1.4.3 The ACE Study

Topic Progress:

It is now thought that addiction is heavily influenced by trauma. Not just the serious types of post-traumatic stress that results from battlefield experiences, near death experiences and serious physical or sexual assault, but also (and perhaps more frequently) from a range of relational and developmental traumas, especially when they occur in early childhood.

Relational and developmental trauma refers to any event which disrupts the normal stages of development in young humans (attachment, exploration, play, skill acquisition and a sense of belonging) – or any event which disrupts the key relationships that should be helping us to configure those abilities (usually parents and teachers).

In the mid 1980s physicians at Kaiser Permanente’s Department for Preventative Medicine in San Diego made a startling discovery that seemed to bear this out. They found that members of their weight loss program often dropped out as soon as they successfully started losing weight.4

This finding led the doctors to speculate as to why their obese patients were seemingly unwilling to let go of their weight? Could overeating be a coping mechanism for obese patients that they didn’t want to let go of, and that they learnt in childhood or adolescence? Could it be that these patients had put on excess weight as a protective mechanism in response to a traumatic childhood?

For example, could someone who had been sexually abused as a child have learned that excess weight made them less attractive to a sexual predator? Or did comfort eating self-medicate such traumas by releasing feel-good neurotransmitters like dopamine and endorphins, which temporarily blotted out the effects of the emotional abuse, stress, and abandonment? Was there indeed, a link between adult obesity and childhood trauma?

In the mid 1990s the Kaiser hospital group teamed up with The Center for Disease Control and designed the Adverse Childhood Experiences Study (also known as the ACE Study).5 The study intended to find a link (if any) between ten common types of childhood adversity and a number of adult health concerns including; overeating, nicotine use, alcohol use and the use of injectable drugs.

The following things were outlined by the ACE study to be the most defining characteristics of an adverse childhood. They are ten common types of adversity which fall under three categories; abuse, neglect and household dysfunction.


  1. Emotional abuse
  2. Physical abuse
  3. Sexual abuse


  1. Emotional neglect
  2. Physical neglect

Household Dysfunction

  1. Domestic violence in the household
  2. Mental illness in the household
  3. Addiction in the household
  4. Separation or divorce of parents/death of a close family member
  5. An incarcerated family member

Respondents were asked a variety of questions pertinent to these criteria in order to determine the levels of abuse, neglect and household dysfunction each respondent have been exposed to. The results were stark. This study (and further studies) found a high degree of correlation between these adverse childhood experiences and poor behavioral health in adulthood – behaviors such as drug addiction, alcoholism, overeating and smoking.6

And this was not the only link. High rates of ACE also indicated much higher rates of chronic and non-communicable diseases such as bronchitis and emphysema, than in those who were not exposed to such adverse experiences.7

In fact, the study also revealed a ‘dose-response’ relationship between ACE and addictive behaviors, meaning that the more a person used illicit drugs, alcohol, nicotine or food to self-medicate, the higher the rate of ACE in childhood.8

Below are threeexamples of the dose-response relationship between ACE and addictive behavior

  1. A severe, hardcore intravenous heroin user who has hepatitis C and who works in the sex trade, might have 9 out of 10 of these ACE’s.
  2. A cocaine addicted, heavy drinking lawyer with a history of convictions for drink driving (but an otherwise functioning life) might have 5.
  3. A cannabis addicted student failing in his grades, might have 2.

This mirrors what we already know about substance abuse disorder (SUD). SUD exists on a continuum. It is not black and white! You are not either ‘an addict’ or a ‘non-addict’. People exist on a range between ‘not really being compulsive in any of their behaviors’, to being ‘full-on addicted to multiple drugs and behaviors’. Most humans are somewhere in-between.

It is also worth noting that household dysfunction and adverse childhood experiences do not seem to be the sole preserve of extremely poor communities or those at the bottom of the socio-economic hierarchy. ACE’s are much more evenly distributed across socio-economic groups than we might like to think. The ACE study was researched using data from over 17,000 predominantly middle-class Americans of various ethnicities.9

The criteria used to define abuse might also come as something of a surprise. Below are some of the questions that were used by the ACE study to determine emotional and physical abuse.

  • “How often did a parent, step-parent, or adult living in your home swear at you, insult you, or put you down?”
  • “How often did a parent, step-parent, or adult living in your home act in a way that made you afraid you might be physically hurt?”
  • “How often did a parent, step-parent, or adult living in your home push, grab, slap or throw something at you?”

Answers of “sometimes,” “often,” or “very often” defined emotional or physical abuse during childhood. Not exactly big traumatic stuff you might think, but this is because the things that cause psychological imbalance in humans are not what you might expect. Humans can deal with floods, and they can deal with hurricanes, but they can’t cope with being abused by the people that are supposed to love them.