It may seem obvious to anyone who has experience with substance use disorders that childhood adversity and addiction are related somehow. Certain patterns tend to emerge whenever people with substance use disorders start talking: having a parent who struggled with addiction, being abused physically or sexually, having a parent who was always in jail or who just wasn’t there at all, and so on.
However, you may not be aware that this phenomenon has been studied fairly extensively and that experts are now seeing a picture emerge of how these experiences affect not only your addiction risk, but also your mental health, your physical health, and even how much money you make. The following is a brief look at how adverse childhood experiences are related to addiction.
Adverse childhood experiences, or ACEs, are a measure of how often you felt frightened, threatened, hurt, insecure, or neglected as a child. ACEs fall broadly into three categories: abuse, neglect, and household dysfunction. Abuse can be physical, sexual, or emotional. Neglect can be physical—such as not having enough food or not having clean, adequate clothing—or it can be emotional, such as feeling unloved.
Household dysfunction includes having a parent with a mental health issue or substance use issue, having a parent who is incarcerated, witnessing domestic violence, or having your parents get divorced. It can be helpful to explore NPR’s interactive questionnaire and learn more about specific ACEs.
One of the largest studies on ACEs was conducted by Kaiser Permanente between 1995 and 1997. The study looked at data from more than 17,000 people and asked questions about adverse childhood experiences. It also collected answers regarding adult substance use and mental and physical health. As you might expect, most people had at least one adverse childhood experience. About two-thirds of respondents said they had at least one, and one-fifth of respondents had at least two.
Your next question might be: how many ACEs can you have before you’re in serious trouble? Ideally, the fewer the better. ACEs tend to be the kinds of challenges that stunt rather than stimulate growth. However, the magic number appears to be four. Each ACE increases your risk a little bit, but the risk jumps when you get to four.
At that point, experts have seen a jump in a variety of negative outcomes, including addiction, teenage pregnancy, and suicide. An ACE score of 4 nearly doubles your risk of heart disease and cancer—most likely from increased drinking and smoking—and increases your risk of developing alcohol use disorder by seven times, compared to someone with no ACEs.
Looking at the data, it may seem obvious that ACEs lead to addiction and other negative outcomes but if you look a bit closer, the picture gets complicated. For example, addiction has a strong genetic component, and even adopted children who are raised from birth by parents without substance use issues are more likely to develop an addiction if one of their biological parents had a substance use disorder.
Additionally, when a parent has a substance use disorder, there are more likely to be other problems, such as neglect, abuse, incarceration, and so on. It’s very hard to untangle the effects of genetics and a child’s environment but they both play a role. The same is true of mental health issues. There is a strong genetic component and it undermines the stability of the household. Mental illness is another route to addiction as well.
Conversely, there is a bit of good news: not everyone with a high ACE count will develop every problem associated with ACEs. It depends a lot on the individual as well as any mitigating factors, such as having community support and being connected with other responsible adults. While ACEs certainly contribute to addiction risk, other factors matter too.
ACEs have several important implications for the treatment of addiction. First and foremost, the strong connection between childhood experiences and addiction underscores the fact that addiction is not a choice. Children have basically no influence over their circumstances and yet those circumstances have an enormous influence over their health and happiness as adults. Therefore, we all need to recognize that shaming or punishing people with substance use disorders is pointless and counterproductive. Compassion and support are far more effective.
Second, it’s important to recognize that addressing trauma will often be a central component of addiction treatment. Research shows that anywhere between 20 and 50 percent of people seeking help for a substance use disorder have a lifetime diagnosis of PTSD. The earlier the trauma, the more challenging it is to overcome. However, people can get better with the right help.
As noted above, not everyone who has a high ACE count suffers the same consequences. One reason is that we’re all different and we all respond to adversity differently. Another reason is that there are often factors, such as positive childhood experiences, that offset the damage caused by ACEs.
These include things like having positive relationships with other adults—perhaps relatives, teachers, or coaches—as well as peers, learning healthy coping skills, having good educational opportunities, having access to food and healthcare, and having good available role models.
These may be available through community programs, public systems, education and public health programs, or extended family. However, as an adult, you may need therapy to address the harm caused by ACEs.
Like genes, ACEs do not determine your destiny, but they can have a significant influence on the rest of your life. We can’t control what happens to us as children, especially when we’re very young. However, we can understand the role that ACEs play in later problems such as addiction and we can respond with compassion, especially toward ourselves.
At Enlightened Solutions, we understand that the roots of addiction are complex. That’s why we treat the whole person, mind, body, and spirit. We address childhood trauma while also helping clients develop healthy coping skills and close connections to their support network. To learn more about our approach to treatment, call us today at (833) 801-5483.
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