The bad kind of ACE

If you’re playing poker, a handful of aces can be a good thing. If you’re growing up, not so much, especially if the aces stand for Adverse Childhood Experiences.

That kind of ACE was the accidental discovery of Dr. Vincent Felitti, who ran a weight-loss clinic in California for the health care giant Kaiser Permanente in the 1980s.

A star of the program was a woman who initially weighed 408 pounds. She lost 276 pounds in less than a year.

Then, something happened. In less than a month, she put nearly 40 pounds back on.

Felitti questioned her about what happened. It came out that, after losing the weight, she was sexually propositioned by an older, married co-worker. While Felitti acknowledged that must have been disturbing, he thought the dramatic weight gain was an extreme response.

Then, she revealed that she had been repeatedly sexually abused by a family member starting at age 10. One could see the weight gain as a kind of protection, conscious or otherwise, from unwanted advances.

Felitti checked with other patients who quit the program and found that a majority reported childhood sexual abuse.

Sensing a connection between childhood experiences and adult outcomes, he partnered with Robert Anda, of the federal Centers for Disease Control and Prevention, to survey more than 17,000 adults in the Kaiser system about the extent and effects of childhood trauma, including various kinds of abuse and family disfunction.

The main finding was that these were “vastly more common than recognized or acknowledged” and that they “have a powerful relation to adult health a half-century later.”

This led to the development of a widely-used ACEs test, which identifies whether people experienced one or more of the following: physical abuse by a parent, sexual abuse by anyone, emotional abuse in the household, physical neglect, emotional neglect, loss of a parent (from death, divorce or separation), growing up in a household with an alcoholic or person with substance-use disorder, living with a family member with mental illness, and the incarceration of a household member.

Add up the “yeses” to these and you’ll have an ACEs score.

Research suggests that, while trauma isn’t destiny, a high incidence of ACEs is associated with a much higher risk for behavioral health issues, such as physical inactivity, smoking, alcoholism, drug use and missed work, not to mention things like incarceration.

High ACE scores also increase risk for severe obesity, diabetes, suicide attempts, sexually transmitted diseases, depression, cancer, strokes, heart disease, chronic obstructive pulmonary disease and even physical injuries, like broken bones.

According to the CDC, people with an ACEs score of six or more die 20 years earlier, on average, than those with no ACEs.

Studies suggest that nearly two-thirds of Americans have an ACE score of at least one, and 38 percent have scores higher than one. Around 12.5 percent have ACE scores of four or more. The most common ACEs were physical abuse (28 percent), substance abuse (27 percent) and the absence of a parent (23 percent).

It’s hard to get an exact handle on the economic toll of ACEs, but the annual costs associated with symptoms are in the hundreds of billions of dollars.

Unfortunately, many children dealing with the effects of trauma are misdiagnosed as having conditions such as attention deficit/hyperactivity disorder or other disorders. Or simply as being “bad.”

Research suggests that a better question to ask in such cases is “what happened to you?” rather than “what’s wrong with you?”

What does this mean for West Virginia? In short, a lot.

A 2014 survey suggests that at least 55.8 percent of Mountain State residents had at least one such experience, and 13.8 percent experienced four or more. That’s likely an underestimate, because of slightly different methodologies.

Consider the connection between ACEs and the state’s opioid problem. According to the WV ACEs Coalition,

“A 2016 study found that individuals who reported 5 or more ACEs were 3x more likely to misuse prescription pain medication and five times more likely to engage in injection drug use. Another study found that over 80% of the patients seeking treatment for opioid addiction had at least one form of childhood trauma, with almost two-thirds reporting having witnessed violence in childhood. Among the different forms of ACEs, sexual abuse and parental separation (for women) and physical and emotional abuse (for men) appear to be particularly highly correlated with opioid abuse.”

Follow-up research by Felitti and Anda suggests that boys with six or more ACEs were 46 time more likely to become intravenous drug users as adults than those with none.

That’s on the front end. It gets scarier if we think about the future effects of the trauma experienced by children dealing with the crisis today.

What can we do about it?

First, it’s time to recognize that punishing trauma doesn’t work, neither for children nor adults.

At the individual level, positive connections with at least one adult contribute to resiliency. So do things like physical activity and developing mindfulness skills.

At the larger level, protective factors include things like helping parents manage stress, building social connections, increasing knowledge of child development and parenting skills, concrete support for families in times of need and promoting positive interactions between children and adults. At the systemic level, obvious steps would be ending poverty, reducing inequality and addressing racial disparities.

We can’t change the past, but the future is unwritten.

(This ran as an op-ed in the Charleston Gazette-Mail.)