How Adverse Childhood Experiences Lead to Adult Addiction

This is part one of a two part series of articles exploring how adverse childhood experiences and complex trauma lead to lifelong physical and mental health problems, such as addiction.

In this first section we’ll look at the Adverse Childhood Experiences study, which links childhood traumas with a host of specific lifelong health problems – and at the end you’ll also find a list of specific questions to ask if you suspect a loved-one’s current problems may originate from long-ago causes.

In the second article, we’ll explore how treatment as an adult can lead to processing and resolution of childhood traumas and to improved health and quality of life – examining why getting treatment so long after the fact makes sense and looking at what type of specific treatment to look for.

What Was the ACE Study?

The Adverse Childhood Experiences (ACE) study was run by Kaiser Permanente and the CDC.

For the study, researchers collected information on the childhood stress experiences and current behavioral, emotional and physical health of more than 17 000 adults in Southern California

• After analyzing this data, they determined that childhood stress exposure significantly raises a person’s risk of lifelong behavioral, mental and physical health problems.

Each study subject received an ACE score based on how many significant adverse childhood experiences they faced. The possible scores ranged from 0 to 7.  Exposure to any of the following before the age of 18 earned subjects one point.

1. Childhood emotional or physical neglect
2. Childhood emotional, physical or sexual abuse
3. Witnessing violence against your mother
4. Living with any drug or alcohol abusing family member
5. Living with any family member who was depressed or mentally ill, or who attempted suicide
6. Living through divorce or separation
7. Living in a household where one or more members were sent to prison.

How Prevalent are Childhood Adverse Experiences?

Based on the study results, we see that 2 out of 3 children will experience one or more adverse events before adulthood.

Study participants were predominantly white middle–class adults with health insurance. In this sample, the prevalence rates were:¹

• 36.1% of study participants reported no adverse childhood experiences
• 26.0 % reported 1
• 15.9 % reported 2
• 9.5% reported 3
• 12.5 % reported 4 or more²

Adverse Childhood Experiences and Addiction

There is a strong correlation between adverse childhood events and addiction risks, and the more adverse experiences you have, the greater your risk.

• Slightly under 3% of people with an ACE Score of 0 report adult alcoholism. For people with an ACE score of 1 that becomes 6%, for a score of 2, the percentage climbs to 10%, for 3 to just under 12% and for people with a score of 4, the percentage tops at 16%. Experiencing 4 or more adverse childhood experiences raises your adult alcoholism risk by more than 500%.
• A male with an ACE score of 6 is 46 times more likely to become an injection drug user at some time in life than a male with an ACE score of 0.
• A person with an ACE score of 6 or greater is 2.5 times more likely to be a current smoker than a person with an ACE score of 0 and more than 3 times as likely to have current emphysema or bronchitis.
  

ACE Score and Lifelong Health

As a person’s ACE score goes up, their risk for the following conditions/high risk behaviors also increases:³

• Depression
• Suicide attempts
• Heart disease
• Domestic violence
• Fetal death
• Multiple sexual partners
• STDs
• Unintended pregnancy
• Teen pregnancy
• Liver disease
• Early initiation of smoking 

Compared to a person with an ACE score of 0, a person with an score of 4 or greater is 4.6 times more likely to experience lifetime depression, 12.2 times more likely to ever attempt suicide, 2.5 times more likely to ever get an STD times 4.5 more likely to experience domestic violence, 5.3 times more likely to ever be raped and 2.4 times more likely to get hepatitis.⁴

Why the Adulthood Influence?

So the statistics paint a startling picture – difficult childhood experiences cause an incredibly strong predisposition to lifelong challenges; but what’s happening that could explain such a strong linkage?

Well, according to the theory, adverse childhood experiences grow into lifelong consequences via the following mechanism:

• Early-life adverse experiences -> social, emotional and cognitive impairments -> the adoption of health risk behaviors -> adulthood disease and disability -> early death.

Research is ongoing, but scientists can already see that early-life traumatic experiences affect the size and functioning of the hippocampus and corpus calosum as well as permanently changing how the brain responds to environmental stress.⁵

Early Death?

Is there any research to back-up this early-death hypothesis?

Unfortunately, yes there is.

Research backs-up the association between adverse childhood experiences and an increased risk of early death. When scientists followed a cohort of people with known ACE scores over a 10 year period they found that:⁶

• People with an ACE score of 6 or more were 1.5 times more likely to die during the 10 year window than matched subjects with an ACE score of 0.
• The average age of death for people with an ACE score of 6 or more was 60.6 years. The average age of death in a matched control group over this same period was 79.1. Among those who died over the 10 year period, having an ACE score of 6 or greater led to an average decrease in lifespan of 18.5 years. 

However, though people with ACE scores of 4 and 5 have significantly higher risks for lifestyle diseases and emotional health problems, researchers did not find any increased risk of early death among people with scores of 1 to 5. Further research is clearly needed to better explain this phenomenon.

Asking a Loved-One about Past Traumas

Do you suspect that someone you care about might have lived through adverse experiences during childhood that may be affecting their health and happiness today?

If it’s an appropriate situation, to find out, ask about specifics from the past that might explain a current problem. Here are some questions you might consider using or basing your own on. These are questions that the Substance Abuse and Mental Health Administration (SAMHSA) advises counselors use when screening for a history of childhood abuse or neglect:⁷

1. Did your parents or guardians treat you harshly as a child?
2. Were you ever physically, sexually or emotionally abused as a child?
3. While you were growing up, did any adult or person 5 years or more older than you ever make sexual advances or contact?
4. Was there violence in your household, while you were growing up?
5. Did you ever have a very traumatic experience while you were growing up, like divorce, the death of a parent, serious sickness in the family or a member of the household getting sent to prison?
6. Was there ever a time while you were young that you didn’t have enough food to eat, clothing to wear or adequate shelter?
7. Was there ever a time growing up when your parents did not protect you as they should have?
8. Did your parents use drugs or drink alcohol frequently while you were growing up?
9. Did you ever feel that you deserved any abuse or neglect, while growing up? 

What Can You Do about Your Childhood Now?

So if you lived through traumatic early-life experiences, is it all doom and gloom? Are you destined to a life of mental and physical illness and early death?

No! Though difficult childhood experiences may lead to maladaptive coping strategies and an increased risk of health problems, you should keep 2 important points in mind:

• Some people are extremely resilient to early-life trauma. Though many people with high ACE scores experience health problems, many also do not.
• Though you can’t erase the past, you can come to terms with past traumas and you can learn healthier coping strategies that greatly reduce any increased health risks.

The take-home message then, is:

1. Childhood traumas have lifelong influences, and a difficult childhood can predispose you to disease and early death.
2. If you have current emotional or behavioral health problems and a history of childhood trauma, getting appropriate treatment to address past traumas may help you to overcome your current problems.

Read part 2 of this article for information on how adult treatment for childhood trauma works and on what types of treatment to look for.