Is there an ACE card in your family?
I still remember when I first learned about adverse childhood experiences and the ACE Study. Adverse childhood experiences are traumatic or stressful events occurring before age eighteen.
I still recall the explosive aha feeling I had, followed by “no wonder!” No wonder my loved ones had developed alcohol use disorders; no wonder I’d developed eating disorders; and no wonder all of us had tried and failed time and again to stop or cut down.
You see, adverse childhood experiences—or ACEs, also referred to as childhood trauma—are among the key risk factors for developing addiction. The other risk factors are early use (drinking or using drugs before age twenty-one), mental illness, social environment, and genetics.
Background on Adverse Childhood Experiences
The concept of ACEs came out of a study conducted in the late 1990s by Kaiser Permanente San Diego and the Centers for Disease Control and Prevention (CDC). It was a huge study involving 17,000 Kaiser patients.
Participants were asked to fill out a ten-question questionnaire. Then their answers were compared to their medical histories. The results showed that experiencing ACEs were linked to a variety of physical and emotional health problems across a lifetime.
These health problems included depression, developing a substance use disorder or addiction to alcohol or other drugs, obesity, diabetes, suicide attempts, heart disease, cancer, STDs, broken bones, smoking, and having a stroke.
Ten Types of Adverse Childhood Experiences Measured in the ACE Study Questionnaire
Of the ten questions asked, five were personal, meaning the experience was something done to the child. These five included
- physical abuse
- verbal abuse
- sexual abuse
- physical neglect
- emotional neglect
Five were related to other family members’ behaviors that affected the child. These five included
- a parent who abused alcohol or other drugs or was addicted to alcohol or other drugs
- a mother (or stepmother) who was a victim of domestic violence
- a family member in jail
- a family member diagnosed with a mental illness
- the disappearance of a parent through divorce, death, or abandonment
The study found that almost two-thirds of the 17,000 participants had experienced at least one ACE. Of those with one ACE, 87 percent had two or more. The more ACEs the person experienced, the more likely they were to have developed an alcohol (or other drug) use disorder, marry someone with an alcohol (or other drug) use disorder, have depression, or have any of the other health problems listed above.
This was certainly true for my mom, who’d developed alcoholism. She had five ACEs (sexual abuse and the disappearance of a parent were two of her five). A person with five ACEs, for example, has an eight times greater chance of becoming an alcoholic. Similarly, I had four ACEs and developed eating disorders (anorexia for one year and bulimia for eleven); it could have just as easily been alcoholism, given my risk factors. And this same pattern is borne out by the hundreds of people with whom I’ve worked over the years.
Since that original study, many other kinds of ACEs have been identified. These include poverty, racism, bullying, watching a sibling being abused, losing a caregiver (grandmother, stepmother, etc.), and homelessness as examples.
The Connection between ACEs and Treating Addiction That Moms Should Know
The connection between experiencing ACEs (aka childhood trauma) and health problems across a lifetime is toxic stress. Coping with ACEs as a child—because of where the child’s brain is at developmentally—can result in toxic stress.
Toxic stress occurs when a child’s fight-or-flight stress response is repeatedly triggered, as in the case of experiencing ACEs. This repeated activation of the stress response causes a child’s brain to “map” fight, flight, or freeze stress reactions, which can then change a child’s brain wiring, mapping, and development.
These brain changes and the toxic stress-related health problems described above can make alcohol or other drug use a compelling soother, which in turn can contribute to how a child develops addiction.
When ACEs are not treated as part of a treatment plan, addiction recovery can be difficult. Understanding this can help moms appreciate that treating ACEs/trauma is a critical part of successfully treating addiction.
Check out NIDA’s Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Numbers 9 and 10 are especially relevant to this article.
For more information on ACEs, treating ACEs, and recovering from addiction when ACEs are involved, please consider reading my latest book, 10th Anniversary Edition If You Loved Me, You’d Stop! What You Really Need to Know When Your Loved One Drinks Too Much.
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