What comes first the chicken or the egg? Many think this is a stupid question that may be unanswerable; however, the question of whether childhood trauma directly correlates to an increase in substance dependence has seemingly been answered. The Adverse Childhood Experiences (ACE) Study, whereby over 17,000 Kaiser Permanente members voluntarily participated in a study to determine the how stressful or traumatic experiences during childhood affect or impact adult health. After all of the data was collected and all identifying information redacted, the Centers for Disease Control and Prevention completed the processing of the information.
The numbers were staggering:
- 11% were subjected to emotional abuse
- 28% subjected to physical abuse
- 21% subjected to sexual abuse
- 13% witnessed their mothers being treated violently
- 27% grew up with someone in the family home abusing drugs or alcohol
- 19% grew up with a family member in the home suffering from a mental illness
- 23% grew up in a divorced family
The study demonstrated that roughly 2/3 of the individuals who suffered adverse childhood experiences had/have serious drug and alcohol problems. Thus, although genetics plays some role in the development of alcoholism and drug addiction, the ACE study findings suggest that environmental issues (adverse childhood experiences) have a dramatic impact on alcoholism and drug addiction.
Additionally, a Harvard neuroscientist Martin Teicher and Harvard pediatrician Jack Shonkoff, determined that flight or fight hormones are a safety mechanism for every human being; however, when an individual is exposed to trauma and abuse on a consistent basis, these hormones become over-bearing for the individual. Additionally, these individuals seem to have major issues with trust as well as live in a constant state of fear and protection, i.e., typical of individuals suffering from alcoholism and drug addiction.
For example, if an individual is walking in the mountains alone and sees a large mountain lion, the increase in adrenaline and cortisol acts to create a fight or flight response without thought. Under these circumstances, the need to run or evade the mountain lion is efficient; however, when a child is faced with fight or flight from a mountain lion every day, the brain stays in a constant state of high alert and emergency. This then creates major issues with the part of the brain –prefrontal cortex-that is responsible for handling math, science, reading etc.. Therefore, the prefrontal cortex has stunted growth given those emergency situations in the brain, i.e., running from a mountain lion take precedence over math, science and reading in school.
Adult Childhood Experiences Triangle
ACE Pyramid Credit Given to CDC Special Supplement
The ACE study and the CDC depicted what the study has discovered, that childhood abuse and experience dramatically impacts and leads to more severe and numbered social consequences, i.e., alcoholism, drug addiction and risky sexual behavior. A primary question the ACE study sought to address is “if risk factors for disease, disability, and early mortality are not randomly distributed, what influences precede the adoption or development of them?” (SEE www.cdc.gov.html). What this question alludes to is the fact that typically, risk factors for chronic illness are not randomly distributed and individuals who have one risk factor typically have one or more risk factors; thus, a clear link to socialization and childhood trauma and abuse.
Childhood Abuse Has Far Reaching Consequences:
Prevalence: About 14% of Children Suffer Abuse
- An estimated 681,000 children were confirmed by Child Protective Services as being victims of maltreatment in 2011 (USDHHS, 2012).
- A cross-sectional, US national telephone survey of the child maltreatment experiences of 4,503 children and youth aged 1 month to 17 years in 2011 found that 13.8% experienced child maltreatment in the last year (included neglect, physical abuse, emotional abuse, custodial interference, or sexual abuse by a known adult) (USDHHS, 2012).
Cost: Abuse Cost U.S. $124 Billion in 2008
Some of the costs associated with abuse of children correlate to the following:
- Improper brain development
- Impaired cognitive (learning ability) and socio-emotional (social and emotional skills)
- Lower language development
- Blindness, cerebral palsy from head trauma
- Higher risk for heart, lung and liver diseases, obesity, cancer, high blood pressure and cholesterol
- Smoking, alcoholism and drug abuse
- In 2011, approximately 1,570 children died from abuse and neglect across the country—a rate of 2.10 deaths per 100,000 children (USDHHS, 2012).
- Maltreatment during infancy or early childhood can cause important regions of the brain to form and function improperly with long-term consequences on cognitive, language, and socioemotional development, and mental health (DHHS, 2001).
- Children may experience severe or fatal head trauma as a result of abuse. Nonfatal consequences of abusive head trauma include varying degrees of visual impairment (e.g., blindness), motor impairment (e.g., cerebral palsy) and cognitive impairments (National Center on Shaken Baby Syndrome, 2009).
- Children who experience maltreatment are also at increased risk for adverse health effects and certain chronic diseases as adults, including heart disease, cancer, chronic lung disease, liver disease, obesity, high blood pressure, high cholesterol, and high levels of C-reactive protein (Felitti et al., 1998; Danese et al., 2009).
- In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman et al., 1996).
- In addition to physical and developmental problems, the stress of chronic abuse may result in anxiety and may make victims more vulnerable to problems such as post-traumatic stress disorder, conduct disorder, and learning, attention, and memory difficulties (Dallam, 2001; Perry, 2001)
- Children who experience maltreatment are at increased risk for smoking, alcoholism, and drug abuse as adults, as well as engaging in high-risk sexual behaviors (Felitti et al., 1998; Runyan et al., 2002).
- Those with a history of child abuse and neglect are 1.5 times more likely to use illicit drugs, especially marijuana, in middle adulthood (Widom et al., 2006).
- Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, and low academic achievement (Kelley et al. 1997). Similarly, a longitudinal study found that physically abused children were at greater risk of being arrested as juveniles. This same study also found that abused youth were less likely to have graduated from high school and more likely to have been a teen parent (Langsford et al., 2007). A National Institute of Justice study indicated that being abused or neglected as a child increased the likelihood of arrest as a juvenile by 59 percent. Abuse and neglect also increased the likelihood of adult criminal behavior by 28 percent and violent crime by 30 percent (Widom&Maxfield, 2001).
- Early child maltreatment can have a negative effect on the ability of both men and women to establish and maintain healthy intimate relationships in adulthood (Colman et al., 2004).
- The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion in 2010 dollars. This economic burden rivals the cost of other high profile public health problems, such as stroke and Type 2 diabetes (Fang et al., 2012).
- The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 (in 2010 dollars) including:
- childhood health care costs
- adult medical costs
- productivity losses
- child welfare costs
- criminal justice costs
- special education costs
- The estimated average lifetime cost per death is $1,272,900, including medical costs and productivity losses (Fang et al., 2012).
What does all this mean?
All of the data presented above as well as the results from the ACE study means that alcoholism and drug addiction is dramatically more complicated to treat than don’t drink, go to meetings, call your sponsor, read the big book and pray. Additionally, it is clear that maltreatment, abuse and negative childhood experiences has as much to do with the why of alcoholism and drug addiction as does genetics. Thus, a more comprehensive approach to treatment is necessary to help individuals recover from their disease.
1. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults Felitti, Vincent J et al.American Journal of Preventive Medicine , Volume 14 , Issue 4 , 245 – 258
- Colman, R., Widom, C. (2004). Childhood abuse and neglect and adult intimate relationships: A prospective study.Child Abuse and Neglect,28(11):1133–1151.
- Dallam, S. J. The long-term medical consequences of childhood maltreatment. In: Franey K, Geffner R, Falconer Reditors. The cost of child maltreatment: Who pays? We all do. San Diego (CA): Family Violence & Sexual Assault Institute; 2001.
- Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., et al. (2009). Adverse childhood experiences and adult risk factors for age-related disease.Archives of Pediatrics and Adolescent Medicine,163(12):1135–1143.
- Department of Health and Human Services (DHHS), Administration on Children, Youth, and Families.Child Maltreatment 2007 [online] 2009 [cited 2009 Apr 7].
Available from URL: http://www.acf.hhs.gov/programs/cb/pubs/cm07/index.htm
- Department of Health and Human Services (DHHS), Administration on Children, Youth, and Families. Understanding the effects of maltreatment on early brain development. Washington (DC): Government Printing Office; 2001.
Available from URL:http://www.childwelfare.gov/pubs/focus/earlybrain/earlybrain.pdf[PDF 454 KB]
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- Kelley, B. T., Thornberry, T. P., & Smith, C. A. In the wake of childhood maltreatment. Washington (DC): National Institute of Justice; 1997.
- Langsford, J. E., Miller-Johnson, S., Berlin, L. J., Dodge, K. A., Bates, J. E., & Pettit, G. S. (2007). Early physical abuse and later violent delinquency: a prospective longitudinal study.Child Maltreatment 12(3):233–245.
- National Center on Shaken Baby Syndrome. [online] 2009 [cited 2009 Apr 07].
Available from URL:http://www.dontshake.com
- Perry, B. D. The neurodevelopmental impact of violence in childhood. In: Schetky D, Benedek E, editors. Textbook of child and adolescent forensic psychiatry. Washington (DC):American Psychiatric Press; 2001. p. 221–238.
- Runyan, D., Wattam, C., Ikeda, R., Hassan, F., & Ramiro, L. Child abuse and neglect by parents and other caregivers. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva,Switzerland: World Health Organization; 2002. p. 59–86.
Available from URL:http://www.who.int/violence_injury _prevention/violence/global_campaign/en/chap3.pdf[PDF 176 KB]Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse and Neglect 20(8):709–723.
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- Widom, C., Marmorstein, N., & White, H. (2006). Childhood victimization and illicit drug use in middle adulthood.Psychology of Addictive Behaviors20 (4):394–403.