To Get to the HEART of the Matter, You Need to Look at the ACEs: Adverse Childhood Experiences and their Correlation to Substance Abuse and other Health Concerns

As many of us know, substance abuse is a common factor in criminal defense work. On any typical day, a felony courtroom anywhere in the state of Texas (or any state for that matter) may see dozens of cases, and I would venture to argue that the majority have a substance abuse component to them.  As some of these cases are non-violent or non-aggravated, many of these clients are screened for drug rehabilitation programs as part of a probation recommendation. Some of these clients get sober, complete the required program, and go on with their lives.

Unfortunately, many clients relapse and find themselves in the unfortunate situation of another charge and perhaps enhanced penalties. Research shows that those who use drugs are more likely to offend than those who do not use drugs. Drug users were 7-8 times more likely to offend than nondrug users.1 Drug users are also more likely to reoffend. 65% of drug offenders are rearrested within 3 years of release from prison, 74% were arrested within 5 years, and 81% percent within 10 years.2 Perhaps the next time your client is discussing their drug addiction, it might be helpful to consider where this behavior first started and how it led to their current situation. Perhaps we are treating the symptom and not the catalyst for the addiction.

When I reflect on the large number of cases I’ve worked on over the past 20 years, it’s clear that a surprisingly high number involved substance abuse, albeit many times that was not the offense charged. For some offenses, like possession of a controlled substance or driving while intoxicated, the substance abuse was clear. However, in many of the other cases, it was an essential element for the actions committed. In my experience virtually all property-related crimes involve substance abuse issues. For example, an addict needing to secure funds to support their habit might commit a burglary or robbery. So the offense was charged as a property-related crime, but the underlying issue is substance abuse.

From there I started to notice that many of my clients had suffered significant childhood trauma. I began to think about the relationship between drug addiction and childhood trauma. Even more so, these addiction problems sometimes began years later and continued decades after the trauma. Surely there must be a connection? How was it that so many of my who clients were deep in addiction also had suffered significant trauma during their formative years? It surely couldn’t be a coincidence that persons who underwent troubling and significant distress during their childhood later turned to drugs. After all, no one wakes up wanting to be a drug addict. The drugs must be a means to an end; to ease the pain and to help forget of the terrifying ordeals they went through and continue to endure today as a result of their trauma.

Due to my curious nature, I started doing some research to see if there was any research on the subject. This led me to the study of ACEs (Adverse Childhood Experiences), an article by Jane Ellen Stevens, and a research article in the American Journal of Preventative Medicine.3 4 This literature began to put the pieces together of the puzzle that had been eluding me for years.

So what are Adverse Childhood Experiences (“ACEs”) and why should we care? ACEs are basically traumatic events that occur before the child turns eighteen (18). ACEs can take many forms like abuse, trauma, and violence and be both direct and indirect. The study of ACEs looks at the relationship of childhood trauma and adult health risk behaviors and disease.5 This does not solely include drug addiction. Evidence from epidemiological and neurobiological studies suggest ACEs such as sexual and physical abuse and related adverse experiences to be closely related to enduring brain dysfunctions that, in turn, affect physical and mental health throughout the lifespan.6

In essence, an ACE questionnaire asks ten (10) questions regarding childhood trauma.7 These question categories cover topics such as psychological abuse, physical abuse, sexual abuse, substance abuse by a parent, depression in the household, and loss of a parent. Research suggests that a high ACE score leads to a greater risk of chronic disease, mental illness, substance abuse, and similar issues.8 9 10

Compared to people with zero (0) ACEs, people with ACE scores are two (2) to four (4) times more likely to use alcohol or other drugs and to start using drugs at an earlier age.11 People with an ACE score of five (5) or higher are seven (7) to ten (10) times more likely to use illegal drugs, to report addiction, and to inject illegal drugs.12

Research has shown that drug use is the coping behavior that people adopt because they weren’t provided with a healthy alternative when they were young.13 Many young people exhibiting early signs of trauma such as trouble concentrating, acting out, depression, or anxiety are placed on prescription drugs to calm them down. While the intent behind this is surely commendable, research shows that the body “keeps score”.14 That is, the brain of someone who suffered multiple ACEs is still triggered by things that remind them of their trauma. Zoloft, Ritalin, and other related prescription drugs do not erase those triggers, memories, or flashbacks.15 Similarly, narcotics ease the pain, albeit temporarily.  The linking mechanisms appear to center on behaviors such as smoking, alcohol or drug abuse, overeating, or sexual behaviors that may be consciously or unconsciously used because they have the immediate pharmacological or psychological benefit as coping devices in the face of the stress of abuse, domestic violence, or other forms of family and household dysfunction.16

As mentioned earlier, high ACE scores do not only lead to drug usage. They also can lead to significant health issues. An ACE score of four (4) or more nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent.17 Exposure to four (4) or more ACEs also had an increased risk for sexually transmitted disease, physical inactivity, and obesity.18 Exposure to higher numbers of ACEs increased the likelihood of smoking by the age of 14, chronic smoking as adults, and the presence of smoking-related diseases.19

Exposure to ACEs can also affect a person’s mental health and related behaviors. There is clear evidence that ACE and ACE-related disorders are associated with enduring effects on the structure and function of neural stress-regulatory circuits such as for example the hippocampus, the amygdala or the ACC (anterior cingulate cortex) and promote alterations in stress sensitivity and emotion regulation in later life.20 Exposure to ACEs can create disturbances in cognitive and affective processing such as a heightened attention toward threatening stimuli, heightened experience of loneliness, social cognitive functioning, and social interactions including aggressive behaviors.21

According to Jane Ellen Stevens’ article, some practitioners consider addiction to be the wrong term to describe those addicted to drugs. It is argued that the term “ritualized compulsive comfort-seeking” should be used instead.22 They state that “ritualized compulsive comfort-seeking” is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.23

As you can see, exposure to ACEs can have detrimental, long-term effects on a person’s personality, behavior, and cognitive functioning, as well as their physical well-being. These do not simply go away when someone becomes an adult. They stick around and affect choices that are made on a daily basis years after the trauma.

So where do we go from here? Why is this important? As any responsible attorney, let alone compassionate human being, one might consider questioning their clients during interviews about their childhood. Instead of focusing on the drug usage, it might be more helpful and probative to inquire about the reasons for the addiction. “Dig a little deeper,” I would say.  

Think of it this way, drug treatment without treating the root cause is like putting a band aid on a bullet wound. We can treat the symptoms, but we won’t see lasting results until we take the bullet out and let the healing begin. Likewise, our clients dealing with debilitating drug addiction will not get better until we discover the root cause(s) of their addiction. Once we identify and treat the reasons for the addiction, the need for drugs dissipates. For many clients, a referral to a therapist can make all the difference. Therapy with a trained mental health counselor is fundamental in addition to rehabilitation with a drug treatment provider.

Many times, during a negotiation or sentencing hearing, attorneys argue that their client had a difficult upbringing. Later on, they also discuss drug usage. However, in my experience it is rare for attorneys to connect the dots to show the relationship. That relationship absolutely exists, so we must connect the dots to help the judge and the jury see the complete picture.

Hopefully this article gave you something to think about. While so many of our clients are struggling with drug addiction, the “root cause” of their forage into substance abuse likely had its basis in childhood traumas and struggles decades earlier. While this does not condone or excuse the offending behavior, it surely puts a different light on it and the many reasons for the conduct and actions that follow. Perhaps the next time your client is discussing their drug addiction, it might be helpful to consider where this behavior first started and how it led to their current situation.

Footnotes

  1. Andrade D, Ritchie J, Rowlands M, Mann E, Hides L.  Substance Use and Recidivism Outcomes for Prison-Based Drug and Alcohol Interventions.  Epidemiologic Rev. 2018; 40:121-133
  2. Antenangeli L, Durose MR. Recidivism of Prisoners Released in 24 States in 2008: A 10-year Follow-up Period (2008-2018), U.S. Department of Justice, Special Report, September 2021.
  3. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  4. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  5. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  6. Herzog JI and Schmahl C. Adverse Child Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan.  Front Psychiatry (2018) 9:420: 1-8. doi:10.3389/fpsyt.2018.00420
  7. A sample ACE Questionnaire is included as an exhibit.
  8. White C. (2016, July 11) The Single Best Medical Appointment of My Life Was When a Nurse Practitioner Asked Me About My Adverse Childhood Experiences.  Center for Health Journalism, University of Southern California.  https://www.centerforhealthjournalism.org
  9. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  10. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  11. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  12. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  13. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  14. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  15. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  16. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  17. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  18. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  19. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study. AM J Prev Med. 1998: 14(4):245-258
  20. Herzog JI and Schmahl C. Adverse Child Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan.  Front Psychiatry (2018) 9:420: 1-8. doi:10.3389/fpsyt.2018.00420
  21. Herzog JI and Schmahl C. Adverse Child Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan.  Front Psychiatry (2018) 9:420: 1-8. doi:10.3389/fpsyt.2018.00420
  22. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
  23. Stevens JE. (2017, May 2) Addiction Doc Says: It’s Not the Drugs.  It’s the Aces…Adverse Childhood Experiences.  ACE Study, Adverse Childhood Experiences, Child Trauma, Community Prevention Programs.  https://www.acestoohigh.com
TCDLA
TCDLA
Sean David Levinson
Sean David Levinson
Sean David Levinson is the founder of the Levinson Law Firm. Sean’s office is a boutique law firm focusing on parole matters throughout the state of Texas. In addition to representing clients before the Parole Board, he also handles parole revocation hearings, Medically Recommended Intensive Supervision (MRIS) cases, Blue Warrant issues, pre-incarceration client consultations, and planning/strategy sessions with defense counsel. He frequently speaks on corrections and parole law topics for bar associations across the state of Texas. As a native Spanish speaker, he consults with clients in both languages. Sean graduated from Arizona State University with a double major in Business Management (B.S.) and Broadcasting (B.A.). He received his J.D. from Northern Illinois University. Sean holds an LL.M. from the Benjamin N. Cardozo School of Law/Yeshiva University. He is licensed to practice law in Texas, New York, and Illinois. He lives in Austin, Texas with his Yorkie, Indiana Jones. He is a certified scuba diver and his favorite band is Counting Crows. He can be reached at (512) 467-1000 or BetterCallSean.com.

Sean David Levinson is the founder of the Levinson Law Firm. Sean’s office is a boutique law firm focusing on parole matters throughout the state of Texas. In addition to representing clients before the Parole Board, he also handles parole revocation hearings, Medically Recommended Intensive Supervision (MRIS) cases, Blue Warrant issues, pre-incarceration client consultations, and planning/strategy sessions with defense counsel. He frequently speaks on corrections and parole law topics for bar associations across the state of Texas. As a native Spanish speaker, he consults with clients in both languages. Sean graduated from Arizona State University with a double major in Business Management (B.S.) and Broadcasting (B.A.). He received his J.D. from Northern Illinois University. Sean holds an LL.M. from the Benjamin N. Cardozo School of Law/Yeshiva University. He is licensed to practice law in Texas, New York, and Illinois. He lives in Austin, Texas with his Yorkie, Indiana Jones. He is a certified scuba diver and his favorite band is Counting Crows. He can be reached at (512) 467-1000 or BetterCallSean.com.

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