Tuesday, May 8, 2018

Adverse Childhood Experiences (ACEs)

I believe that ACEs are epidemic in American culture. So many of us have high ACE scores and this is far more common than we may be aware of. We are not alone. And there is an urgent need to address and treat the root causes of so much suffering which, if left untreated, will be passed on generation after generation. We can heal ourselves and support the healing of others. Another world is possible. ― Molly

"Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today... When I look at what our nation's response has been so far, I wonder - why haven't we taken this more seriously?... I'm beginning to believe that we marginalize the issue because it does apply to us. Maybe it's easier to see in other zip codes because we don't want to look at it. We'd rather be sick... The science is clear. Early adversity dramatically affects health across a lifetime. Today we are beginning to understand how to interrupt the progression from early adversity to disease and early death. And 30 years from now, the child who has a high ACE score, and whose behavioral symptoms go unrecognized, whose asthma management is not connected and who goes on to develop high blood pressure and early heart disease or cancer, will be just as anomalous as a 6 month mortality from HIV Aids... This is treatable. This is beatable. The single most important thing that we need today is the courage to look this problem in the face and say this is real. And this is all of us. I believe that we are the movement." ― Nadine Burke Harris (Excerpted from her TED talk: https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime)


The study found those with adverse childhood experiences were at higher risk for heart, lung, and liver disease, obesity, diabetes, depression, substance abuse.

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.
ACEs include:
  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Intimate partner violence
  • Mother treated violently
  • Substance misuse within household
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member
ACEs are a good example of the types of complex issues that the prevention workforce often faces. The negative effects of ACEs are felt throughout the nation and can affect people of all backgrounds. Successfully addressing their impact requires:
Pyramid showing the correlation between adverse childhood experiences and health problems later in life.
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 and Prevention Efforts

Preventing ACEs and engaging in early identification of people who have experienced them could have a significant impact on a range of critical health problems. You can strengthen your substance misuse prevention efforts by:
  • Informing local decision-making by collecting state- and county-level ACEs data
  • Increasing awareness of ACEs among state- and community-level substance misuse prevention professionals, emphasizing the relevance of ACEs to behavioral health disciplines
  • Including ACEs among the primary risk and protective factors when engaging in prevention planning efforts
  • Selecting and implementing programs, policies, and strategies designed to address ACEs, including efforts focusing on reducing intergenerational transmission of ACEs
  • Using ACEs research and local ACEs data to identify groups of people who may be at higher risk for substance use disorders and to conduct targeted prevention

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

ACEs and Behavioral Problems

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