Adverse Childhood Experiences (ACEs)
Adverse childhood experiences (ACEs) are a significant risk factor for substance use disorders and can impact prevention efforts. Adverse childhood experiences (ACEs) are stressful or traumatic events, including abuse and neglect. They may also include household dysfunction such as witnessing domestic violence or growing up with family members who have substance use disorders. ACEs are strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse.
Mark Welty, one of TVN’s resident PhDs, co-authored a recent study about trauma-informed work with from our own data related to ACEs.
ACEs are a good example of the types of complex issues that the staff of The Village Network often faces. The negative effects of ACEs are felt throughout the nation and can affect people of all backgrounds. Successfully addressing their impact requires:
- Assessing prevention needs and gathering data
- Effective and sustainable prevention approaches guided by applying a prevention framework
- Prevention efforts aligned with the widespread occurrence of ACEs
- Building relationships with appropriate community partners through strong collaboration
How childhood trauma affects health across a lifetime | Nadine Burke Harris
Types of ACEs
- Mother treated violently
- Substance misuse within household
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
Many studies have examined the relationship between ACEs and a variety of known risk factors for disease, disability, and early mortality. The Division of Violence Prevention at the Centers for Disease Control and Prevention (CDC), in partnership with Kaiser Permanente, conducted a landmark ACE study from 1995 to 1997 with more than 17,000 participants. The study found:
- ACEs are common. For example, 28% of study participants reported physical abuse and 21% reported sexual abuse. Many also reported experiencing a divorce or parental separation, or having a parent with a mental and/or substance use disorder.
- ACEs cluster. Almost 40% of the Kaiser sample reported two or more ACEs and 12.5% experienced four or more. Because ACEs cluster, many subsequent studies now look at the cumulative effects of ACEs rather than the individual effects of each.
- ACEs have a dose-response relationship with many health problems. As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance use disorders. Furthermore, many problems related to ACEs tend to be comorbid or co-occurring.
ACEs Research and Behavioral Health
Research has demonstrated a strong relationship between ACEs, substance use disorders, and behavioral problems. When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning or ability to cope with negative or disruptive emotions may be impaired. Over time, and often during adolescence, the child may adopt negative coping mechanisms, such as substance use or self-harm. Eventually, these unhealthy coping mechanisms can contribute to disease, disability, and social problems, as well as premature mortality.
ACEs And Substance Use Disorders
- Early initiation of alcohol use. Underage drinking prevention efforts may not be effective unless ACEs are addressed as a contributing factor. Underage drinking prevention programs may not work as intended unless they help youth recognize and cope with stressors of abuse, household dysfunction, and other adverse experiences. Learn more from a 2006 study on initial alcohol use among adolescents.
- Higher risk of alcohol abuse as an adult. ACEs such as child abuse, parental alcoholism, and family dysfunction correlate with a higher risk of problem drinking behavior in adulthood. Learn more from a 2002 study on adverse childhood experiences and alcohol abuse as an adult.
- Continued tobacco use during adulthood. Prevalence ratios for current and ever smoking increased as ACEs scores increased, a 2011 study on ACEs and smoking status found.
- Prescription drug use. Prescription drug use increased as ACEs scores increased, according to a 2008 study of adverse childhood experiences and prescription drug use.
- Lifetime illicit drug use, drug dependency, and self-reported addiction. Each ACE increased the likelihood of early initiation into illicit drug use by 2- to 4-fold, according to a 2003 study on childhood abuse, neglect, and household dysfunction and the risk of illicit drug use.
ACEs And Behavioral Problems
- Increased risk of suicide attempts. ACEs in any category increased the risk of attempted suicide by 2- to 5-fold throughout a person’s lifespan. Learn more from a 2001 study on childhood abuse, household dysfunction, and the risks of attempted suicide.
- Lifetime depressive episodes. Exposure to ACEs may increase the risk of experiencing depressive disorders well into adulthood—sometimes decades after ACEs occur. Learn more from a 2004 study on ACEs and the risk of depressive disorders in adulthood.
- Sleep disturbances in adults. People with a history of ACEs have a higher likelihood of experiencing self-reported sleep disorders, according to a 2011 study on ACEs and sleep disturbances in adults.
- High-risk sexual behaviors. Women with ACEs have reported risky sexual behaviors, including early intercourse, having had 30 or more sexual partners, and perceiving themselves to be at risk for HIV/AIDS. Learn more from a 2001 study on ACEs and sexual risk behaviors in women.
- Fetal mortality. Fetal deaths attributed to adolescent pregnancy may result from underlying ACEs rather than adolescent pregnancy, according to a 2004 study of the association between ACEs and adolescent pregnancy.