ACEs, Opioids and Families

June 9, 2021

Chad T. Rodgers, MD, FAAP, Chief Medical Officer, AFMC; Partner and Pediatrician, Little Rock Pediatric Clinic

Arkansas ranks first in the nation for those who have experienced at least one Adverse Childhood Experience. We are one of the highest in the country for children who have experienced three or more. Arkansas also ranks second in opioid prescriptions per 100 persons and 33rd in opioid-related deaths.

Adverse Childhood Experiences (ACEs) are intense and sometimes prolonged exposure to stressful events or conditions during childhood causing a sustained stress response (increased heart rate, blood pressure, sweating, decreased digestion and/or increased utilization of the body’s energy stores) that has an impact on mental and physical development. ACEs are common. If a person has one, they are more likely to have experienced others. The more ACEs you have, the more likely you are to experience lifelong consequences, not only to your mental health but also physical health (high blood pressure, diabetes, obesity, cancer and others).

The original ACEs study looked at ten areas of trauma. They included what might be what is typically thought of as trauma: physical, sexual and emotional abuse, but also neglect of some physical and emotional conditions (food insecurity, lack of housing and not feeling like you belong). Five areas of household dysfunction are also included: separation from a parent due to divorce or parental incarceration, a family member with significant mental illness or substance abuse, and witnessing violence in the home. For more information about the original study and ACEs, go to the Center for Disease Control’s resource page.

We have learned a lot about ACEs over the years. We have also learned that there are other forms of trauma. What may be traumatic to one person may not be traumatic to another. We have also gained a great deal of science to support why trauma has such an impact on our bodies and minds.

For many, substance abuse by a family member accounts for some or all their ACEs. Opioids themselves can be a source of trauma, but opioid use often begins in response to physical trauma (e.g., pain killers for painful accidents). Mental trauma can also drive opioid use, and we are all aware of the powerful addiction opioid use can cause.

The overprescribing and overuse of opioids have led to a health crisis. It has destroyed lives and families. We will see its impact for generations. During the pandemic, the rate of substance abuse continues to increase.

Efforts by the state have helped combat the pandemic of opioid use. There is a downward trend in prescriptions. Efforts to destigmatize substance abuse and increase support to individuals and their families have been shown to increase the chances of recovery. But we still have a long way to go. We must continue to acknowledge the impact of ACEs and now ask “What happened to you?” rather than “What is wrong with you?”

Providing resources to children and families helps raise them out of the depths of addiction. Identifying families in crisis and teaching the building blocks of resilience buffers the impact of childhood trauma. We all have a role to play, big and small. Research and experience prove nurturing, safe and consistent adult-child relationships foster the resilience we need to buffer ACEs so that we all grow up healthier and happier.

For more information about the original study and Adverse Childhood Experiences, go to the Center for Disease Control.