ACES and Trauma: What’s It All About?
One of the most significant studies that affected the way I think about trauma is the ACE Study conducted by Kaiser Permanente - often just referred to as ACES in the therapy world - which looked at the way adverse events that happened to children prior to the age of 18 affected their long-term health and life expectancy.
This study was conducted on 17,000 people and produced results that were astonishing.
It linked childhood trauma to addiction and other mental health illnesses. But shockingly it also increased physical diseases like obesity, cardiac issues, diabetes, chronic fatigue syndrome, cancer, stroke, Crohn’s disease, colitis, irritable bowel, kidney disease, asthma, and a shortened life span.
This was a significant finding that in my mind would make the treatment of trauma vitally important if we were going to offset these repercussions in people’s lives. Although the original study was conducted in the 1990s, nothing seemed to happen.
The results were huge in their significance and a German doctor named Dr. Vincent Felitti would go on to point these out in greater detail in 2003 in his article “The Origin of Addiction”.
A child with a score of 6 out of 10 on the ACES questionnaire had a 250% greater chance of being a smoker. Four or more on the ACE score result in a 500% increase of being an alcoholic. A score of 6 or more resulted in a 4600% chance of being an IV drug user. Felitti clarifies that adverse childhood events cause social, emotional, and cognitive impairments, which lead to the adoption of health risk behaviors, which lead to disease and disability and finally premature death.
Some things identified by the study that could put your health (mental and physical) at risk were:
having a parent who is addicted to drugs or alcohol
having a parent who is incarcerated
having a single parent
having a mentally ill parent
experiencing domestic violence in the home
having both parents not present in the home
Despite the relevance of this study and the importance of the findings, there still seemed to be little that was done with what was found. The idea of being trauma-informed was talked about a great deal and certainly those that treated trauma continued to treat trauma, but the relationship between addiction and trauma remained a quiet truth that wasn’t discussed much.
The fact that experiencing childhood trauma would lead to compensating behaviors in order to cope just wasn’t understood and that surprises me, at least from the trauma side of treating people. The addiction side had long approached addiction from a punitive stance.
In my early years in the addiction field and in my own recovery and treatment, I saw many very toxic interactions where treatment staff referred to clients in demeaning ways. They believed in the ‘tear you down, build you up approach’. They had very little patience and rehabs were like revolving doors with three strikes and you're out. You would be presented with pages of rules with no way to remember them all, but they served as a sure way of ridding them of people they decided they didn’t want to work with. Addicted clients were seen as the cause of all of their problems and were treated as such. You either towed the line or you could get out. We were often told that, don’t worry, there were many more people that could take your place. Addicted people were immoral degenerates that needed to be cajoled into getting better because they didn’t have the sense to do it themselves. That was one end of the pendulum that would eventually swing the other way with equally dangerous results.
It was interesting that despite the importance of the ACE study and Felitti’s article it was never fully applied to addiction; nor did it ever get any real traction in the medical world. Then along came the Alberta Family Wellness Initiative.
I ran across this on the internet one day and it was the first time I heard of The Brain Story. This was a nineteen-module course offered free of charge on their website and as an absolute lover of knowledge and learning, I thought ‘Great! A free course!’. I began the course, and I was amazed at what I learned and the quality of the information that was available. In my mind, this was a state-of-the-art level course. It had some of the experts in their fields weighing in on the neuroscience of addiction and how children become vulnerable based on the experiences they have as children. The information and the way it was presented and the quality of it mesmerized me. I started telling everybody I could about it. I was approached by someone and asked if I would like to participate in a project to help spread knowledge of this program to other people and organizations. I quickly signed up and became a Brain Builder. I developed a PowerPoint presentation and began presenting at different conferences. The presentation was called A Match Between Lived Experience and the Neuroscience of Addiction and included information on The Brain Story. This made a big difference in people’s understanding of addiction and was a very popular presentation.
Essentially, the science makes sense especially when compared to the lived experience.
Did the ACE Study Make a Difference to Addiction?
"Female opium addict hides her face - Mazar-i-Sharif detox centre" by Jacksoncam is licensed under CC BY 2.0
This study should have changed the way we viewed addiction, but unfortunately it did not. There has been a drive to destigmatize addiction, but as far as treating addiction, the trend has moved towards not treating it but to maintaining it.
The pendulum has swung the farthest it can in the other direction.
We will chauffer the addicted person all the way to the cemetery and, in the apparent act of kindness, we will provide the drugs to medicate their end of life. It’s like we’ve completely given up on helping addicts and have just decided to give them all a comfortable death. Not admitting to the fact that they often die on the streets.
This is the least expensive choice. It avoids the cost of treatment and causes no interference with the money earned by legal addictions. Science has enlightened us and politics has dropped a curtain. I left the addiction field because there was nothing that could be done to fight this trend, and I could no longer be part of it.
Did the ACE Study Help Inform the Medical Profession?
You can only be informed if you want to be informed. I am just going to speak to one area as it relates to the many compensating behaviors that lead to health risks and shorter life spans.
Obesity is a problem for many Canadians. We see a lot of clients who engage in emotional eating. There is a plethora of diets offered to people and we often hear our friends tell us of the latest diet they are trying. Some people get so frustrated with weight issues that they opt for bariatric surgery. I can’t begin to tell you how many people I have encountered while working in addiction who came in for alcoholism that only occurred after having bariatric surgery. They never had a problem with alcohol before and they are very angry to suddenly find themselves in treatment for alcoholism.
The doctors mentioned that they should be careful when drinking alcohol after the surgery, but they hadn’t expected they would end up alcoholic. I asked these people if the doctors had discussed the origin of their weight issues or had discussed trauma with them or had recommended trauma therapy for them before having the surgery and they all said they had not.
So, if we look at the ACE study, we know what it's going to tell us. It's going to say the eating issue is related to trauma and when the bariatric surgery stops the eating, they move to another compensating behavior like alcohol. If the trauma had been treated, the eating may have resolved itself with no need for surgery and no move to alcohol.
The main thing that the ACE study revealed was that childhood trauma was more common than we thought it was and that it had lifelong consequences. It also pointed to the importance of treating it whether in childhood or in adulthood. Untreated trauma does not remain silent but shows up in these unhealthy behaviors that cause health risks and shortened life spans.
I believe that the ACE study was one of the most significant studies that was ever conducted, and it was one that should not be ignored by anyone no matter what field that they work in. For those of you that may be interested in The Brain Story, you can find it here. It is completely free and you do receive a certificate of completion when you finish it if that matters to you. But if you have significant childhood trauma, do it for yourself.
If you have trauma, seek therapy to resolve it. You owe it to yourself and those who love you to have a healthier life. I’m very well-educated when it comes to resolving trauma and I’ve lived through my share of it. Please contact the clinic and ask for me, Karen. I’d love to help you.