ACES & OPIATES Connecting the Impact of

Adverse Childhood Experienceson Addiction

• Adverse Childhood Experiences (ACE) Study

• Adverse Childhood Experiences Categories

• Measuring the correlation of health risk behaviors and diseases to exposure to childhood emotional, physical, or sexual abuse and household dysfunction.

(American Journal of Preventive Medicine, 1998)

Study Design • Largest scientific research study of its kind

• Initiated in 1995

• Requested participation of 26,000 consecutive patients seeking medical treatment at Kaiser Permanente in San Diego ; 71% agreed

• Over 17,500 + participants mostly middle-class American Adults

(Adverse Childhood Experiences, Overcoming ACEs in Alaska, 2015)

What is an Adverse Childhood Experience?

1. Physical Abuse2. Emotional Abuse3. Sexual Abuse 4. Incarcerated Relative5. Mother treated violently

6. Substance Abuse 7. Mental Illness 8. Loss of a Parent 9. Physical Neglect 10. Emotional Neglect

Toxic Stress

Toxic Stress occurs when a child experiences strong and/or prolonged adversity, including trauma, parental neglect or

exposure to violence.

Many of these experiences have been closely associated with parental or caregiver use of various substances including

alcohol, opioids or amphetamines.

This can result in a child with attachment problems, a less developed and smaller brain, and fewer neural connections which can lead to cognitive deficits

(Adverse Childhood Experiences, Overcoming ACEs in Alaska 2015)

How Does Exposure to Toxic Stress Effect Brain Development ?

• It can result in smaller brain size.

• It can disrupt the development of brain circuits.

• The individual then develops a low threshold for stress and becomes overly reactive to adverse experiences throughout the lifetime.

(Adverse Childhood Experiences, Overcoming ACESs in Alaska, 2016)

What Else Effects Brain Development ?

Introduction of foreign chemicals into the maternal blood stream, including alcohol, drugs and

environmental factors.

Introduction of maternally produced adrenal steroids produced by external stress

In addition to one time external stressors that produce adrenal responses, some mothers may be in a

constant state of hyper-arousal.

What causes a state of maternal hyper-arousal?

Domestic violence Low socio-economic status Lack of social support History of violence and abuse as a child Poor parenting skills

The higher the number of incidents of childhood exposure to abuse

and violence the greater the risk of an early death.

Childhood Exposure to Toxic Stress Effects in Adulthood

(American Journal of Preventive Medicine, 1998)

(Finkelhor& Dziuba-Leatherman, 1994)

Childhood Exposure to Toxic Stress Effects in Adulthood

How is Toxic Stress Different Than Other Types of Stress?

Now that we have an understanding of how ACE’s affect our brains let’s

talk about how drugs affect our brains and behaviors.

Brain Overview Brain Stem- Controls Basic Functions of Life. • Heart Rate• Breathing

Cerebral Cortex• See, hear ,feel, taste• Thought Processing, Problem Solving,

Decision Making

Limbic System• The reward/pleasure part of the brain• Activated by life sustaining activities and

also by abusive drugs• Responsible for emotions both positive and

negative

DopamineMost drugs of abuse target the brain’s

reward system by flooding it with dopamine

• Dopamine is a neurotransmitter that activates the natural reward system

• Drugs such as heroin overstimulate the reward system producing a euphoric effect

• The use of this drug is then reinforced leading to high levels of tolerance and addiction

( Drugs, Brains, and Behavior: the Science of Addiction, National Institute on Drug Abuse, 2016)

“In our detailed study of over 17,000 middle-class adults of diverse ethnicity, we found the compulsive

use of nicotine, alcohol and injected street drugs increases proportionately in a strong graded, dose –

response manner that closely parallels the intensity of adverse life experiences during childhood……Our

findings are disturbing to some because they imply that the basic causes of addiction Lie Within Us and the

way we treat each other, not in drug dealers or dangerous chemicals.”

Within Us

(Felitti VJ The Origins of Addiction, Evidence from the Childhood Experience Study, 2004)

500% increase in adult alcoholism is related in a strong, graded manner to (four or more) adverse childhood experiences

Felitti, VJ, The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study, 2004

Male child with an ACE score of six has a 4,600%Increased likelihood of becoming an injection drug user.

Felitti, VJ, The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study, 2004

What Does ACES Look Like in Alaska?

Source: Alaska data from the 2013 Alaska Behavioral Risk Factor Surveillance System, AK DHSS, Division of Public Health, Section of CDPHP

What are the most common ACEs among Alaska Adults?

How do ACEs compare between Men & Women in Alaska?

Researchers from the Nurses’ Health Study II “ found that women who were exposed to  trauma and had at least four PTSD symptoms were 60% more likely to have a heart attack or stroke than women who reported having no trauma.”

(http:www.cnn.com/2015/06.30health/ptsd‐heart‐attack‐stroke‐risk‐women/index.html)

What data is there about the Bristol Bay Region?

How childhood trauma affectshealth across a lifetime

Treatment, Prevention and Resilience• Treatment for addictions can be social,

therapeutic or medically assisted.

• Prevention activities generally includeeducation, systemic awareness activities, early screening and community organization.

• Creation of protective factors to build resilience, positive coping skills, clinical care, Spirituality, positive family and social supports, positive role models and healthy inter-personalrelationships.