By Dr. Adi Jaffe

Is substance use disorder a biological disease that is driven by environmental factors or not?

It should come as no surprise to you that childhood trauma, particularly unresolved trauma, can lead to mental health issues and struggles with substance abuse later in life. Although it took decades of research to fully understand the scope of their impact, today we have a pretty good understanding of just how damaging adverse childhood experiences (ACEs) can be on development and coping.

"Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs." - Dr. Daniel Sumrok

What are ACEs?

Adverse Childhood Experiences (ACEs) are traumatic events that occur in childhood.
Abuse (physical, emotional, sexual) and/ or neglect
Exposure to parental domestic violence
Household dysfunction e.g. parents with an untreated mental health condition or substance use disorder
Parental separation or divorce
Loss of parent through death, deportation, incarceration or being removed from the family home by child protection services

The above are just a few examples. As I’ve discussed in my podcast, many different adverse experiences, whether perceived at the time to be of significance or not, may lead to trauma. Stressful experiences in childhood may also stem from outside the family home. For example, bullying, witnessing violence, racism, being an immigrant, homelessness, living in a war zone and moving house often (such as in the case of military families).

A substantial portion of the people I’ve worked with over the past 11 years have experienced at least one of these ACEs. Most have experienced two or more.

What does research say about ACEs and long-term outcomes?

Much of the research has stemmed from the original CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, the most prominent investigation to date into childhood abuse and neglect and its impact on adult health and wellbeing. Data was collected between 1995 to 1997 from over 17,000 participants.

The ACE study looks at types of early trauma and the long-term outcomes for these children in later life. Participants were required to answer ten questions about specific forms of childhood trauma and mark whether they had experienced this or not. For each type of trauma, they received a score of 1, the highest being 10. For example, a person who was sexually abused was exposed to domestic violence and had a parent with a substance use disorder, would have an ACE score of three.

The study found that a person with an ACE score of 4 has nearly double the risk of cancer and heart disease than someone without an adverse childhood experience. What’s more, the likelihood of developing an alcohol use disorder increases 7-fold percent and the likelihood of suicide increased 12-fold.

People who have had an ACE are two to four times more likely to start using alcohol or drugs at an early age, compared to those without an ACE score. People with an ACE score of 5 or higher are up to ten times more likely to experience addiction compared with people who haven’t experienced childhood trauma.

The research has also revealed that people with higher ACE scores are more likely to experience chronic pain and misuse prescription medication, and are at increased risk of serious health conditions such as:

• Heart disease

• Cancer

• Depression

• Substance abuse

• Liver or lung disease

• Stroke

• Diabetes

In the United States, 60% of adults had experienced at least one traumatic event in their childhood and 25% had experienced at least 3 ACEs.

How do we make sense of all the research?

There’s an overwhelming amount of evidence supporting this notion: the majority of people currently experiencing mental health or addiction problems have a history of adverse childhood experiences. That’s not to say that all children who experience trauma will go on to have a substance use disorder, because there are a lot of other factors at play, but it is a nearly-necessary component of a person’s history that requires serious consideration in treatment.

"Ritualized compulsive comfort-seeking (what traditionalists call addiction) is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed." - Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine.

It’s also important to note that the ACE study simply reports on correlations, not causal links. We cannot say that experiencing physical abuse or a messy divorce in childhood will directly lead to a substance use disorder.

What we do know is this: Adverse childhood experiences are bad for your emotional and physical health and wellbeing in adulthood.

We must also consider all the other factors that influence a person’s behavior including socioeconomic factors such as income, education, and access to resources.

Now, I don’t want to overwhelm you with all the research that points toward the power of our trauma histories. Your ACE score is not destiny. With help, you can learn healthy coping mechanisms, and how to have healthy relationships. We also need to account for genetic, environmental and spiritual factors that influence our behavior.

And while the research sheds light on how powerful childhood trauma can be in our life’s trajectory, it also helps inform government, communities, and individuals about the importance of compassion. The link between adverse childhood experiences and later health problems is even more of a reason to reduce stigma and shame associated surrounding addiction. Children do not have control over their home environment, so, therefore, we cannot expect them to overcome their difficulties as adults without compassion and support.

How can we help people with ACEs overcome substance use disorder?

We need to focus on providing resources to the people at greatest risk and making sure those resources go into programs that reduce or mitigate adversity.

Dr. Daniel Sumrock says we can do these things to help people change addiction by:

Address a person’s unresolved childhood trauma through individual and/ or group therapy

Treat people with compassion and respect
Use harm minimization principles such as providing medication treatments for addiction (such as buprenorphine or methadone)
Help people with an addiction find a ‘ritualized compulsive comfort-seeking behavior’ (addiction) that is less harmful to their health.

IGNTD Hero Program takes ACEs into account, getting to the "why" of your struggles with substances, not just putting a Band-Aid on the compulsive seeking symptom. Indeed, we believe that focusing on the symptoms is harmful.

So if this is something you’d like to address either for yourself or for someone you know then find out more about my approach to addiction at the IGNTD Hero Program or in my book The Abstinence Myth.

Childhood Trauma, Health + Substance Use

Is substance use disorder a biological disease that is driven by environmental factors or not?

What are ACEs?

What does research say about ACEs and long-term outcomes?

How do we make sense of all the research?

How can we help people with ACEs overcome substance use disorder?