S02E16 - Adverse Childhood Experiences (ACEs)
“You may remember abuse and neglect you endured as a child and think it was your fault. It wasn’t.
You may remember abuse and neglect you endured as a child and feel it as if it is happening now. It isn’t. The childhood abuse and neglect you endured is over. If you have strong, adverse reactions while we move forward on this topic, please breathe, and ask for support.
You may think there is something inherently wrong with you because you have an addiction and/or mental health diagnosis. There isn’t.
You may feel inclined to harshly judge yourself about the way you have treated, thought about, and/or talked about yourself, others, and including any children you may have. The latest research, that we will go over today, supports the concept that you did the best you could with what you were given, and that any harsh judgments are not helpful for change.
Similarly, your parents/caregivers did the best they could with what they were given. This is not intended to deny any anger you might be feeling. Please work with your individual therapists to express this anger safely.”
As our group therapist finished with his opening statements, he moved into an area of inquiry that I had never stopped to even consider.
‘focus on what happened TO you VS. What’s wrong WITH you’
He explained that with a trauma informed approach to recovery, the focus shifts from what happened to you vs. what’s wrong with you.
As soon as I heard those words come out of his mouth my tears started flowing.
This is what I have been wrestling with deep down inside of myself for my entire life. Parts of me were taught and have always believed that I was a deeply flawed and an inherently bad person. Other parts, with ever so quiet voices, knew that wasn’t true, but those voices had always been drowned out by much louder voices; the voices of my church, the manmade interpretations of the Bible that I had viewed ‘as the voice of God’, the homophobic climate that I had been raised in, my own internalized homophobia, and my own harsh self-criticism against my addictive and compulsive behaviours.
I was being presented with new information that I had never even considered. Up until now, my addiction recovery treatment had been about stopping and eradicating behaviours. In this world, addiction was the root of my sinful nature and something that needed to be cast out of my life.
With all the new trauma-informed pyschoeducation I was receiving here in rehab, I was starting to discover that my challenges with addiction where a symptom of something deeper. I was starting to discover that there might be an opportunity for me to go beyond a binary view of addiction recovery to uncover ‘the WHY’ that drove parts of me towards compulsive and addictive behaviour in search of some sort of maladaptive solution.
Our group therapist continued his conversation with us,
“Asking WHY is important. When we explore ‘the why’ we have an opportunity for better overall outcomes:
- We start to understand the ‘why’ behind addiction and mental health, as well as ways to recover.
- We increase hopefulness and responsibility for change
- We help to reduce shame, especially about thinking that you are inherently flawed or caused your own abuse or addiction
- We help reduce blame of others
What if I told you that there is population-based clinical evidence that shows that the major factor underlying addiction in adults is childhood trauma. It is proven that those who suffer from addiction in their adult life are those who had adverse childhood experiences when they were younger. Your perceived challenge with addiction isn’t the problem. You are not the ‘problem’. It’s what happened to you that has caused this ‘problem’.”
Adverse Childhood Experiences Study (ACEs)
He continued by introducing us to the work of Dr. Vincent Felitti and his Adverse Childhood Experiences Study (ACEs) which has been called ‘the largest, most important public health study you never heard of’
Dr. Felitti’s 2003 work entitled “The Origins of Addiction” found that the major underlying factor of addiction is adverse childhood experiences that have not healed with time and that are overwhelmingly concealed from awareness by shame, secrecy, and social taboo. The ‘compulsive’ individual unconsciously seeks relief by using materials or methods with known psychoactive benefit because they perceive not to have any other resolutions available. They don’t want to be addicts. They are trying to protect themselves.
The Adverse Childhood Experiences (ACE) Study provides population-based clinical evidence that unrecognized adverse childhood experiences are a major, if not the major determinant of who turns to psychoactive materials and becomes ‘addicted’.
Dr. Felitti states “we find that addiction overwhelmingly implies prior adverse life experiences”.
As our group therapist continued with introducing today’s topic, my analytical mind was doing cartwheels.
‘If this study provides clinical evidence that Adverse Childhood Experiences are THE major determinant behind addiction, why hadn’t I ever heard of it before today?
Why had none of my previous therapists ever brought up this ground-breaking study? Why was this never discussed with any of my doctors when I shared that I was struggling with addiction? Why was this topic never mentioned in any of the dozens of 12-step meetings that I had been to?’
My internalized questioning was interrupted as our therapist started to share ten simple yes/no self-assessment questions that form the basis of the Adverse Childhood Experiences Study and allow individuals to discover their own ACE score.
“If each of you could find some space in your workbooks, I’m going to read you the ten questions that form the ACE study. As I read each of these questions, I would like you to simply record the number of YES answers you give yourself.”
Question 1 – Before your 18th birthday, did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you? OR
Act in a way that made you afraid that you might be physically hurt?
“If you answered YES to this question, or to any of the following questions, simply record the YES down in your notebook. If you answered no, you don’t have to record anything.”
Question 2 – Before your 18th birthday, did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you? OR
Ever hit you so hard that you had marks or were injured?
Question 3 – Before your 18th birthday, did an adult or a person at least five years older than you ever…
Touch or fondle you or have you touch or fondle their body in a sexual way? OR
Attempt or actually have oral, anal, or vaginal intercourse with you?
Question 4 – Before your 18th birthday, did you often or very often feel that…
No one in your family loved you or thought you were important or special OR
Your family didn’t look out for each other, feel close to each other, or support each other?
Question 5 – Before your 18th birthday, did you often or very often feel that…
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? OR
Your parents were too drunk or high to take care of you or take you to a doctor if you needed it?
Question 6 – Before your 18th birthday, was a biological parent ever lost to you through divorce, abandonment, or other reason?
Question 7 – Before your 18th birthday, was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? OR
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard OR
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Question 8 – Before your 18th birthday, did you ever live with anyone who was a problem drinker or alcoholic, or who used street drugs?
Question 9 – Before your 18th birthday, was a household member depressed or mentally ill, or did a household member attempt suicide?
Question 10 – Before your 18th birthday, did a household member go to prison?
After reading us all ten questions, we were instructed to add up the number of YES answers that we had marked down in our workbooks. If we had six YES answers our ACE score was six. If we had five YES answers, our ACE score would be five.
The simplicity of the ACE test started to set off some alarms in my head.
‘How could the answers to ten yes/no questions determine whether someone was going to have challenges with addiction? This seems more like a Cosmo dating quiz than something with actual credibility.’
I easily added up my score, and during that initial session, I scored a four.
Back inside my head, I started to downplay and brush off this quiz as nothing important.
‘Hmmm, a four is low. With all of my sessions about trauma, I thought my score would be much higher. I guess the ACE score isn’t all that magical. I doesn’t give any indications of why I struggle with addiction. I guess this test is only for individuals who have had extreme childhood trauma.’
Our therapist continued his session by sharing that the average ACE score in the US is a score of 1 and that any score over 3 is considered high.
This piece of information stopped me cold. ‘My score of 4 is considered high?’
He put up the breakdown of how ACE scores were distributed across the US population
ACE scores across the US population
- 42% of the population have an ACE score of 0
- 22.9% have an ACE score of 1
- 12.8% have a score of 2
- 8.2% have a score of 3
- 5.7% have a score of 4
- 3.8% have a score of 5
- 2.3% have a score of 6
- 1.2% have a score of 7
- 0.3% have an ACE score of 8 or more
My jaw dropped. Suddenly my little ACE score of 4, didn’t seem so little.
But the seriousness of the ACE study didn’t stop with the number that I saw in front of me.
Our therapist continued with educating us on the background of the original ACE study from the mid 1990s. He shared that even though the ACE study and scores that we had just calculated are extremely reliable for linking to chronic health, mental illness, and substance use problems in adulthood, the ACE scores in front of us don’t show the full picture.
He shared that the ACE study was originally created and run between 1995-1997 with 18,000 participants. Of these original 18,000 participants, 70% of them were white, 70% of them attended college, and all of them had paid health benefits.
‘Huh, college educated, working, white people, not exactly the picture of a diverse population that would fully show the impact of trauma. This can’t be the full story.’
Trauma the ACE study does not include
Our therapist agreed with the thoughts in my head as he explained that even though an ACE score gives us a solid understanding into adverse childhood experiences, it by no means, considers the breadth and scope of childhood trauma that we acknowledge and talk about today.
“The 10 ACE questions do not cover the adverse childhood experiences of living in an unsafe community where a child is exposed to regular community violence, the impact of queer children growing up in an non-affirming home or culture, the experience of systemic discrimination based on race or gender, spiritual abuse, terrorism, or even the impact of being bullied by peers in any type of environment.”
ACEs + Health Impacts
After sharing some of the limitations of the ACE study, he started to share some of the correlations between ACE scores and mental health.
People with an ACE score of 4 or more, compared to those who have an ACE score of 0 have a:
- 4x to 12x increased health risk for alcoholism, drug abuse, depression, and suicide attempts
- 2x to 4x increase in being a smoker and having poor self-rated health outcomes
- 2x to 4x more likely to have had 50+ sexual intercourse partners, and contracting sexually transmitted diseases
- 4x to 1.6x increase in being physical inactivity and severe obesity
- Children with ACE scores of 2, 3, and 4+ are significantly more likely to have moderate to severe ADHD
- Those with an ACE score of 6+ see a reduction to their life expectancy by 20 years.
After sharing statistic after statistic of how an individual’s ACE score could almost predict challenges in later life, he made sure to over emphasize the following
“We now know that addictive behaviours are not the results of moral failings or signs of lack of willpower or bad character – they are caused by actual changes in the brain caused by childhood trauma.”
As I heard him repeat that statement my floodgates opened up again. I tried to hold back the tears, but it was no use. For a brief moment, the years of constant self-gaslighting stopped. In that tiny moment, I found a sliver of self-compassion that took the sting away from years of hating myself, beating myself up for making ‘poor choices’, and believing that who I was some sort of moral failing.
The therapist spotted the tears that I was trying to hide, and he slowly approached.
“What’s going on for you right now?”
I didn’t know how to respond. I tried to regain my composure, but it was not use. Instead of finding the perfect words I blurted out,
“This shows that I’m not an evil sinner”
He got closer to where I was sitting, looked me in the eyes, and responded.
“No, you’re not an evil sinner. None of this is your fault. With what you lived through; you didn’t have a chance.”
He then shared a powerful quote from Dr. Gabor Mate, one of the world’s foremost experts in childhood development, trauma, and addiction.
“We don’t need a stitch more research on what causes addiction. We don’t need one more bit of research on what causes violence, rape, psychopathic behaviour, or mental illness. If you simply applied what we already know, we would have a totally different world. If you treat children well, they’ll turn out okay. You don’t treat children well, they don’t turn out okay.”
With love in his eyes, he started to help me open to the possibility that my challenges weren’t specific to me and weren’t any type of individualized failing. He shared that with my history, my behaviour and challenges were common, typical, and to be expected.
ACEs + Impaired functioning
According to the National Child Traumatic Stress Network the list of expected impaired functioning and behaviours in individuals like me who grew up in environments like I did includes:
- Lack of impulse control
- Self-destructive behavior
- Low self-esteem
- Shame and guilt
- Distrust for others
- Learning difficulties
- Lack of empathy
- Aggression against self and others
- Difficulty describing their own feelings
“James, there is nothing inherently wrong with you. The problem is what happened to you. You are not a bad person. You are not evil. You have been trying to protect yourself. And you did what you thought you needed to do. You are safe. And the challenges that you have been struggling with are trauma responses that you created out of necessity when you were younger. These old protective mechanisms have gone from useful towards useless. You no longer need to protect yourself like that.”
I paused and listened to his words but immediately got scared.
“But what if I don’t know who I am without those protective mechanisms?”
He stayed present with me and my questions and shared,
“That’s exactly why you brought yourself here. You brought yourself here to be reminded of who you were actually created to be. In this moment you are safe and surrounded with individuals who want to see you thrive. Childhood trauma isn’t the end of the story. It was an unfortunate starting point for you, but change is possible.”
I let those words sink in as he took a step back from me and started to speak to the group of us.
“ACEs are just the beginning of this journey. They help give insight into what has happened to an individual. They don’t dictate any type of final outcome for that person. What we’ve learned over the past two decades is that change is possible. Even when fully mature, the brain is highly adaptive and will grow, heal, and respond to new environmental stimuli. This is where our final concept for today comes into play.”
Healing from Adverse Childhood Experiences
We were all asked to flip forward in our notebook to a section titled Protective and Compensatory Experiences (PACEs for short). I read the introduction.
“Protective and Compensatory Experiences are positive experiences that can increase resilience and protect against risk of mental and physical illness. PACEs act as buffers, protectors, and promote healing of childhood trauma”
I quickly scanned down the list on the page in front of me
- Unconditional love
- A best friend
- Giving back – helping others in community projects
- Being involved in interest groups or hobbies – sports, music, social
- Access to healthy psycho-educational resources
- Exercise or physical activity
- Healthy eating
As I reflected on that list, I immediately noticed that connection with self and connection with others was the common denominator.
As I continued to reflect, one of my housemates asked a question that was starting to percolate in my mind too.
“If all of these things are helpful, what about the relationships where we have to fight to be seen?”
Our therapist responded,
“That’s a great question. We heal, grow, and thrive in relationships, places, and space where we feel safe enough to be authentically seen, heard, and known. Growth and healing start when we feel safe. Safety needs to be your number one priority as you move forward with your recovery.”
His answer gave me something new to think about. What are the spaces, places, and relationships where I feel safe enough to be seen, heard, and known?
Do I feel that way with myself? Do I feel that way with everyone in my family? Do I feel that way with all my friends and relationships? Do I feel that way at work?
I know what it feels like to survive and fight to be seen. But outside of this rehab experience, do I know what it actually feels like to be safe?
I’m not sure that I do. I guess that what it feels like to have an ACE score of 4.
ACEs in Canada?
- Lower risk for conditions like depression, ADHD, asthma, cancer and diabetes
- Reduce risky behaviours like smoking, heavy drinking, and other addictive coping mechanisms
- Improve education and job potential for those who have experienced childhood trauma
- Stop ACEs from being passed from one generation to the next