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Adverse Childhood Experiences and the Role of Trauma

Learn more about adverse childhood experiences and the role of trauma.

In this article, you will learn more about adverse childhood experiences and the role of trauma

Adverse Childhood Experiences (ACEs) are events that occur in a child’s life that have a negative influence during childhood and may have a lifelong impact on a person’s physical and mental health. ACEs can involve any action or nonaction that results in harm or the threat of harm to a person under 18 years of age and have been linked to a range of chronic health conditions, including eating disorders, substance abuse, self-harm, and early death in adulthood (23).

The original ACE Study was conducted in California between 1995 and 1997 in a primary care setting and aimed to retrospectively look at the impact of household dysfunction in childhood on people’s lives during adulthood. The researchers found that the number of traumatic childhood events significantly increases the risk of developing a range of negative health problems including depression, alcoholism, and substance addiction. What really surprised the researchers was that the 8,506 participants came from mainly middle-class American homes (24).

A further body of research established a link between ACEs and the development of trauma-based stress disorders such as posttraumatic stress disorder (PTSD) in adulthood. When a person experiences a toxic stressor, like a sexual assault or physical or verbal abuse in early life, it can seriously impact the child’s normal development starting a chain of additional stressors that can overwhelm the individual coping mechanisms (25).

In recent decades psychologists like John Bowlby have attempted to explore the relationship between the child and their primary caregiver, usually the mother, during the child’s early years. Bowlby found that children who have been ignored by preoccupied mothers are likely to be unhappy, anxious, or detached. Detachment is a defensive process employed by the child when they are emotionally hurt through physical or psychological isolation from their primary caregiver. If they are left isolated for a long time, as in the case of a substance-abusing parent or a caregiver suffering from a mental illness, the child’s attachment instinct may be permanently deactivated leaving them incapable of forming loving relationships throughout their lives (12).

This has been further supported by neuroscientists, who have found that the levels of dopamine in the reward pathway of a baby’s brain fluctuate with the appearance and disappearance of its mother during its early life, suggesting humans are biologically programmed to bond with their caregiver from birth (6).

Among the many theories that attempt to explain why people with dysfunctional childhoods turn to drugs and alcohol are “the observational learning theory” and “the self-medication hypothesis”.

Observational learning and modeling of behaviour occur when a child observes a parent consuming drugs or drinking alcohol. If the substance-using parent is also the child’s primary caregiver, the risk of the child accepting these behaviours as a normal model for their own behaviour is markedly increased (25).

Another theory derived from clinical observations suggests people turn to substance use as a way of self-medicating their response to emotional or psychological distress. Simply put, drugs relieve psychological distress by enabling the individual to feel better about themselves while at the same time increasing the individual’s desire to consume the drug again (26).

Adverse childhood experiences can be the result of many or different adverse events from physical or sexual abuse to growing up in a household without love or a role model to bond with. And an overwhelming body of research suggests that people who experience multiple ACEs are at an increased risk of experiencing serious health problems, drug addiction, depression, and suicide in adulthood (11).


6. Maté G. Addiction: Childhood trauma, stress and the biology of addiction. Journal of Restorative Medicine. 2012;1(1):56-63.
11. Harris NB. Toxic Childhood Stress: The Legacy of Early Trauma and How to Heal. London: Pan Macmillan; 2020.
12. Bowlby J. A Secure Base. London: Routledge; 1988.
23. Nurius PS, Green S, Logan-Greene P, Borja S. Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis. Child Abuse Neglect. 2015;45:143-53.
24. Felitti V, J., Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-58.
25. McLaughlin KA, Koenen KC, Bromet EJ, Karam EG, Liu H, Petukhova M, et al. Childhood Adversities and Post-traumatic Stress Disorder: Evidence of Stress Sensitisation in the World Mental Health Surveys. The British Journal of Psychiatry. 2017.
26. Khantzian EJ. The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard review of psychiatry. 1997;4(5):231-44.

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Identifying and Responding to Drug and Alcohol Addiction in Nursing, Midwifery and Allied Healthcare Practice

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