Since that original study, the generally-accepted definition of an ACE has expanded. Now, experiences such as bullying, racism, the death of a loved one, serious injury/disease/accidents, natural disasters, and exposure to war or acts of terrorism can all be considered examples of ACEs.

How Common are Adverse Childhood Experiences?

The original ACE study respondents were middle-class, primarily white, and had at least some college education. According to that study, 64% of U.S. children have at least one ACE, while 12.5% have four or more.

A later study focused on ACEs within the Philadelphia Urban community, and looked at a more racially diverse group who had graduated high school. Among respondents, 83% had at least one ACE, and 37% had four or more.

The CDC-Kaiser Permanente study also breaks down the types of ACEs by prevalence and gender:

• Emotional abuse (10.6%): 13.1% Women, 7.6% Men
• Physical abuse (28.3%): 27% (W), 29.9% (M)
• Sexual abuse (20.7%): 24.7% (W), 16% (M)
• Violence against mother (12.7%): 13.7% (W), 11.5% (M)
• Substance abuse (26.9%): 29.5% (W), 23.8% (M)
• Mental illness (19.4%): 23.3% (W), 14.8% (M)
• Separation/Divorce (23.3%): 24.5% (W), 21.8% (M)
• Incarceration (4.7%): 5.2% (W), 4.1% (M)
• Emotional neglect (14.8%): 16.7% (W), 12.4% (M)
• Physical neglect (9.9%): 9.2% (W), 10.7% (M)

ACEs and Addiction

“The basic cause of addiction is predominantly experience-dependent during childhood and not substance-dependent.”

~ Dr. Vincent Felitti, MD, Chief of Preventive Medicine, Kaiser Permanente

Of special relevance, for each ACE experienced or witnessed, the risk of initiating drug or alcohol use increases by as much as 400%.  So someone with 5 or more ACEs is up to 2000% more likely to abuse substances than someone who has with zero.

Why might this happen?

Firstly, unresolved or unprocessed ACEs can cause a person to experience post-traumatic stress.  This could manifest as constant hyperarousal, unreasonable fear, anger, depression, anxiety, nightmares, flashbacks, avoidance, and emotional detachment or numbing. It is even possible for the person to completely block out the past trauma, so they may not even be aware of why they are suffering from these feelings.

Secondly, in some cases, the trauma may have so severe as to leave the person permanently injured or in lingering physical pain. Also significant is the fact that people with post-traumatic stress report considerably greater pain severity. This subjective pain experience may be what leads some ACE survivors to abuse prescription painkillers and street opioids such as heroin.

As Dr. Gabor Mate wrote in his book, In the Realm of Hungry Ghosts, “Thus addiction to opiates like morphine and heroin arises in a brain system that governs the most powerful emotional dynamic in human existence. The attachment instinct. Love.”

Finally, brain development during childhood is affected by experiences and environment, especially before the age of five. Positive experiences promote healthy brain development, while negative experiences can lead to unhealthy or delayed brain development.

Prolonged or repeated exposure to trauma directly affects the regions of the brain responsible for emotional regulation, higher cognitive functions, fear response, learning, decision-making, and short-term memory. In other words, trauma, especially repeated trauma, compromises a child’s normal brain development, often resulting in:

• Sensitivity to outside stimuli, creating exaggerated fearful responses in situations where they should feel safe.
• Hyper-vigilance, where they feel that they must always be “on guard”.
• An overactive stress response that inhibits social skills and disrupts their everyday life.
• A diminished ability to understand the consequences of their actions.
• Poor impulse control.
• A reduction in the production of “feel-good” neurotransmitters such as dopamine, serotonin, and epinephrine. This is important, because a shortage in these brain chemicals, which support positive moods, can lead the person to look for other ways to make themselves feel better — drugs, alcohol, overeating, gambling, sex, or risk-taking activities.
• An increase in the production of adrenaline cortisol, also known as the “stress hormone”. This is the same hormone that is produced during the “fight or flight” response to actual or perceived threats.  Long-term elevations in cortisol levels disrupt the architecture of the developing brain. 

All of these factors are closely related. When a person is in physical or emotional pain, or when they are struggling with the symptoms and consequences of a mental illness, they may attempt to remedy the situation by self-medicating with alcohol, drugs, or risky behaviors. And because their brain chemistry has already been altered by their traumatic experiences, they are at greater risk for abuse, dependence, and addiction.

The Health Consequences of ACEs

Numerous studies have established a definite link between ACEs and health problems later in life. Part of this is due to the toxic stress, and part of it is because people who cope with trauma by self-medicating with cigarettes, alcohol, drugs, food, and risk behaviors tend to lead an unhealthy lifestyle overall.

• Heart disease: ACEs are associated with a higher body mass index (BMI), waist size, and clinical obesity. Adults who experienced physical abuse as children are 3.7 times more likely to have cardiovascular disease as those without such a history.
• Cancer: ACEs involving sexual abuse are associated with a cancer risk that is nearly two-and-a-half times higher than the rest of the population.
• COPD: 5 or more ACEs translates to a risk of a chronic obstructive pulmonary disease such as bronchitis or emphysema that is 2.6 times higher.
• Liver disease: For every ACE, the risk of liver disease increases by 20%. Even more significant, compared to people with zero ACEs, those with six or more are almost 23 times more likely to engage in harmful behaviors that are known risk factors for liver disease, such as alcoholism and intravenous drug use.
• Rheumatoid arthritis: For every ACE above two, the risk of RA or another autoimmune disease rises by 20%.
• Diabetes: Up to 50% of patients with Type II diabetes self-report four or more ACEs. Neglect is the type of ACE that has the strongest association with later development of the disease.
• STDs: Among women with zero ACEs, only 4.1% report an STD, but among those with four, the rate is 13.5%. For those women with six or seven ACEs, the STD rate is 20.7%, or greater than 1 in 5.

Among men with zero ACEs, the STD rate is 7.3%, but with four, the prevalence increases to 17.1%. For those men with six or seven ACEs, the STD rate is 39.1%, or nearly 2 in 5.

ACEs and the Cost to Society

“No child should ever be the victim of abuse or neglect — nor do they have to be. The human and financial costs can be prevented through prevention of child maltreatment.”

~ Dr. Linda Degutis, DrPH, MSN, Director, National Center for Injury Prevention and Control

The maltreatment that is most-often the cause of ACE has many negative effects on survivors that can last the rest of their lives. These include poorer health, social and emotional difficulties, and a reduction in economic productivity.

These effects also impact the nation’s healthcare, welfare, education, and criminal justice systems. In 2012, Child Abuse and Neglect, The International Journal published a report from the CDC estimating the lifetime cost for each surviving victim to be $210,012.

To put that number in perspective, the estimated costs of other major health conditions such as stroke and Type II diabetes were $159,846 and $253,000, respectively.  Here’s a breakdown of that estimate:

• Childhood health care: $32,648
• Child welfare: $7728
• Special education: $7,999
• Adult medical care: $10,530
• Lost productivity: $144,360
• Criminal justice: $6,747

In 2015, the CDC’s National Center for Injury Prevention and Control released an updated estimate with a much higher lifetime cost. By applying a monetary value to such intangibles as pain, suffering, and grief, the per-victim cost jumped to $830,928.

Recovering from ACEs: Trauma-Informed Care

“While psychological trauma is characterized by disruptions in a person’s sense of control, addiction can also be viewed as a disorder of control, or more accurately, an inability to control. The loss of control is insidious, often unrecognized by the addict until, in Alcoholics Anonymous terms, life becomes unmanageable.”

~ Psychological Trauma and Addiction Treatment, Dr. Bruce Carruth, PhD, LCSW (Editor)

Obviously, survivors of multiple ACEs are at greater risk of serious health problems, both mental and physical. And because a traumatic childhood can lead to unhealthy coping mechanisms that contribute to the development and progression of these health problems, recovery can be difficult without specialized professional help. 

But the potential health complications stemming from childhood trauma do not have to be lifelong. By employing the principles of trauma-informed care it IS possible to safely and successfully recover, regaining your health, your sobriety, and your balance in life.

SAMHSA has identified six key principles of a trauma-informed approach to treatment:

• Safety — Clients feel physically and emotionally safe
• Trustworthiness — By establishing treatment goals, clarifying recovery tasks, and setting appropriate boundaries, providers can maximize trust while empowering clients to participate in their own progress.
• Collaboration and mutuality — Clients and encouraged to exert control over their own treatment and recovery by working with providers.
• Empowerment, voice, and choice — Treatment is tailored to the client’s unique needs, strengths, and values, with emphasis on personal choices.
• Peer support — By participating in group therapy with other trauma survivors, clients can gain strength, insight, inspiration, and support from peers with similar experiences and challenges.
• Cultural, historical, and gender issues — Clients are shown the respect and acceptance they deserve as individuals.

As you can see, these principles are based on the concepts of choice, empowerment, respect, acceptance, and most of all, safety — all of which were missing during their traumatic experiences.

But by adhering to these principles, clinicians create a safe and welcoming therapeutic environment where people who have experienced trauma can open up enough to receive the lessons of recovery.

Trauma-Informed Addiction Recovery in Tennessee

“We were able to…link the likelihood of opioid use disorder relapse to ACE score…I personally call opiate use disorder a symptom of trauma. Opiate use disorder is a symptom of trauma. PERIOD.”

~ Dr. Daniel Sumrok, former Director for the University of Tennessee’s Center for Addiction Science and current Medical Director for Integrative Health Centers

A study conducted by the University of Memphis and the University of Tennessee Health Sciences Center found that there is a connection between ACEs and opioid addiction:

• Patients at an opioid clinic were surveyed, and nearly half had four or more ACEs.
• The average number of ACEs was 3.5.
• Each ACE increased the risk of opioid addiction by 17%.
• 54% of the clinic relapsed, most often on the first visit.
• Higher ACE scores related to an increased risk of relapse.

This information is important, because among Tennessee residents the rates of both ACEs and multiple ACEs are higher than the national average. In fact, 18% of Tennessee adults — nearly 1 in 5 — have four or more ACEs.

But there is good news — for every trauma-informed treatment visit, the chances of successful recovery improve by 2%. This is encouraging news for ACE survivors who once turned to opioids, alcohol, and other dysfunctional behaviors.

Trauma-informed treatment is an empathetic and supportive approach that makes the patient a partner in their own recovery, and it works because it means that providers are — finally — acknowledging how a person’s experiences, both as a child and as an adult, can shape their life and health. That understanding is one of the biggest keys to the individualized, evidence-based treatment approach that has proven to be the best drug rehab model.

As Dr. Sumrok says, “…treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.”

If you live in Tennessee and you or someone you care about is struggling with an addiction to opioids, alcohol, or other drugs, Integrative Health Centers can help. More than just another rehab program, Integrative Health Centers provides both comprehensive addiction recovery services and primary health care. Our Medical Director, Dr. Daniel Sumrok, is a nationally-recognized expert on both Adverse Childhood Experiences and Substance Use Disorders, and that experience is used to create a safe space that supports both a return to sobriety and healing in mind, body, and spirit.

To take your first steps on your own personal journey of recovery, contact Integrative Health Centers TODAY.