Let's begin with a perceptive quote from Dr. Gabor Mate, a Canadian physician with deep experience working with men and women who are severely addicted to drugs:

The statistics that reveal the typical childhood of the hard-core drug addict have been reported widely but, it seems, not widely enough to have had the impact they ought to on mainstream medical, social, and legal understandings of drug addiction.

Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse. One group of researchers was moved to remark that 'our estimates...are of an order of magnitude rarely seen in epidemiology and public health.' Their research, the renowned Adverse Childhood Experiences (ACE) Study, looked at the incidence of ten separate categories of painful circumstances -- including family violence, parental divorce, drug or alcohol abuse in the family, death of a parent, and physical or sexual abuse -- in thousands of people. The correlation between these figures and substance abuse later in the subjects' lives was then calculated. For each adverse childhood experience, or ACE, the risk for the early initiation of substance abuse increased two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than did those with none.

The question," Dr. Mate writes, "is never 'Why the addiction?' but 'Why the pain?


In the Realm of Hungry Ghosts: Close Encounters with Addict

In his well-received book, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, author J.D. Vance also brings up ACEs as he considers the struggles of so many friends and family members he grew up with:

...I learned that behavior I considered commonplace was the subject of pretty intense academic study. Psychologists call the everyday occurrences of my and Lindsay's [his sister] life 'adverse childhood experiences,' or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood."

We could not agree more with Mr. Vance's last sentence. The consequences of ACEs often include incarceration related to drug or alcohol abuse. Often, the incarcerations are repeated, as if the door of the jail is revolving.

Taking seriously the impact of ACEs demands they be measured and, once measured, that appropriate interventions are available to those who score high enough to be at risk for bad outcomes, especially substance abuse.

Take the ACE test