ACEs and Addiction: Breaking the Cycle of Trauma and Substance Use

Adverse Childhood Experiences

In her TED Talk, Dr. Nadine Burke Harris, the California Surgeon General, described childhood trauma as a toxin that can reduce life expectancy by 20 years and the Adverse Childhood Experiences Study as something that everybody needs to know about. In the study, researchers asked 17,500 adults about their history of exposure to what they called adverse childhood experiences or ACEs.

The 10 ACEs originally included:

1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Physical neglect
5. Emotional neglect
6. Parental mental illness
7. Parental substance dependence
8. Incarceration of a parent
9. Parental separation or divorce
10. Domestic violence

For each ACE a person had experienced, they would get one point on their ACE score. There was a maximum of 10 points, if they had gone through every possible traumatic event. The researchers found:

• ACEs are common. 67 percent of adults have at least one ACE.
  • 12 percent, or 1 in 8 adults had four or more ACEs.
  • The higher your ACE score, the worse your health outcomes are likely to be.
• For a person with an ACE Score of 4 or more, they had:
  • 4 times the likelihood of developing depression.
  • 12 times the risk of suicidality.
  • 7 times the likelihood of developing alcoholism.
  • 2-4 times the risk of using alcohol or other drugs.
  • 2-4 times the likelihood of beginning to use at a younger age.
• For a person with an ACE Score of 5 or more, they had:
  • 7-10 times the likelihood of using illegal drugs.
  • 7-10 times the risk of becoming addicted to illegal drugs.
  • 7-10 times the likelihood of injecting illegal drugs.
  • 3 times the risk of misusing prescription pain medications.

Changes to the Brain

Further research has found that not only were people with high ACEs scores more likely to make choices that could lead to poor health later in life, but the brain itself is changed by trauma. Those changes, independent of the person’s choices, could also have negative impacts on their health.

• The pleasure and rewards center of the brain can become damaged, offering a partial explanation for substance addiction.
• The prefrontal cortex can become inhibited, which makes impulse control difficult.
• The amygdala, the fear response area, is also potentially impacted because it is activated continuously and causes the body to release stress hormones which are not meant to be utilized so often and can ultimately lead to damaged health from over-activation.

Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine, says that the correlation between trauma and addiction is so strong that rather than calling it addiction, we should call it ritualized compulsive comfort-seeking and view it as a normal response to the adversity experienced in childhood. He states that of the 1,200 patients he has treated for addiction, almost 92 percent have an ACE score of 3 or more.

Dr. Sumrok’s solution to changing the illegal or unhealthy ritualized compulsive comfort-seeking behavior of addiction, which is also supported by Safe Harbor Recovery in Portsmouth, Virginia, is to:

• Utilize individual and group therapy to address trauma
• Treat people respectfully
• Provide medication-assisted treatment (MAT)
• Help survivors to develop healthier ways to cope, which will help them to feel better, but won’t place their life at risk or violate the law

Recent Studies

The initial ACEs study only included 10 possible forms of trauma, but more recent studies have also looked at the impact of other adverse experiences that can increase risks of poor health outcomes, including:

• Racism
• Witnessing violence outside the home
• Bullying
• Having a parent deported
• Living in an unsafe area
• Being placed in foster care
• Homelessness
• Living in a war zone
• Being an immigrant
• Moving repeatedly
• Witnessing abuse of a sibling
• Involvement with the criminal justice system
• Attending a school that enforces a zero-tolerance discipline policy

Preventing Trauma and Building Resiliency

In addition to addressing trauma in adults, it is critical to recognize that it is frequently possible to prevent ACEs. The Centers for Disease Control and Prevention (CDC) has ACEs training available for parents and professionals working with families, to help them understand and reduce the adverse experiences children are having.

When ACEs cannot be prevented, building resilience can help survivors to avoid the negative consequences statistically associated with the level of trauma they have navigated. Things that build resilience include supportive relationships with adults during childhood, a trusted friend to confide in and other protective factors that mitigate the situation. Trauma-informed therapies, which we strive to offer at Safe Harbor Recovery in Portsmouth, Virginia, can also be beneficial, including talk therapy, art, yoga and mindfulness training.

Researchers have linked the following personal traits to resilience:

• Optimism
• Cognitive flexibility
• Active coping skills
• Maintaining a supportive social network
• Attending to one’s physical well-being
• Embracing a personal moral compass

To a person in recovery, some or all of the characteristics listed above may look familiar, as they are areas which are often addressed while in treatment. These are not fixed, unchangeable attributes. People who are willing to put in the time and work are able to build their own resilience through a variety of recovery-related experiences.

The SAMHSA-HRSA Center for Integrated Health Solutions has more information on trauma and how to address it.

Getting Help

If the trauma that you or a loved one has experienced is leading to substance issues, Safe Harbor Recovery Center in Portsmouth, Virginia has professionals available to help the healing process begin.