In my last post, I discussed ACEs and their effects on a macro-level. As previously discussed, adults with high ACE scores are more likely to exhibit maladaptive behaviors, including drug and alcohol use disorders. In 2017, approximately 19.7 million American citizens, aged 12 and older, had a substance abuse disorder related to abuse of alcohol or illicit drugs. In 2016 the Centers for Disease Control (CDC) conducted a review of all drug overdose data. They found that accidental drug overdose was the cause of death for 63,632 Americans in 2016. The rate of overdose deaths increased in all categories, regardless of age, gender, ethnicity, sexual orientation, and socio-economic class.
Additionally, drug and alcohol disorders place a great strain on the criminal justice system. In 2018, 456,000 people were incarcerated for drug possession, trafficking, or other non-violent drug offense. According to a 2017 study by the National Institute on Drug Abuse, drug abuse and addiction cost the American economy more than $740 billion annually in “lost workplace productivity, healthcare expenses, and crime-related costs.” When the cost of addiction tops $740 billion and places such a strain on society, we are all affected by addiction, whether or not we personally struggle with substance abuse.
While the statistics surrounding ACEs and their effects are alarming, it is easy to detach from their significance when the test participants are nameless entities and the statistics are nothing but numbers. As part of the Criminal Law and Policy class curriculum on the foster care system, we were given the privilege of speaking with community members who are involved in the dependency court system. One such member, Mario, spoke with our class regarding his experiences in the dependency and criminal justice systems. Mario now serves as a parent-mentor in the dependency court program . Today, Mario is nearly 11 years sober, but his current sobriety came from a tumultuous past
As the parent mentors shared their experiences with our small class, we all sat in silence as we listened to their harrowing experiences of painful childhood memories, eventual substance abuse, losing their children, and a long journey to sobriety. Before they began sharing, I anticipated that most of their talks would be about their struggles with substance abuse and how they began using illicit drugs. Instead, the main focus of their talks, especially for Mario, was how much they love their children. Repeatedly, Mario emphasized how much he loved his children, even when he was struggling with addiction. Mario explained that his drug and alcohol use actually increased in order to “suppress” painful feelings. To me, this was significant as it appeared that Mario was using substances to numb trauma, which is a maladaptive behavior indicative of ACEs.
I wanted to talk with Mario more about his upbringing and see if there were any links between adverse childhood experiences and subsequent maladaptive behavior, namely his struggle with drug and alcohol use. I sent Mario and email and he graciously agreed to meet with me. On a sunny April afternoon, I sat down with Mario and listened as he shared stories about his upbringing and the challenges he faced as an adult.
Mario grew up in Morgan Hill, California, the youngest of four children. As a child, Mario remembers being very poor. Every summer, Mario would help his family pick prunes in the fields. From sunrise to sunset, he would work with them in the fields to earn money for the family of six. When Mario started school, he remembers the struggle of feeling like he did not have “enough”. The feeling of being “different” was something that started in elementary school when he noticed that his peers had clothing he would “never afford on his own.”
Mario’s parents worked long hours, so he and his siblings spent much of their time at their grandmother’s apartment complex. Unlike school, everyone looked out for each other in the complex and he felt like he belonged. Mario and his siblings spent a lot of their time at the complex center’s basketball hoops. At the court, Mario would watch the older teenagers play sports, smoke, drink, use drugs, and sell stolen items. Mario remembers watching strangers passing through the complex get “jumped” for being part of the wrong gang. Mario wasn’t afraid of the violence because he was part of the complex “family,” but he remembers seeing it often. Mario recalls his grandmother’s apartment complex fondly, but also remembers that drugs and alcohol were something “you couldn’t escape.”
At school, Mario had difficulty focusing and struggled with the material. In junior high school, Mario finally found the feeling of “belonging” he was searching for. The people, who created his new sense of belonging, were involved in gangs and illicit substance use. Like many 7th grade boys, Mario’s focus was “girls and hanging out with friends after school.” Hanging out with friends meant drinking. This carried on into high school, where Mario’s drinking increased. On weekends, Mario became the life of the party. When he was drinking, people loved to be around him. Eventually, Mario’s drinking would reach a problematic point. Not only would Mario struggle with alcohol abuse, but he would grapple with an addiction to methamphetamines, become homeless, and face losing all four of his children.
Prior to interviewing Mario, I briefly described the phenomenon of ACEs, as explained in my previous post, and administered a standard ACE test. Initially, Mario had an ACE score of 1, with an indication of verbal abuse for an adult in the household often putting him down. However, after Mario shared stories from his childhood, I administered the ACE screening for a second time. Mario’s new score was 3. (I will discuss his final score later).
Additionally, as a preliminary note, I would like to address the difficulties in transcribing parts of one’s life and trying to fit every action made into a neatly formed box of ACEs. While some parts of Mario’s childhood may be considered “traumatic” according to ACE criteria, there were many, many, many other experiences that took place in a loving, caring home. I greatly respect Mario, his journey, and his dedication to his family as a loving husband and father.
As Mario shared his childhood experiences, I noticed that there were some recurring experiences and themes. Those were: childhood poverty, maladaptive coping mechanisms, repeated interactions with the justice system, and a lack of preventative measures. I will discuss those at length below.
In 2012, Child Protective Services (CPS) received 3.2 million reports of child abuse and neglect. Out of those cases, 686,000 children had substantiated cases of neglect or abuse. Of those 686,000 children, 18% were physically abused, 9% were sexually abused, and 8.5% were psychologically abused. 78.3% of victims suffered neglect without physical, sexual, or psychological abuse. In these situations, the neglect cases are substantiated by issues relating to poverty.
Two out of the ten ACE questions directly relate to neglect due to poverty without mention of drugs and alcohol. (The full list of ACE questions can be found here.) Those questions are:
Rooted in the questions of neglect are feelings of isolation, instability, and a lack of self-worth. Throughout Mario’s early childhood, he experienced many of these feelings. For example, Mario first felt the struggle of not having “enough” when he entered elementary school. Mario stated that he felt “different” from his peers when they came to school wearing Oakley sunglasses and riding dirt bikes – things that his parents could not afford. Throughout elementary school, Mario found solace and belonging in his time spent at his grandmother’s apartment complex. At the complex, Mario felt like he belonged. There, people were not wearing Oakley sunglasses or riding dirt bikes. Instead, in the complex, Mario watched as teenagers played basketball, smoked, drank, used drugs, sold stolen items, and physically assaulted “outsiders”. But, even though the environment had many aspects that were illicit in nature, Mario remembered the complex “family,” and that in the complex, “everyone looked out for each other.” Back at Mario’s elementary school, people associated the complex with being “bad,” but Mario didn’t care. The complex acted as a protective “barrier” and people knew “not to mess with you” if you were from there.
Although Mario felt like an “outsider” at school, he gained a sense of belonging from being part of the complex. Moreover, through his identity as a member of the complex, he earned a form of respect from his peers at school who knew not to “mess” with him. The complex served as a form of community for Mario while he finished elementary school.
Mario finally felt like he truly “belonged” when he entered junior high school. He met other people who were poor – just like he was. But the people who now created Mario’s sense of belonging were involved in gangs and illicit substance use. Mario finally felt like he had a group who “had his back,” but in this new form of community he entered a life of gangs and drinking.
This carried on into high school, where Mario’s drinking increased. On weekends, he became the life of the party. When he was drinking, people loved to be around him. Mario would impress people by opening Coronas with his teeth. In fact, Mario’s best friend’s girlfriend bought him a pager and paid his pager bill as a way to reach him to invite him to parties. At that time, Mario also met the mother of his four children, Maria*. (*Name has been changed). Unlike his friends, Maria* hated when Mario drank and told his friends not to give him alcohol. She told Mario that his drinking made him a “smartass” and wanted him to stop. Eventually, Mario’s drinking reached a problematic point. His friends stopped drinking so much as they exited the “party scene” for college and to have families of their own. However, Mario, felt like he “belonged” as the life of the party and wasn’t ready for it to end. As a result, he eventually turned to different behaviors that affected his life, Maria’s* life, and his future children’s lives.
In his early twenties, Mario used methamphetamines for the first time. As a child, drugs were something that Mario never thought he would use. Alcohol use was something that was accepted, even from a young age. At family BBQ’s everyone would drink; it was an activity that was pervasive and accepted. Drugs, on the other hand, were taboo. The first time Mario used meth, he was scared about how it would make him feel and the physical side effects. However, when he used meth, the physical reaction was something he had never felt before; the high was like nothing he had ever felt. The incomparable high that Mario experienced was contrasted to a life faced with uncertainty. Mario was losing his sense of “belonging” as the party scene was winding down, but methamphetamines allowed Mario to push those feelings away and keep living the party lifestyle.
Because Mario felt isolated and “different” in adolescence, he was likely compelled to acquiesce to social pressures in order to gain a sense of belonging, which included alcohol use. Mario’s feeling of being “different” was caused by the fact that he did not have the same items as other children, items that demonstrated levels of wealth or status. Although Mario’s family worked hard to provide for Mario and his siblings, he did realize that they were very poor once he entered the public school system and was introduced to children from different socio-economic backgrounds. Even though Mario is nearly thirty years away from elementary school, he still remembers the details of youth his age having Oakley sunglasses that his family was unable to afford. Additionally, while in school, Mario struggled academically. Though many children gain a sense of belonging and worth from their academic successes, those were not available to Mario. Instead, he found his sense of belonging and value in his identity as the life of the party. Because Mario lacked a rooted sense of community and sense of self-worth from his scholastic environment, he turned to milieus that were accepting and where he could have status. When Mario was drinking, not only was he the center of attention but his friends were literally paying for ways to ensure that he would be part of the party. Like Mario’s childhood experiences at the complex, drinking with friends provided a sense of community and status that did not require wealth or academic achievement.
It is not surprising that youth, who are longing to feel a sense of “belonging” will engage in activity to gain a feeling of community. For Mario, that meant drinking and gang-ties at the complex. (For more information about gangs providing a sense of family, click here.) The behavior, without understanding why the youth is engaging in it, is particularly straining on foster parents. Of the estimated 200,000 licensed foster homes, between 30-60% of foster parents drop out of fostering each year. When ACEs are misunderstood, foster youth are viewed as delinquents. As noted by one of my peers, a child who has experienced trauma, like foster youth, are more likely to have behavioral issues. For that reason, it is not surprising that over 70% of all State Penitentiary inmates have spent time in the foster care system. Like Mario, these behavioral issues can often express themselves through maladaptive coping mechanisms that break the law.
Maladaptive Coping Mechanisms:
According to the 2017 article from the International Journal of Child Abuse and Neglect, adults with high ACE scores are 3.73 times more likely to use illegal drugs and 2.84 times more likely to engage in heavy alcohol use. More specifically, a 2016 article from the American Journal of Preventative Medicine which conducted an in-depth analysis of ACE scores based on the 2010 CDC Behavioral Risk Factor Surveillance System data found that an ACE indication for verbal abuse in childhood increased the odds that a person would develop the maladaptive behavior of binge drinking.
The National Child Traumatic Stress Network released a primer on trauma and substance abuse for youth service providers. It addresses the strong connection between substance abuse and ACEs, explaining:
According to the self-medication hypothesis of substance abuse, people develop substance abuse problems in an attempt to manage distress associated with the effects of trauma exposure and traumatic stress symptoms. This theory suggests that youth turn to alcohol and other drugs to manage the intense flood of emotions and traumatic reminders associated with traumatic stress or PTSD, or to numb themselves from the experience of any intense emotion, whether positive or negative.
The phenomenon of ACE trauma and maladaptive coping mechanisms is evident in Mario’s own depiction of what emotions drove him to use drugs and alcohol. Mario initially explained that he used alcohol in order to gain a sense of “belonging.” When he was drinking, he became the “life of the party” and felt like he belonged to a group that valued him. When the drinking spiraled out of control and Mario began to once again experience feelings of isolation, he turned to drug use in order to once again belong to a group. Finally, when Mario’s children were taken away as a result of his drug use, his usage did not decrease. Instead, Mario tried to “suppress the absence of [his] daughter by using drugs” and his usage increased in proportion to his feelings of guilt and shame. Mario’s use of drugs and alcohol were directly linked to traumatic feelings that shaped his adolescence.
During my interview with Mario, he not only explicitly mentioned that he used drugs and alcohol to “suppress the absence of [his] daughter by using,” but he also described other homeless individuals, struggling with addiction, as “broken people” who were “using narcotics to cover up the underlying pain that they were dealing with.” For Mario and the people he was encountering while homeless, they used narcotics and alcohol to soothe their emotional turmoil. While they were high on methamphetamines or drunk on alcohol, it pushed away their emotions and allowed them to momentarily escape the trauma they were carrying. Mario said that he was “comforted” to be around other “broken people.” In that setting, where everyone was avoiding their trauma by abusing substances, the behavior was normalized and once again, Mario did not feel alone.
I want to note that when I administered Mario’s first ACE examination, his score was only 1. However, after going over his childhood, we realized that Mario’s score was likely much higher. After re-administering the test, we found that the score was much higher, with a new score of 4. It is very possible that, several decades after one’s childhood, it would be difficult to recall specific instances of abuse. However, it is also likely that, as adults, people are more likely to edit their childhood by changing or suppressing memories of trauma. This could be a form of a coping mechanism that causes a subconscious repression of traumatic experiences. However, while this could be an unintentional response to trauma, it significantly affects the effectiveness of possible ACE treatment.
Furthermore, a difference in ACE score from 1 to 3 is noteworthy in that it significantly increases the likelihood of maladaptive behaviors and poor health indications. For example, according to the 1998 Kaiser-CDC study, when compared to individuals with an ACE score of 0, a person with 4 or more ACEs had a 1.6 times greater chance of developing diabetes, 3.9 times greater chance of developing chronic bronchitis or emphysema, and 2.3 times greater chance of developing hepatitis. Therefore, suppressing adverse experiences could impair the ability to make a proper diagnosis as to the extent of trauma and harm an individual’s overall treatment.
Had Mario been administered an ACE test early on during his childhood, perhaps he could have received additional resources that could have prevented maladaptive behaviors later on in life. Schools play an important role in identifying childhood trauma. One way that school can help spot and treat ACEs is by becoming a “trauma informed school system.” As one of my peers discussed in her research, foster youth have a difficult time in the current academic system as it is not geared for children who are dealing with ACEs.
Poor academic performance should serve as an indicator for the school system that an ACE test should be administered. A standard ACE questionnaire is only 10 questions. It is relatively quick to administer and straightforward in its questioning. It would be an easy and cost-effective way to conduct a preliminary screening for childhood trauma.
Cost of Failing to Implement Preventative Measures:
Maladaptive behaviors, like alcohol and drug abuse, cause a substantial strain on various governmental systems. The criminal justice system, child welfare system, and healthcare system all experience huge financial stress as a result of ACE expression. As mentioned above, drug abuse and addiction cost the American economy more than $740 billion annually in “lost workplace productivity, healthcare expenses, and crime-related costs.” When we fail to intervene with prevention and early intervention, we fail to prevent another generation of children from experiencing adverse childhood trauma.
The University of California, Berkeley recently released an article based on a 2018 study featured in Pediatrics journal. The study found that ACEs affect the biological health of children; maternal ACEs and maternal stress during pregnancy had a strong correlation with negative developmental outcomes in infanthood. The study found for each ACE reported by the mother, there was an 18% rise in the risk that the child would acquire a suspected developmental delay. “A higher number of maternal ACEs also significantly increased the child’s chance of having suspected delays across multiple domains (e.g., motor, social, communication [delay]) rather than just a single domain.” Preventative care is the only way to eliminate the generational problem of ACEs. According to a 2018 study published in the Journal of Health Education and Behavior, parents with ACEs realized that their own childhood trauma was being passed down to their children through their parenting methods and behavior. For example, “Participants spoke consistently about how their own burden of ACEs affects their children and their parenting behaviors and described the cyclical sequence in which ACEs transfer from one generation to another. Parents described how a parent’s trauma history is passed down to their children through unresolved mental health problems.” (Interview quotes with parents on page 3).
Preventative care would help children, who are suffering from ACEs, not create another generation of youth who will also have to battle their own adverse experiences. Many children enter the foster care system when their parents are arrested for engaging in maladaptive behavior like abusing drugs and alcohol. For example, in 2017, 690,548 children were served by the foster care system. Of these children, 20,131 youth were removed due to parental incarceration; 14,684 youth were removed for parental abuse of alcohol; 96,720 were removed for parental abuse of narcotics; and 166,991 children were removed for parental neglect. Over a third of all removals could have been prevented or assisted by ACE preventative care to target and prevent maladaptive behaviors.
An example of these children removed for parental abuse of narcotics are Mario’s own four daughters. They are an example of the next generation who, due to parental narcotics use, experienced the trauma of removal. Like foster youth, they are at a greater risk of developing maladaptive behaviors of their own due to their high ACE score. When ACE tests are given and an emphasis is placed on preventative care, these are the youth that are being veered away from a life of pain and maladaptive coping mechanisms.
It is important that we focus on preventative care and treating ACEs before they transform into maladaptive behaviors. For foster youth who tend to have ACEs at rates that far surpass their peers, how do we tailor ACE testing and treatment to be most effective? Standardized ACE testing, therapeutic foster placements, and trauma informed policies are three tools that can be used to help break the generational cycle of ACEs for foster youth. I will discuss them in my next post.