works in reducing adolescent violence? An empirical review of the field. Center for the Study and Prevention of Violence, Boulder, CO.

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