Addiction doc says: It’s not the drugs. It’s the ACEs…adverse childhood experiences.

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He says: Addiction shouldn’t be called “addiction”. It should be called “ritualized compulsive comfort-seeking”.

He says: Ritualized compulsive comfort-seeking (what traditionalists call addiction) is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.

He says: The solution to changing the illegal or unhealthy ritualized compulsive comfort-seeking behavior of opioid addiction is to address a person’s adverse childhood experiences (ACEs) individually and in group therapy; treat people with respect; provide medication assistance in the form of buprenorphine, an opioid used to treat opioid addiction; and help them find a ritualized compulsive comfort-seeking behavior that won’t kill them or put them in jail.

This “he” isn’t some hippy-dippy new age dreamer. He is Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine. The center is the first to receive the Center of Excellence designation from the Addiction Medicine Foundation, a national organization that accredits physician training in addiction medicine. Sumrok is also one of the first 106 physicians in the U.S. to become board-certified in addiction medicine by the American Board of Medical Specialties.

Sumrok, a family physician and former U.S. Army Green Beret who’s served the rural area around McKenzie, TN, for the last 28 years, combines the latest science of addiction and applies it to his patients, most of whom are addicted to opioids — but also to alcohol, food, sex, gambling, etc. He sees them in the center’s two outpatient clinics: his clinic, which the Center for Addiction Science has taken over as its rural clinic, and another that opened recently in downtown Memphis.

Since he first sat down in the early 1980s to write a research paper (“Public Health Legacy of the Vietnam War: Post-Traumatic Stress Disorder and Implications for Appalachians”) to describe the symptoms of the newly named post-traumatic stress disorder in Vietnam veterans – “problems with the law, having trouble sleeping, anxiety, divorce, sleep troubles, substance use disorders, depression, anxiety, cognitive and chronic pain issues” — Sumrok has pieced together the ingredients for a revolutionary approach to addiction. It’s an approach that’s advocated by many of the leading thinkers in addiction and trauma, including Drs. Gabor MatéLance Dodes and Bessel van der Kolk. Surprisingly, it’s a fairly simple formula: Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.

“My patients seem to respond really well to this,” he says.

ACEs understanding changes practice

Learning about ACEs more than two years ago was a big turning point for his understanding of addictions, explains Sumrok. “I was working in an eating disorders clinic and someone told me ‘90 percent of these folks have sexual trauma’. I remember thinking: That can’t be right. But that was exactly right. Since I’ve learned about ACEs, I talk about it every day.”

He also practices it every day, by integrating ACEs assessments for all patients in his clinics. He currently has about 200 patients who are addicted, most to opioids (heroin and prescription pain relievers, including oxycodone, hydrocodone, codeine, morphine, and fentanyl). “I’ve seen about 1,200 patients who are addicted,” he says. “Of those, more than 1,100 have an ACE score of 3 or more.”

Sumrok knows that score says a lot about their health and ability to cope: ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused. Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.

The ACE Study is one of five parts of ACEs science, which also includes how toxic stress from ACEs damage children’s developing brains; how toxic stress from ACEs affects health; and how it can affect our genes and be passed from one generation to another (epigenetics); and resilience research, which shows the brain is plastic and the body wants to heal. Resilience research focuses on what happens when individuals, organizations and systems integrate trauma-informed and resilience-building practices, for example in education and in the family court system.

The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. Having an ACE score of 4 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. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)

High ACE scores also relate to addiction: Compared with people who have zero ACEs, people with ACE scores are two to four times more likely to use alcohol or other drugs and to start using drugs at an earlier age. People with an ACE score of 5 or higher are seven to 10 times more likely to use illegal drugs, to report addiction and to inject illegal drugs.

The ACE Study also found that it didn’t matter what the types of ACEs were. An ACE score of 4 that includes divorce, physical abuse, an incarcerated family member and a depressed family member has the same statistical health consequences as an ACE score of 4 that includes living with an alcoholic, verbal abuse, emotional neglect and physical neglect.

Subsequent research on the link between childhood adversity and addiction corroborates the findings from the ACE Study, including studies that have found that people who’ve experienced childhood trauma have more chronic pain and use more prescription drugs; people who experienced five or more traumatic events are three times more likely to misuse prescription pain medications.

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Dr. Dan Sumrok with group therapy members at McKenzie, TN, clinic (Photo: Yalonda James, The Commercial Appeal)

“ACEs just doesn’t predict substance abuse disorders,” says Sumrok. “All of our major chronic diseases link to substance abuse, so this is too big to ignore.”

Whether you’re talking about obesity, addiction to cigarettes, alcohol or opioids, the cause is the same, he says: “It’s the trauma of childhood that causes neurobiological changes.” And the symptoms he saw 40 years ago in soldiers returning from Vietnam are the same in the people he sees today who are addicted to opioids or other substances or behaviors that help them cope with the anxiety, depression, hopelessness, fear, anger, and/or frustration that continues to be generated from the trauma they experienced as children.

Learning about ACEs helped him understand that the original definition of PTSD, which many people still cling to, is not accurate. In the 1980s, PTSD was defined as a result of trauma that was outside the realm of normal experience.

“That was just wrong,” says Sumrok. “Divorce, living with depressed or addicted family members are very common events for kids. My efforts are around helping people to see the connections, and that their experiences are predictable and normal. And the longer the experiences last, the bigger the effect.”

He also says, “Drop the ‘D’, because PTSD is not a disorder.” It’s what he learned from van der Kolk, who wrote The Body Keeps the Score. “Bessel says we’ve named this thing wrong. Post-traumatic stress is a brain adaptation. It’s not an imagined fear. If one of your feet was bitten off by a lion, you’re going to be on guard for lions,” explains Sumrok. “Hypervigilance is not an imagined fear, if you’ve had one foot bitten off by a lion. It’s a real fear, and you’re going to be on the lookout for that lion. I tell my patients that they’ve had real trauma that’s not imagined. They’re not crazy.”

Patients who learn about their ACEs understand that they can heal

This is what happens when a person sees Sumrok for the first time: They fill out the 10-question ACE survey (Got Your ACE Score?) in the waiting room. “Then when I see them, I go through each question and ask them again,” says Sumrok, who also does a normal physical exam. “Frequently, there’s a difference between the two. For example, this morning, I saw a woman and she reported an ACE score of 1 on the survey. Then, when I asked her the questions, she reported nine out of 10.”

That’s just how I grew up, she told Sumrok. She didn’t think being beaten, humiliated or seeing her mother smoking crack every day was harmful or unusual, especially since most kids she knew were experiencing the same thing.

Sumrok normalizes their addiction, which he explains is the coping behavior they adopted because they weren’t provided with a healthy alternative when they were young. He explains the science of adverse childhood experiences to them, and how their addictions are a normal – and a predictable – result of their childhood trauma. He explains what happens in the brain when they experience toxic stress, how their amygdala is their emotional fuse box. How the thinking part of their brain didn’t develop the way it should have. How it goes offline at the first sign of danger, even if they’re not connecting the trigger with the experience. Drugs like Zoloft don’t really help much, he tells them. Zoloft and other anti-depressants don’t remove the memory triggered by the odor of after shave that was worn by your uncle who sexually abused you when you were eight, or the memory triggered by a voice that sounds just like your mother who used to beat you with a belt, or by a face of a man  who looks like your father who used to scream at you about how worthless you were…the examples are infinite. That’s why van der Kolk says, “’The body keeps the score’,” Sumrok says.

“After I explain all this to them, many of them stare at me and say: ‘You mean I’m not crazy?’” says Sumrok. “I tell them, ‘No, you’re not crazy’.” Sometimes he yells out the door to his nurse: ‘Patsy! Where’s my not-crazy stamp? I need to stamp this person’s chart.”

For people who are addicted to opioids, he prescribes buprenorphine (one of the brand names: Suboxone), which helps them to withdraw from opioids and to keep their job, or return to work. For most people, the drug is less addictive than other opioids. Sometimes if people are young, healthy and haven’t been addicted long, they can withdraw from opioids without buprenorphine.

“There’s no buzz associated with buprenorphine,” says Sumrok. “They can concentrate and think. Once they’re free of the continuous distraction of the acquisition and use of substances, they become pretty valuable employees.”

For people who are addicted to alcohol, he prescribes naltrexone (one of the brand names: Revia), because alcoholics have a high risk of death if they aren’t provided medication. And in this current national attention on opioids, Sumrok is careful to point out that although 33,000 people died from opioid overdose in 201588,000 people die annually from alcohol-related causes, and 480,000 from cigarette smoking. The complicating factor — and why policies don’t work when they chase the eradication of one drug, only to focus on eradicating the next popular drug of choice for “ritualized compulsive comfort-seeking” — is that many people use opioids and alcohol and cigarettes. And if they receive no help to get at why they’re using legal or illegal substances, they will move on to another, more easily accessible drug when the current drug they’re using becomes more difficult to find.

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All patients sign a contract agreeing that they won’t drink alcohol or take other drugs. “We don’t mess around with that,” says Sumrok. “We can’t deal with them being deceptive, because if they drink or do other drugs, it can kill them. If their drug screens aren’t consistent, we ask them to find another doctor.” Just about everybody stays, he says.

They also participate in group therapy. For physicians who prescribe buprenorphine, it’s now required, but Sumrok had seen the research about the effectiveness of group therapy, and had started 12-step groups for his patients about 10 years ago. Talking with others who have the same experiences helps each person normalize their own experiences. Sumrok and the others in the group help each other find “ritualized compulsive comfort-seeking behaviors” that won’t kill them or put them in jail, such as coaching their kid’s soccer team or volunteering at a food bank. (Sumrok often quotes Forest Gump: “Helping helps the helper.”). He also encourages them to integrate other rituals into their lives, such as walking 30 minutes a day or other exercise, joining a 12-step group or finding a path to encourage a spiritual awakening.

“Six months into this,” says Sumrok, “they start saying things like, ‘My wife and I are back together’, they’re hanging out with their kids. It’s pretty cool to see how people get their lives back. My favorite word is ‘normal’. When they tell me they feel normal, I know they’re doing okay.”

So, how long does it take before they’re cured? “How long should you take insulin if you have diabetes?” responds Sumrok, making the point that this is a chronic disease, that people should be in treatment for as long as it is necessary, and that some may relapse. His goal is for them to not have to use buprenorphine, but he knows that because of the number and duration of their ACEs, and the paucity of resilience factors provided to them when they were children, many will need continual support. He helps them learn how to integrate that support into their lives.

“When a diabetes patient comes in with a blood sugar level of 300, we don’t say: ‘Give me back that insulin.’ We intensify the treatment to get them back in balance,” explains Sumrok. “Only in addictions do we shame people. We tell them they can’t be part of this recovery anymore. We create a teeny hoop that’s called abstinence, and not too many people can jump through that hoop. If every time we saw a diabetic, we told them that their kidneys were going to fail, they would be blind and we would amputate their extremities, there wouldn’t be many diabetics who got help. I have patients who drop out, and then return a couple of months later, and say, ‘Doc, Christmas came, I saw some of my buddies, and I started using again.’ I tell them, ‘Come on in. Let’s work with you.’ And I remind myself that I’m not saving souls, I’m saving their asses. It’s about getting them so they can function at work, at home, at play. It’s not about making them perfect human beings.

“It has been abundantly clear to me and reinforced over a 40-year career,” continues Sumrok, “that patients desire, and respond better to, sensitive and informed care. From the Navajo Nation to Appalachia to Memphis and from the mountains of Honduras to the jungles of Amazonia, people regard respect as the sine qua non of quality care.”

Stories AND data drive solutions

Although Sumrok thinks his approach benefits his patients, he knows he needs data to prove it. When he saw a recent study that said 43% of people on buprenorphine were using other opioids, he did his own analysis of a sample of his patients, and found that only 8% were using other opioids. After tracking down those who were, most had good reasons, such as a man whose arm and shoulder were in a new cast after surgery repairing an injury, and he was taking a narcotic. Only one did not, and when shown his drug test, he said, “You know what? I slipped.” He talked about it in group, says Sumrok, and everyone in his group hovered around him to make sure he’d continue the program.

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Dr. Karen Derefinko

Because Sumrok has kept fastidious records of the patients who have done their ACE scores, Dr. Karen Derefinko, a clinical psychologist and assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, is starting a research project to examine all 1,200 records in Sumrok’s clinic in McKenzie to look at the relationship between people’s ACE scores and their adherence to treatment and their relapses.

“We think that people with high ACE scores are likely to have more relapses,” she says. “And that may be because people with higher scores have fewer resources and more difficulty associated with adhering to their treatment plans.”

She and her research assistant will de-identify the records, so that all information is anonymous, and then collect the data. Once that data is analyzed — probably within two months — Derefinko and her assistant will conduct focus groups of some of Sumrok’s patients. She’s already been sitting in some of the groups.

“Dan encourages this participatory nature of his groups,” she says. “People are very willing to talk. After the group sessions, they’re often not done talking about why they came to Sumrok and why other programs didn’t work for them.”

Through the records and the focus groups, Derefinko hopes to identify barriers to care, which include basics such as how people can find good care easily (most of Sumrok’s patients find out about him through word of mouth), being wary of the treatment because it isn’t explained to them, or — what Sumrok hears a lot — being judged or talked down to instead of given understanding and respect.

“In Shelby County, people complain about barriers to care, which many people think is because of economics,” she says. “But it may not be just economics that is keeping people from accessing treatment; it may be more about being judged, and not knowing what the treatment looks like.”

Being treated with respect builds trust, trust builds health

One of Sumrok’s patients – I’ll call him John, which is not his real name – has been driving 140 miles from Southeast Missouri to see Sumrok for the last five years. He began using drugs off and on during his 20s. When he was in his 30s, he injured his back, was sent to a worker’s comp physician, who prescribed stronger doses of pain killers until his back stopped hurting.

“I was taking pain pills like candy,” says the 46-year-old, who is married and has a son. “All of a sudden, the pills are gone, and you’re very sick, and I start looking for them everywhere – on the street, taking them from family members without asking – just to keep me from getting sick. I thought I had to have them to function. If I didn’t have six or seven pain pills, I wasn’t going to be able to get out of bed. If I didn’t get them, I’d be sick, puking….I’d do about anything to have those pills.”

After he spent his and his wife’s life savings, and the money they’d put away to buy a home, and his retirement fund from a previous job; after he saw friends die from overdosing; and after he realized that he was risking losing his wife and son, he told his wife he needed help, and they found Sumrok.

“It’s been a miracle, for sure,” says John. As the Suboxone took effect, “after two or three weeks, I began to feel normal again.”

About two years ago, Sumrok asked him to fill out the ACE survey. “It really did make a difference,” says John. He had never connected experiences in his childhood with using drugs as an adult.

“When I was just a baby,” recalls John, “my grandpa took me from my mother, and told my parents: ‘When you guys are stable, I’ll let you have him back.’ Up until I was 10 or 11, I called them ‘Mom’ and ‘Dad’.’” His older sisters were sent to live with his other set of grandparents. He didn’t live with his parents again until he was 15 years old. His sisters were adults and out on their own by then.

Until he did the ACE survey and talked with Sumrok about his childhood, it didn’t dawn on him that losing his mother, father and his sisters at a young age could have affected him in ways he didn’t realize. “I knew I was loved by my grandfather and grandmother, but being a young kid and seeing other kids going out with their parents was frustrating,” he says. “I lived with old people who never left the house, while my parents were out running around. I maybe thought my mom and dad didn’t care about me enough to change. I might have always felt like I wasn’t important enough to my mom and dad for them to change the way they were living and acting.”

But now he has a better understanding of what it was like to be a 19-year-old in the late 1960s and involved in the drug and party scene then, as his parents were. He understands them better, and why they weren’t able to care for him. He and his family members have “had our discussions,” says John. “My family life is a whole lot better. I didn’t have relationships with my parents or sisters. We only live seven miles apart, and I barely saw them twice a year, if that. But now I have my wife back. I’ve got my son back. And I see my parents and sisters all the time. We’re a tight-knit family.” He’s also able to hold a job, and is a reliable employee.

John sees Sumrok once a month now. He participates in group therapy, where they can safely talk about their ACE scores without having to get into specifics. He checks in with Sumrok, who renews his prescription.

“I like group therapy with Dr. Sumrok,” says John. “He talks to us with respect. We feel very comfortable with him. Dr. Sumrok never lies. I trust him fully. And he trusts me. It took five or six months to build that trust. The more I met with him, the more I realized that he was really concerned about me. He wants to help people. Let him train more doctors in the procedures he uses. You can’t treat people like they’re nobodies.”

A 29-year-old patient, who chose to be called “Mr. Big” since I’m not using his real name, has been seeing Sumrok for the last six months. He had been in a methadone treatment program, and found Sumrok after he couldn’t pay for treatment any longer. Sumrok was the only physician who would take his insurance. Mr. Big filled out the ACE survey in the waiting room, but reported his score as a two. Then Sumrok went through the survey with him, and Mr. Big’s score climbed to an 8.

“It does help me understand my addiction better,” says Mr. Big, who is a single father of two children, five and six years old. “For one, my trauma in my childhood was very dramatic. I thought everyone’s parents did what they were doing. I could see why I related to narcotics and stuff. It was the only place I had to turn. I started taking opiates when I was 11 or 12 years old. I was playing football, and broke my ankle. They gave me painkillers that made me feel like Superman. I couldn’t get enough, because I wasn’t feeling like Superman without it.”

The Suboxone helps him feel “normal — probably the way everybody else feels,” says Mr. Big. “Nothing I took ever gave me that feeling before. I’m a better person, father, and a better brother” to his sister, whom he convinced to also get help from Sumrok.

The first time he went for help, to a methadone clinic, he didn’t like it for two reasons: Methadone made him nod off or feel high, and the people at the clinic treated him as if he was a number, or just there for the drugs. “That’s just unprofessional, in my opinion,” he says. “Sumrok actually sits down and talks to you like a human being.”

Mr. Big wants to work with Sumrok to develop a “game plan so that I can live without my medicine,” he says. He just wants to live a normal life. What does a normal life mean?

“It means that I’m home overnight with my children,” he says. “I don’t have to rob, lie, steal, or cheat to find drugs. I can fit in with society and not be high off my mind. I can wake up every day and do stuff. My children — they know Daddy’s not in bed sick any more. It’s wonderful. I’m wore out. I never knew that first grade and kindergarten had homework that was so complicated.”

With addictions and deaths on upswing, how to increase addiction docs?

Prescription and illicit opioids are the “main driver of drug overdose deaths,” according to the CDC, with 33,091 deaths in 2015. That’s four times more than 1999. And between 2014 and 2015, Tennessee saw a 13.8 percent increase in opioid deaths. More than 1,000 people died from opioid overdoses in 2014, and tens of thousands of people lead desperate lives, most of them unknowingly fueled by their childhood experiences. Only 10% of these are getting the help they need, says Sumrok.

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Dan Sumrok is just one doctor, in one part of the country. How can what he does be scaled up to thousands of physicians who can treat addiction — all types of addiction — successfully in all parts of the U.S.? By doing what Dr. David Stern, Robert Kaplan executive dean and vice-chancellor for clinical affairs for the University of Tennessee’s College of Medicine and the University of Tennessee Health Sciences Center, did: launch the Center for Addiction Science.

“This really starts with Dr. Altha Stewart, who’s the director of the Center for Health in Justice-Involved Youth,” says Stern. “She’s the one who showed me that kids with high ACE scores end up in trouble. When I developed the Center for Addiction Science, it had to be like a cancer center, it had to be multi-disciplinary. In the old days, we thought people who had addictions were weak in the moral department. You really needed someone to straighten you out, because your mother didn’t do a good enough job.”

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Dr. David Stern

But that approach doesn’t work. Neither does criminalizing addictions. Stigma drives problems underground, says Stern, instead of driving them to a solution. The center is taking an integrated approach to using research and education to help people in all possible ways, from physiology to genetics to counseling.

Stern believes that every physician should know about ACEs science, which is one of the reasons he chose Sumrok to lead the center, along with his willingness to be creative and seek solutions across disciplines. “Two of the most prevalent things in acute care are depression and addiction,” says Stern. “I think it’s important to be able to understand what ACEs mean to patients, what addiction is all about, how to recognize it, how to treat it.” He’s in the process of finding an associate dean for medical education, and is looking for someone who will integrate ACEs and other social determinants of health into the school’s curriculum.

“I think a medical school should provide for the community it serves,” says Stern. “This medical school should be the medical school for Memphis. We should develop solutions that are scalable.”

Dr. Altha Stewart, associate professor of psychiatry in the University of Tennessee College of Medicine, learned about ACEs in 2009 when a group in Shelby County began educating people about ACEs science. They brought Dr. Vincent Felitti, co-founder of the ACE Study, and Robin Karr Morse, who wrote Ghosts from the Nursery: Tracing the Roots of Violence, which was published in 2007, to give a presentation. (Karr-Morse later wrote Scared Sick: The Role of Childhood Trauma in Adult Disease with Meredith S. Wiley; it was published in 2012.)

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Dr. Altha Stewart

“It’s become a core part of what I do now in my professional work,” says Stewart, who was recently named president-elect of the American Psychiatric Association. She’s working with the Shelby County community and the local criminal justice system to integrate trauma-informed and resilience-building practices to find ways to help youth who enter the justice system — all of whom have likely experienced ACEs — instead of shaming, blaming or punishing them.

The things that have happened to kids — as well as to many people who come into the health care system — are out of their control, says Stewart. “When you’re a child, you don’t control the people who abuse and assault you, who create hostile environments, who don’t provide you with clean clothes,” sheAltha_Stewartpres says. “If a child can’t control their environment, because of these things they grow up thinking they’re bad, different, horrible people. This new approach (integrating trauma-informed and resilient-building practices based on ACEs science) helps them feel like they’re not drowning anymore. When they can pop their head out of the water and get a breath, and see outstretched hands, a life preserver, a life boat, that changes their entire perspective.”

When Sumrok began integrating ACEs into addiction treatment, that was innovative, says Stewart. “If you don’t ask these questions, people tend not to tell you,” she says. Sumrok’s approach is part of a shift in patient engagement and involvement. “The trend in health care is that patients are partners in their treatment.”

This new knowledge about why and how humans behave the way they do also speaks to how “we have trained the medical profession,” says Stewart. The traditional approach is that physicians “know everything. The people whom we treat know nothing. We tell them what to do, and if they don’t get better or do what we say, it’s their own fault.

“That’s simply not true,” she emphasizes. “Some of us have come to understand that there’s more expertise in the community and our patients than we’ve understood. That takes a bit of humility on the part of a physician, and an understanding that we are partners in helping a person heal.”

Sumrok’s experience with the young fellows at the Center for Addiction Science is giving him some real hope that the medical profession can change. When he’s explained to them how important it is to ask patients about ACEs and other aspects of their lives — such as food availability, safe housing, transportation, jobs (in the medical profession vernacular: social determinants of health) — “they say ‘isn’t that just taking a patient history?’”

He and others at the University of Tennessee Health Sciences Center have an opportunity to educate young physicians outside the state, too. Derefinko is also director of the newly created National Center for Research of the Addiction Medicine Foundation. The foundation oversees the 130 addiction medicine fellowships at 46 medical schools across the country.

“We want metrics to understand the impact they’re having” when they go out in the world, says Derefinko: where they go, whom they’re treating, how they’re practicing, whether they’re integrating ACEs science. In addition, the foundation will be developing some accreditation guidelines so that all fellows receive the latest and best education in addiction medicine.

One of those elements, says Sumrok, has to be empathy, which physicians can practice by listening, acknowledging and understanding how the experiences in a person’s childhood and adulthood have shaped their lives and health.

“Can you teach empathy?” he asks. “Can people learn to be empathetic providers? I think you can. I think so.”

235 responses

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  3. Thankyou. This is giving me hope that I can heal and help my kids and the community.
    Stigma of human suffering STINKS.
    I’m tired of having to defend myself from more abuse when I’m seeking help.
    Julia

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  5. Pingback: Addiction doc says: It’s not the drugs. It’s the ACEs – adverse childhood experiences. | Jackson Psychotherapy

  6. Fascinating and clarifying article, and the ACEs and Resilience tests were revealing and helpful.
    I can recommend ‘In The Realm of Hungry Ghosts’ by Dr. Maté as well, which is excellent.
    It seems our collective understanding of the nature of addiction is becoming more precise, which I think is essential in terms of how it is viewed by society at large (ie not as a defining characteristic, but as a symptomatic behaviour created by a deeper wound).
    I think it is also essential to remember that nobody is addicted to the substance or behaviour (as such), but to the increase of endogenous morphines that is provoked by that substance or behaviour.
    One is seeking the comfort that love provides. Addiction is a love—replacement therapy, in my experience, but that love that was lost can’t be replaced.
    However, you can learn to love yourself, which includes the cessation of addiction.

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  8. It’s an excellent article. Garbor Maté’s book “In the realm of the hungry ghosts” is also excellent, and humbling. This is, however, and unfortunately, not new news. It is how we worked with addicts in the Sydne Drug Advisory Centre in the mid 1970’s. It is also a policy which has been successful in Europe for a long time. Unless, and until, the concept of a “War on Drugs” can be addressed, politically, the situation is unlikely to change. There is far too much money tied up in policing and incarcerating those who become “addicts” for it to change any time soon, particularly in our current combative political climate.

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  10. Pingback: Addiction doc says: It’s not the drugs. It’s the ACEs – adverse childhood experiences. By Jane Ellen Stevens, from acestoohigh.com | Star Foundation Blog

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  12. Pingback: National Survivor User Network (NSUN) Bulletin - 17 July 2017 - Altering Images of Mentality

  13. Pingback: Classical Values » The Moral Reality Of The War On Drugs

  14. Pingback: Addiction doc says: It’s not the drugs. It’s the ACEs – adverse childhood experiences. – Life on Fire

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  17. Please!! I need you to help my boyfriend!! I need to get him a therapist right away who specializes in this & can help him!! I will pay ANYTHING to get him help before it’s too late. I am in the Alsip, I’ll area & need a doctor ASAP!! PLEASE SOMEONE RESPOND TO ME & HELP US!!

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  18. Very good article…I’ve looked at ACE’s as they relate to addition and other life problems…however, an ACE score of 0 doesn’t mean you’re immune to addiction…but reviewing ACEs with an addict/alcoholic is a very sound approach to achieving recovery…

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  19. I always thought the answer to addiction is in the “why”. Been through rehab at a young age
    There to understand the why and learning to love myself has been a long road. Thank you for your research.

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  20. Pingback: Addiction: It’s not the drugs. It’s the ACEs – adverse childhood experiences. – breathwork-science

  21. When a sex addict gives his wife herpes, HIV, hepatitis…it’s going to be pretty hard to offer him something other than anger. “Sex addiction” drives sex trafficking. It is part of compulsive abusive sexual relational disorder. Calling it sex addiction is a huge disservice to the patients and the people that have a life time of suffering as a result. Many people have ACE’S and do not end up addicted.
    Character disturbance (as per George Simon) is a part of the picture here.

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  22. Nothing at all mentioned about the death of a parent or a parent with a chronic disease. My mother passed away from cancer when I was eight, after being ill for almost 2 years.

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    • Hi, Kathy: The original ACE Study looked at only 10 types of childhood adversity, but subsequent studies have included others, including racism, bullying, involvement with the foster care system, moving often, homelessness, etc. Living with a parent who’s very ill for a long time and losing a parent certainly qualify as ACEs.

      Like

  23. This is an amazing article. I have an ACE score of eight. Pretty high. I consider myself a fairly high functioning person. With that said, I will probably die young as I have major intimacy issues and I move in and out of addiction behaviour every few years — which is a self-soothing behavior but not the least bit healthy.

    Like

    • I just want to add that although I consider my resilience to be exceptionally high, it isn’t an antidote. I still exhibit highly addictive behavior. I’ve just learned how to work around it.

      Like

  24. Ace score 7. Clean since 4 6 16. DOC opiates. Interesting case study, with some troubling conclusions. The medically assisted treatment program is not what I recommend, but can be somewhat effective in extreme cases, but only as a step down tool. The theory of childhood trauma being a precurser to substane abuse is not new to me, but the health risks for other chronic diseases, due to increased ace scores, is surprising. I feel the calling addiction a disease is misleading. My recovery requires constant attention, my addiction is still here, which makes it disease like. I have a mental illness that becomes activated when I use. I feel my addiction is more of an allergy than a disease.

    disease of add

    Liked by 1 person

    • I’ve always like the allergy model over the disease model since, generally, you must have exposure to the allergen before you realize effects…however both are just models to simplify and make more understandable a very complex issue…the AMA looks at addiction as a brain reward system disease and there is certainly data to support that position…I believe that everyone has a biological potential to become an addict much like everyone has the potential to become a diabetic…some have a greater potential than others and that’s genetically determined…it’s not a digital yes/no condition but more of a continuum…with repetitive heavy use over time, just about anyone will be come an addict/alcoholic but there are those who become addicts/alcoholics in a rather short period of time (Type I vs Type II alcoholics)…the discussion of ACEs in this article (and elsewhere) is of great insight because it looks to address why people get into repetitive heavy use in the first place… I don’t think there is a singular path to addiction, but a high ACE score definitely increases the potential that someone will use drugs to self medicate and continue until they reach the point of biological addiction…

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  26. One thing that should be mentioned is that children with such issues not only struggle with substance addiction, we are basically addiction prone. Can be addicted to shopping, eating/binging, hoarding… I get addicted to everything I do… even gambling. That is on top of the regular substance I used to be involved with but no longer. I now choose to be addicted to healthy things (legal things)…

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  28. I think my son is taking dangerous drugs like heroine. I don’t know if he has any addictions. He is also taking a narcotic that his doctor prescribes him improperly. We live in the Dallas, TX area. Is there someone you can recommend here that can help him?

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  29. Scored a 10. I have no addictions but my health is an incredible disaster. Four chronic illnesses – two of which are life threatening. Attention span issues and diagnosed ASD – so I have NOT (obviously) read all the comments above. Is there any hope for someone like me?

    Like

  30. I currently study Diploma of Alcohol and Other Drugs and Diploma of Mental Health issues concurrently in Melbourne Australia. For those asking ‘if they can learn (or are they too old)’; I can tell them, I am in my mid-60’s. NO ONE IS EVER TOO OLD TO LEARN new information, if they choose to put in the hard work. This information Dr Dan Sumrok has offered could be [an entire addition] Master’s Degree Thesis &/or PhD to go forward learning more. I personally appreciate the information Dr Dan and others have offered to add to my own knowledge base. My goal is attending training in USA and bringing it back to this region to teach others. THAT is what it is all about: ‘Each one Teach one’ (Frank Laubach, 1884-1970, Literacy); this LITERACY about Substance Healing and Rehabilitation needs to be taught/learned by others, as well.
    Kind regards and thank you for your continuing work, Dr Dan and others, AdvocateWorldWide.

    Like

  31. The ACE study is 100% accurate. I scored about a 6 or 7. I was sexually abused when I was young. Later when I was a teen I became addicted to sex, then alcohol, then drugs. I have been to 8 or 9 treatment centers and have been unsuccessful staying sober. I’m currently going to the methadone clinic and have been for over 4 years.

    Liked by 1 person

  32. Wonderfull! I have known this from my own personal experience. I fell off a balcony age 18month was traumatized as a result of and being handled by medical staff. I have a mood disorder and don’t handle stress well also have gut problems . I don’t seem to get the right kind of help. I am 61years old Email richard.j.jackson@hotmail.com

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  33. How about… rather than spending money on fighting the war on drugs and then more money on treatment, as a society we wage a war on (seems to be popular at the moment) and spend resources fighting child abuse, family violence, poverty, racism, discrimination, unemployment, sexism etc etc? Too radical?

    Liked by 1 person

  34. There is a slippery slope when everyone who has SUD has to have experienced ACE. Many did not. You do them no favors by forcing them into a pigeon hole where the normal experiences of growing up are labeled as “trauma.” I am not talking about the true trauma survivors I work with as a child welfare attorney. I am referring to the upper middle class kids raised with every advantage and a 0 ACE score who nonetheless became addicted to drugs. Any one size fits all approach creates problems for those who are not in that category. Group therapy to recover from trauma is of no use to someone whose addiction is not driven by trauma. And like many others working with the SUD population, I have yet to find anyone who fully recovered with suboxone, rather I have seen many times suboxone being abused, being sold, and leading to relapse.

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    • I would bet that if you traced back on these middle-class, “zero ACE” kids, you’d find that there is trauma in their ancestry. Addiction often skips a generation. Epigenetics explains that trauma in our ancestors gets passed down in our genes. Just because something is not currently included in the ACE assessment doesn’t mean it shouldn’t be. Rather than throwing the baby out with the bath water, these circumstances need to be understood and included in the ACE assessment.

      Liked by 1 person

    • Ava, it may not look like a “big T” trauma but lack of self worth / self love can be established in any childhood regardless of money and class. It’s not necessarily what we experience but how we perceive it and what beliefs we form about ourselves. Coming from a privileged background can cause some sensitive souls to suffer with huge guilt and shame, or carry great weights of expectation etc. To end up so abusive of self indicates to me that there is some deep level of trauma, possibly unconscious and/or preverbal, much of which can occur in the womb or during birth without anyone being aware. We might also consider the physiological and psychological patterns set up in new borns by drugs given during labour, and our subsequent reliance on them later in life…

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    • “upper middle class kids raised with every advantage and a 0 ACE score who nonetheless became addicted to drugs”

      I had every advantage, but was emotionally abandoned at 18 months when the next baby was born as was she when the third one came – I am addicted to alcohol – I suffer from anger, depression and sadness. I am 62 and have tried to get rid of it with EFT but it still lingers.

      Yet I am an intelligent person and function in society, but life is a drag and I can’t wait to numb myself at the end of the day (or sometimes at the beginning of the day)
      My score is 3 – my thinking is that umc kids that have everything, but no emotional support score at least a 1

      Like

  35. Hi, I have an ACE’S score of 7. When I started my transformation a few years back the most refereeing and healing words I heard were ” Honey, you weren’t crazy, they were!” Luckily I never did drugs and alcohol usage was limited to my college days- I believe my need to be in full control kept me from partaking.
    The problem with ACE’S is you know you’re different than most, you struggle more with routine life skills, but you don’t know why. I also think many us tend to have more of a creative mind; that combined with the unhealthy mechanism we develop really sets you apart from others. Without an outlet for the creativity, people just don’t know what to do with how different they are. It’s extremely difficult to “fit in” with emotionally well persons. They try to numb all that creative energy so it won’t drive them crazy. What helps as an adjunct therapy is daily work on developing self awareness and then learning techniques to retrain the brain. I wrote “Stuck in Our Stories No More” a step by step guide on how I transformed my mind, body and soul. I train individuals, corporations (employee assistance programs) and health care team providers.

    Leslie Peters RN
    Nurse Consultant, ACE’s

    Like

    • Hi, Leslie: Since the ACE Study and subsequent ACE surveys in more than 30 states show that ACEs are common, I think that if we create a culture where we can be more open about our ACEs, we’ll all discover that most of us have ACEs and have incorporated mostly unhealthy ways of coping — including over-achieving, engaging in thrill sports and over-eating.

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    • Hi, Michelle: Thanks for your question. Bullying wasn’t included in the original ACE Study (and low self-esteem comes from ACEs of many types), but it and several other types of ACEs have been included in subsequent ACE surveys. Some of those are racism, involvement with the foster care system, living in an unsafe neighborhood, and witnessing violence outside the home. What some people are beginning to do is to ask the people they’re serving about their traumatic experiences, and adding those. For example, Roseland Pediatrics in Santa Rosa, CA, serves people who have immigrated to the U.S., so one of the questions they incorporated in their ACEs assessment is “Did you lose a family member to deportation?”

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  36. This is right on target and moving in the right direction. I didn’t see depression and suicides addressed and childhood trauma is definitely the cause. I struggle daily and have searched over 30 years for relief. I’m trying cbd oil now with not much improvement.

    Like

    • Please look into Advanced Integrative Therapy (AIT). It is an energy psychotherapy that heals childhood trauma and it works.

      Like

    • http://www.thesacredplant.com has a webinar series explaining in detail the use of cannabis for medicinal purposes. The right kind, strength and method of delivery is crucial.

      I too have struggled a long time – it started after I had my first baby – I was asking myself:”how can anyone beat kids?”
      I am 62, my score is 3

      Like

    • May I suggest EMDR. It helped me more than years of other therapy, recently I am trying somatic psychotherapy and this also is very helpful.

      Like

  37. Implementing Trauma Informed Care has elevated the quality care I deliver to my patients resulting in more positive patient outcomes. I am a psychiatric nurse working in hospital acute care unit for 22 years. For the past 20 years I identified the negative consequences of childhood events determined ones behaviors. Patients need assistance in identifying this. New, effective interventions need to be implemented and available for both inpatient and outpatient populations to save lives!

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    • Joe M, what does the word “spiritual” mean in this context? Your advice may be helpful for people who are “spiritual”, but people who aren’t spiritual actually do get better and conquer their addictions. I’ve seen them do it. I’ve also seen very spiritual people die from the struggle. Calling it a spiritual problem and disregarding the science/medical/psychological/chemical aspects of this problem is incomplete.

      Like

  38. While I agree that treating all people with respect returns the best results and that the ACE concept may be true for many, my 40 + years working with addicts informs me that addiction can come about in a multitude of ways and affect even people whom have had stellar childhoods. In contemporary addiction treatment the most effective approaches start with assessing biological, psychological, and social factors that are core issues in subjective addiction and/or other mental health issues. The biopsychosocial approach was strong body of evidence and many years of global research to back it up.

    I also have found that addiction destroys the sense of family and creates comfort seeking, after all, drug and alcohol use is all about instant gratification that is contrary to long term goals. So I can see why this instant gratification seeking may get confused with childhood issues. However, I have worked with hundreds of addicts who have lived to retirement age with very high social functioning and visit their doctor for some obscure pain issue, get a prescription for Percocet, and have their life unravel in a few years as addiction sets in and instant gratification becomes the primary focus. These cases are used to support the biological approach that some individuals are more predisposed to develop addictive tendencies than others. To disregard this theory and attempt to say the person had unresolved childhood issues is a slippery slope. If the person had never visited the doctor, they would have never been exposed to opioids and thus addiction and given the unresolved childhood issues never would have impacted their life.

    So to hold the ACE theory true in absolute, would be to say that opioid use brings out unresolved childhood issues after living 65 years of very high social functioning and that giving the person buprenorphine will help reverse the neurological damage created by the opioids. In sum, one drug that activates opioid receptors creates neurological damage yet another drug that attaches to opioid receptors fixes the problem, of course with the proper therapy.

    Great dialogue, but let us be careful to not put the blinders on.

    Liked by 1 person

  39. Pingback: My End Game | attunedself

  40. I’m a counselor who specializes in psychoactive-assisted recovery.
    It is astonishing to me that this article doesn’t mention therapeutic value of Ibogaine and Ayahuasca in addiction treatment.
    Prescription of Suboxone and group therapy is an excellent short-term solution for some people, but most folks, especially the younger generation, resist this form of treatment and for good reason: it is a life sentence and never-ending contract with Big Pharma.
    And why should they opt for Suboxone, when they can detox with Ibogaine in just a 48-hour long session? Why should they be forced to do 12-step, when joining an Ayahuasca circle will provide spiritual, emotional and physical healing, on a level of depth and authenticity that is exactly what they’ve been looking for all along?
    There is no longer any reason to deny the therapeutic value of Ibogaine / Ayahuasca intervention for addiction. In fact, these medicines have been researched internationally and there is plenty of scientific data available that shows exceptional, unparalleled benefits on the brain, as well as cognitive-emotional functions. Simple google them and check publications on PubMed.
    Dr. Gabor Mate has worked with Ayahuasca traditional doctors for many years, so is Jascque Mabit, a french MD who started Takewasi center in Peru, the first in-patient center to treat addicts with Ayahuasca.
    In 2012, I co-founded an in-patient center in Mexico, that specializes in post-Ibogaine integration (therapeutic aftercare) called Living Clean Ibogaine (www.livingcleanibogaine.com). Since then we supported recovery of dozens of people, healing from opiate addiction. Our long-term success rate is close to 70% and it can be even better. We worked with middle-class families from US and sons of political leaders from Europe, we bridge indigenous medicine tradition of Mexico and Amazon with integrative medicine, as well as yoga, nutrition and T-Group process as group therapy (much more effective than 12-step!!!).
    Ibogaine is illegal in Mexico and Ayahuasca is in legal “gray zone”. I understand that MD like you can’t legally prescribe these drugs.
    But I also believe that to be in integrity with this profession and to really respond to this dramatic moment of epidemic, at the very least this article must mention the existing practice and research in the area of psychoactive-assisted recovery. Otherwise it is just as misleading as the very stigma of addiction that the concept of ACS is attempting to overcome.
    I’m available.

    Danesh Oleshko, LLM
    Director, Co-founder,
    LivingCleanIbogaine.com

    Like

    • Questions: Ayou a recovered alcoholic or addict yourself? How long have you been prescribing your combination drug-therapies? Less than 10 years? Longer?Longitudinal studies conducted? What is your rate of recitivism for your program? Are there side effects to the drugs you use? As Thomas Szazz stated many years ago: the psychological / psychiatric professions have created a plethora of regimens but most treat the symptoms not the root cause.

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  41. Pingback: Helping Families With Opioids and ACEs ⋆ Andrea Patten

  42. Grew up with an effed up childhood, mother tried to commit suicide and I found her at age 11 along with many other things. Growing up and even now never drank, did drugs, smoked no promiscuity but food was my comfort. Never went to any sort of therapy until now and I’m in my 40’s. Recently found out my score is a 6 and I’m having a hard time of letting go of the notion that I have to have a brave face on 24/7. As she said I picked a profession that reflected my childhood, running from one emergency to the next. I’m just overwhelmed now and not sure where to go from here.

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  43. Makes COMPLETE sense!!! I have longgggg believed the chronic self (ill prescribed ) medicating is a result of trauma and no healthy or soft place for individuals to get the inner healing tools they NEED!! Nature vs Nurture and self worth is lost in trauma….pain is so individually experienced even if all children in the family seen the same things! I hope more CARING and tool instilling programs are implemented around the world!!!

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  44. I think this is absolutely fantastic.. Nice to know there is a movement that truely addresses the needs of these patients, with dignity.

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  45. Because some ER doctor prescribed suboxone to one of my brothers years ago, they are both now every bit as controlled by and addicted to it as they ever were any street drug. When you can’t hardly find a doctor to prescribe it (seems like one for every three counties), I have a hard time believing it’s a good thing. There’s obviously a lot I don’t know about drug abuse, but I do know the heartache of having two addicts in the family.

    Like

    • Sorry to hear about your brothers. Addiction is a family disease, and it’s super taxing to those closest to the addict or recovering person. I know from personal experience.

      As for the Suboxone issue, it’s not a magic fix, but isn’t supposed to look like what you described it to be in your post. Suboxone treatment is medication-assisted therapy, not purely medication therapy (chemotherapy). Individuals who are working with a Suboxone provider are usually required to attend weekly counseling sessions, have a treatment plan for active recovery, and should be discussing a taper with their prescribing physician. If their Suboxone doc is simply writing them scripts for refills with no conversations around progress, recovery-oriented movement, and a game plan towards a gradual taper, there’s something wrong. Of course, it is up to your brothers to actually show up and lean into these services in order for them to be successful, and thus the recovering individual has a bigger responsibility for their own recovery than anyone else. It’s not a question of blame or duty — it’s a question of empowerment.

      Like

  46. Wow. This article was like a kick in the chest. My son is 30 years old, and has abused every drug out there, and has been in and out of prison since he was 18. He’s in prison now, and will get out in September. I have known for years that divorce and several other issues affected him deeply. He needs you. I would like to get him in to help as soon as he gets out. We live in Northeast Arkansas. Can you direct us to the proper help? Thank you so much.

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  47. Pingback: Addiction or “Ritualized Compulsive Comfort-Seeking?”

  48. I moved to El Dorado County, California recently which seems to have many more people (by my own observation and by some professional input from others) with addiction issues. Is there someone in this part of the country who understands ACE’s that I could collaborate with (I’m a pastor and help find meaningful solutions) to bring some hope? We host an AA meeting on our church campus, but I’d like to help facilitate folks finding even more help.

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  49. Pingback: The WHY of sugar addiction - The Abundant Energy Expert

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  51. I am filled with joy and hope for these people…….. the medical community finally are understanding this….. stop looking at us as if we have 4 eyes!!!!! We are just like you!!!!! We all are not jobless losers, bad parents,and careless spouses!!!!! The world has been short changed by writing us off!!!!!! So much pain,and shame has been handed out to great people simply because they are sick!!!!!!! I know no other illness where people get treated like criminals rite off the bat!!!!! This is why people don’t get help!!!!! It’s not help at all!!!!!!! It hurts very bad…… after all….. Nobody wants to be different!!!! We just long to be NORMAL!!!!!!!!! Thank god for you!!!! Keep up the good work❤️

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  52. Pingback: Groundbreaking Study: This Type of Childhood Event Linked to Addiction, Risk of Heart Disease, Cancer, and Major Chronic Illnesses | Amrita Wellness Medicine Clinic & Alina Porojan Outrageous Aging Clinic

  53. Pingback: Groundbreaking Study: This Type of Childhood Event Linked to Addiction, Risk of Heart Disease, Cancer, and Major Chronic Illnesses | AltHealthWorks.com

  54. I read through this whole article. It appears to be spot on, I have a child that is addicted to heroin and has overdosed and almost died. If the ambulance did not have Narcon on board, he wouldn’t of made it to the hospital. i’m so grateful to the men who saved his life. He is now currently incarcerated, for the next two years due to his overdose. It is my opinion, that in the state of Idaho, its easier to lock him away rather try to figure out whats going on with this child…he’s 20. He was an athlete, very popular intelligent, well spoken and handsome, still is. His father walked away when he was young, I remarried sometime later and subsequently, his step father walked away as well. He started to run with a tough crowd strangely enough, none of these kids had a father in their life. I honestly believe this is do to trauma in his life, he suffers from severe anxiety and was also diagnosed with ADHD. Rather than throwing these kids in prison and spending tax payers dollars, wouldn’t it be more beneficial to try and use the resources to get them into some counseling and rehabilitation, out in the community and working. These people have no idea what these kids go through being incarcerated. When they come back out they can’t integrate back into society, they have little or no self esteem, can’t get a job or anywhere to live due to their felony. It’s hard for them to be in public places…sad deal. I also have a daughter that’s heading off this year to do an intern at Stanford and she’s only 18. Why is it that my son is hurting so deeply, does not having a farther in the picture or two fathers walk out of his life play a part in this? I can’t help but wonder as the whole group of boys my son was using heroin with are now all incarcerated and all fatherless.

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  55. Bupe??!! Really? I was a surgical unit nurse in a hospital where it was given to post-op patients. They should signs of addiction within 24 hours. Getting them off it, just a few days post op so we could discharge them, was difficult; they became hostile, uncooperative, complained about everything, etc.
    If you are given people Bupe all you are doing is substituting one narcotic addiction for another.

    Like

  56. I have a family going back generations whose addictive personalities have provided lives that survived, but Looking through the eyes of a care worker, lives that could have been without so many of the tears and pain.

    Could I at 61 still learn and teach others some of these tools?
    I’m from NZ but living in Melbourne Australia at the moment

    Like

  57. Great, great article. My ACE is about 4, but I have a high resilience score. I have never abused drugs or alcohol, nor even tried marijuana, and became a pharmacist LOL.

    BUT my body sure remembered. I now have RA and MS. Is there any data supporting autoimmune diseases to high ACE scores? And if psychotherapy etc can help decrease the risk?

    Like

    • Stress from ACE can negatively affect gut bacteria which can lead to all sorts of chronic illnesses. google stress and gut bacteria eg. The microbiome: stress, health and disease. (antibiotic use also affects gut heath).
      then investigate ways of improving gut health. going gluten free, eating fermented vegetables, taking supplements, there is a lot of information on youtube eg. Healthy Gut Healthy Body: Intestinal health & chronic disease.
      Google and read about Doctor Terry Wahls who has reversed her MS with diet.
      All the best.

      Like

  58. Gerald May has some very enlightened ideas about attachment and addiction (worth a read)
    There is no doubt that Dreadful ACEs make for dreadful addiction and morbidity/mortality
    It’s the subtle “ACEs” which cause an awful lot of harm ,ones like religious belief whether they be Christian Jewish Muslim or any other .
    Forcing our beliefs on children messes with their minds . How many people realise the psychological damage of “pushy parenting”,or parents forcing little girls to perform in beauty pageants or the like
    I could write an list of “acceptable “behaviours which are damaging to children’s minds
    Very few people have escape ACEs .

    Like

  59. Folks if you really want to get straight or sober – if you know without a doubt deep down that how you are living is going to kill you or end up in prison – AA & NA are free to you. All you have to do is show up. They work practically in “saving asses”. I’ve been sober almost 36 years thanks to the AA program and the people in AA who you can not bullshit like you can MD’s / psychologists / psychiatrists who do not suffer the addiction themselves. In fact, many of us who are real alcoholics / addicts have tried EVERYTHING including doctors, drugs, religion, therapy, etc. before getting to AA / NA as a last stop. I guess you might say AA has been addressing “ACE’s” (as you call them) since 1935 working thru the 12 steps. Just my 2-cents.

    Like

    • I have advised12Steps to clients for many years and I believe in it.
      I also am aware of clients on medically assisted treatments being shamed at times in the rooms.
      Bill W ,an infantry lieutenant in the trenches of WW1 certainly suffered what today would be called PTSD. It just wasn’t called trauma in the 1930s.
      The Big Book speaks eloquently about trauma without using the word.
      It also acknowledges more to come and willingness to incorporate new info.
      I look for the common threads.
      I also have been at 12 Steps meetings from Barrow ,Alaska to Ojojona,Honduras ,no copay or deductible required.
      No church or party affiliation required.
      Only a desire to stop using.
      Same story really.
      I hope we can agree that carrying the good news to others I’d more important than defending any single paradigm.
      It works if you work it.Thank you.
      Dan

      Like

      • Yes Sir. We can most certainly agree.

        In addition to your insight on ACE’s I would add that in my opinion – not provable of course – personality trait(s), factor(s), gene(s), etc. may be inherited & passed on that predisposes one towards alcoholism / addiction. While such an individual may have some “internal” challenges in life, as long as this person stays away from alcohol / drug abuse, everything is OK. Otherwise, introduction of alcohol / drugs brings the predisposition into “full bloom”. It is only a matter of time. Your ACE’s may or may not contribute to development.

        I believe Jack Anderson wrote an article (1930’s or 1940’s) regarding alcoholism / AA, fairly new phenomena’s at that time. In it I believe he mentioned that extreme immaturity and / or being an only child as the most 2 common characteristics exhibited by alcoholics. I have found this true to varying degrees just as I have found that alcoholics are many times above average in intelligence if they stay away from drinking.

        If you have not read it already, an interesting read on AA / Oxford Group that you mentioned in your reply above, is the book “Not God”. Written as an objective historical research by the author if I’m not mistaken (Ernest Kurtz). He was granted access to much of the “closed” literature, notes & AA files at the time. Don’t let the book title fool you. (I sense however you have already read this book.)

        Lastly, there is a saying in AA that seems to dovetail into your ACE’s: Isn’t it amazing that people who get sick by the mouth (drinking) are healed by the mouth (talking it to death). Free association therapy within psychoanalysis also comes to mind.

        BR Tom W.

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      • Thank you Dr. Sumrok for your desperately needed work. I recently discovered the ACE’S study by chance. Why is that? This information is ground-breaking and revolutionary. I have a score of 8. I’m 56, and never understood why my life has been filled with addiction and relationship disasters. I live in Eugene OR, and have searched for support groups and treatment programs, but people don’t know what I’m talking about or where to send me. I’m in AA, and have been clean and sober again for 3 months. (3rd. time) I believe dealing with my trauma is the key to having a “normal” life.

        Like

      • Adam:

        Most certainly. There are a number of ways to success in defeating addictions at various stages. “If it works, don’t fix it”.

        IMO, there is an inverse relationship between the remaining amount of willpower (self-will) of the alcoholic / addict and conquering the problem alone. Once all willpower is gone, I find it very unlikely an individual will succeed without help, without which in most cases will end up in the penal system or early death (say nothing of impact on their families).

        The 12 step program is the last stop for many of us – when all else has failed. It is an extremely pragmatic program. IMO only, if one cannot make it in such a program, then from my experience and observations, the progressive physical nature of the disease (or “syndrome”) will take its course. I think it is a mistake to divorce the physical aspect of alcoholism from the “ACE” induced emotional / mental aspect. I would postulate that over time many people have had “ACE’s”. (Freud, Jung, Adler et al invented a whole school of thought on such.) But they live normal lives not becoming alcoholic or addicted. Only an alcoholic / addict has an additional physical trigger that if left untreated progresses over time. Again, just my 2 cents. BR, Tom W.

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    • With attention to their autonomy,respect, and nonmaleficence always seeking beneficence.
      The hard things are addressed right away and the impossible things take a little longer.
      It’s the way I heard it in the Navy.

      Liked by 1 person

  61. Pingback: 癮癖成因不是藥物,而是童年逆境經歷ACE (Adverse Childhood Experience) – 施博士 – 顱脊工房 (活水顱蝶 徒手醫治) DR Cranial Holistic Healing Centre 《CHHC》 “無論你的健康處於甚麼水平,顱脊系統的發

  62. What is left out is that long term PTSD (or PTS if you prefer) is genetic in origin and we know the genes. Well at least quite a few of them. Funny enough no test for those specific genes has been devised despite being widely mooted a few years back.

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  63. Where can I find this treatment for my daughter? She is currently in Syracuse, NY but Charlotte, NC is also an option. Thank you!

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  64. Ive listened to Dr Garber Mate on TED TALKS. I’m reading the book The Body Keeps The Score. And going through intense therapy for DID. Ive been molested as a young girl. Raped & Stocked as a woman. 2 bad marriages. Currently getting off opioids, that were prescribed after a MVA. I have a serious Gambling Addiction. Ive fought my entire life to quiet my mind and memories of a traumatic childhood. It didn’t work,when as an adult my past was just to overwhelming to stay in the present. I fell apart when I learned my 8 yo son had been sexually abused. Your article gives me hope! Especially for others who need help. Not one additive person should ever be treated LESS THAN! I truly believe addiction is the direct link of childhood trauma.

    Liked by 1 person

      • Dr Sumrok my son HSS been addicted to pain meds since his ankle accident in 2007 fell off a roof crushed his ankle and heel he’s has no job no money no insurance we are willing to help what we can but if something doesn’t haven’t I’m afraid the worse will happen I think he has tried subutox given by a friend not sure any suggestions would help with your ACE program

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  65. Good knowledge but no solution and that does not help my son’s problem.
    Can’t help a 52 year old man hooked on meth for 10 years!
    It is really a hopeless situation. Homeless and a walking mental case. No money, no insurance, no HELP.
    Hopeless 😫

    Like

    • I’m in the same situation with my son he’s been an addict for 10 yes anything available to him he has no job no insurance no money and I don’t have any idea how to get in touch with this program he is 35 yes old he needs help before matters get worse he’s been incarcerated a few times I’ve never given up but I’m at the point of no returns locations of one of the ACE CLINICS near my location would be appreciated desperate in Marysville Tn 37801

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  66. I was sent this email today which is Sabbath afternoon. I have been struggling and all these ways in my PTSD and addictions since my childhood. I started smoking weed, and drinking in early TEEN years.
    Been diagnosed with all kinds of things from the VA hospital here in Loma Linda California.
    PTSD, bipolar manic depressant, stress and anxiety disorder, ect…..
    I’m 57 years old now and I am suffering with so many health issues it’s sometimes too much to even handle.
    after reading this article I’m more than willing to go down to the VA on Monday morning and see dr. Mickey ask who’s the head of the psychiatric unit and ask him to read this email and hopefully he’ll be willing to treat me so that I might stand a chance on recovering and getting back to somewhat of a normal life.
    thank you so much for this informative information.
    I just wish you all were out here in California and that’s so far away.
    and if someone wants to reach me by phone to talk with me or encourage me I am leaving you my cell phone number. 909-246-6393
    I just want to thank God for this blessing today that which I received.
    God bless all of you.
    Sincerely and respectfully,
    Alan DesChamps Sr.

    Liked by 1 person

  67. I found this most helpful, I am a survivor of child trauma in very sense of the word and have struggled with alcohol abuse. I today am proud of how far I have come along this journey.

    Liked by 1 person

  68. First, one physician can’t just decide PTSD is not a disorder. Second, physician’s don’t think addiction is strictly a physiologic process but is strongly affected by past experience, but remember: many members of the same family often suffer from addictions, but not always the same addiction, and they don’t have the same personal traumas, therefore, there appears to be a genetic predisposition to addiction with variable penetrance and variable expression.

    Liked by 1 person

  69. Pingback: Addiction doc says: It’s not the drugs. It’s the ACEs – adverse childhood experiences. | lorie adair

  70. Pingback: The Surprising Link Between Broken Families And America's Opioid Crisis - The Right Side of News

  71. For years, I have felt that my daughter’s extremely traumatic treatment for leukemia between the ages of 3 and 6 contributed heavily to her addiction. Her treatment included over 300 spinal tap/chemo injections and bone marrow aspirations WITHOUT anesthesia because that was not used then. By the time her chemo was over, she resembled a survivor of Mengele’s horrible concentration camp experiments. Since she is in the first group of survivors, I imagine there is a growing number of childhood cancer survivors who deal with addiction now. Are you doing any work with this particular group? Or do you know anyone who is? Thank you.

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    • We have seen children survive cancers and sickle cell disease who after their childhood treatment suffer addiction.

      Like

  72. Both my daughters are addicted to opioids. Between the 2, I have 5 grandkids . I suffered with depression since I was little. I am now raising 5 grandkids. I feel like I’m going g to destroy their lives by being the only one in their lives.

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  73. Donna:
    This is right on, and van de kalk and Lance Dodes were my main guys, along with Logotherapy (Frankle) and others. Listen, give respect, seek out trauma (big and small) and help people discover purpose…healing can then occur. It takes time, though, and often we just don,t have a sufficient amount of it.
    Bob Anderson

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  74. My name is Sean, and I grew up in central England; a place called Nottingham. I now live with impact of deep, wounding childhood abuse. Together those form psychological, emotional, physical and sexual in nature. My head feel to my arm resting on my desk. I found myself thum;ing the table in dismay. I read British psychotherpatist’s book: Who Says I’m An Addict?’, and, some years ago, benefited massively from his alternative interpretation of the impact of childhood psychological abuse, before he moved to Zurish, Switxerland. Yet, as agonisingly predictalbe, our world-renowned, and valued NHS remains stuck in limbo, ‘treating’ people like me with more or less useless cognitive therapy: my despair-saturdated approach that merely lead to the essenitally obvious realisation that (a) ther was a problem, related to my childhood problem, and that (b) that problem lay inside of me. Not an entriely useless, but fatally handicapped limntation, it was only until I recieved eye-movenemt desensitisation and reprogrsamine theraoy: ‘why must I be constantly inflicted with the pain of continuous misunderstandibng by a profession, that is, psychological medecine, that here, in the UK, refuses to accept contemporary thinking, in spitev of it’s obvious, and increasinlly obvious accuracy in common with the overwhemlming number of us who relate with the understandable agone, and releif, of lethally infected, arguably by the profession itself, with acsense of long-overdue understanding, and now frustration and the inability to find answers to ur cognitive, bandonment trauma within the massive majority of NHS-diafgnosed conditions?’ But for \David, and later, Patrcia Heyland’s professionally deepr quidance and depth of understanding willingness to embrace less conventonal, but significantly more effective methodsv of treatment, I’d still be thumping my frustrated fisats on this desk, oblivious to what is now such a compdlling and pesuavie answer to this issue. cd

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  75. Love this work and as a potentially high ACE scorer look foreard to taking the test myself. Would like to know more and if this type of treatment is available in the world elsewhere.

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  76. ACE addiction may apply to some individuals. But, what I see happening more is the inability to understand real Chronic Pain and the need to address what opiod treatment does in the human body when in tremendous non stop continuous knawing pain. Yes opidods may become dependent but their ability to illustrate how it affects the human brain, and the Nervous System to aid in helping chronic pain is in no way a means a of getting high, but in fact a means of neutralizing the ability to cope with the normalcy of living a fairly decent and productive life… In order to understand Chronic Pain you need to experience it and live with it for years.

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  77. I am a nurse in a clinic that prescribes buprenorphine for opiate addicted people. We have a higher rate of relapse than what you describe. It seems “subs” are not always enough to get people to stop using opiates. I would love to talk with someone On the staff about methods, learns about trainings or come to visit and learn some new strategies about what is working in recovery; How to talk to participants in our program about ACEs. Any info would be welcome.

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  78. My upbringing left me with feelings of shame,
    deep sadness, trust issues, poor self with
    and major depression and anxiety. It is difficult
    to be around people who drink or abuse drugs.
    but my addiction is to food. At 5’3″ I once weighed over 300#. I have always struggled with my weight. After many years of Psychiatric
    treatment I am now in a drug regime that has me feeling the best I ever have mentally. Fibromyalgia and arthritis plague me and I struggle with how to cope with pain despite access to all sorts of opioids and other meds
    I have. I firmly agree with the ACE accessment and treatment plan. I wish it was available in our area for those who struggle here.

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  79. EMOTIONAL BRAIN TRAINING by Dr Laurel Mellin. Takes this to a whole new level. Teaches you how to rewire the brain. SHOWS YOU HOW!!! Life saving. Life changing. Thanks for the article.

    Like

  80. I have been on suboxone for 5 years and it makes me feel how I think normal people feel. Before opiates and suboxone I suffered from severe depression. When I have to change Drs due to insurance I’ve fighting to stay on it every since. Dr says we don’t give suboxone for depression. I told them if they took me off that it would be a death sentence. They don’t care the just want me to take more antidepressant s. Very frustrating.

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    • One of the first observations of buprenorphine when initial studies were done at Columbia is that about 85% of clients got an antidepressant effect.
      It is correct that it is not approved as an antidepressant.
      But it works.

      Like

  81. I was wondering if there were support groups/treatment centers for this in Austin Texas?
    I’m from a family of 7 kids. I estimated my score at a 5 and several of my siblings’ scores to be higher than that.

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  82. I love this!
    Are there any resources available to find a dr and/or therapist in my area who understands ACES and treats patients accordingly? I’m in the Phoenix area….

    Like

  83. there may be addictions, but I also believe there is something that looks like addiction I call, Something Other Than Addiction SOTA.

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    • My daughter and her husband have just returned from a year of work at Rotarua.
      Historical trauma with the Maori?

      Like

  84. My child (45 yrs old) was raised in our home with an alcoholic father. He has struggled his whole life with the affects. Alcohol has also been his attempt to cope. I love your concept of Empathy rather than shame! Is there a connection worth Oregon Health Sciences University?

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  85. Wow – This article has my son’s name written all over it. No matter your ACE score – because everyone has had different levels of experiences – it seems from reading this it can help whether your score is 1 or 5 and that there are different approaches depending on the individual. We have been struggling for years trying to find the right help and still feel lost. Definitely need to check into this more. Wish there was something and doctors exactly like this here in Michigan or even if we could go there.

    Like

    • We are working on increasing the workforce who are trauma informed.
      Stay in touch and I will ask some Michigan contacts.

      Like

  86. Sorry my son had a blessed life with a wonderful loving family. He was placed on ADHD meds after he and my husband also Ryans biological Dad ( sad that I need to say that. But asked all the time!) Married 26 years we talked it over. I’m a nurse and was not ok with medication for a normal, high energy strong willed, heigh IQ kid In the 4th grade!

    It felt wrong to me but we felt so pressured. Thisewerethe first pills that sent a very clear message. If you don’t feel right or are getting yelled at or under stress pop pills.

    It all makes me sick!!

    Not all SUD sufferers have univing horrible memory of family. Our son Ryan knew we were NEVER GOING TO GIVE UP

    May he Rest In Peace at last. 7 rehabs failed him but they were paid so let’s face it,that’s ALL that matters.

    God help our next generation along with this one. 🙏💔🙏😥

    it felt wrong to me. Little boys NEVER SAT STILL in my day.

    Look at the mess we’re in. My son had no abusive family, he did had an over zealous prosecutor in Iredell County NC which was very traumatic on his life.

    Like

    • I am sorry for your loss.
      Many traumas haunt kids that are not included in the ACE questions.
      Many ADHD kids are misdiagnosed as you say.
      Many also hate being labeled and feeling like they are stigmatized by it

      Like

  87. Thank you. Very informative and accurate.
    I lost my father(who was a retired physician ) to opiate overdose in 2015.
    I struggled with addiction most of my adult life.
    I’ve been clean 2 years now, and I went through 7 treatment centers over the years before finally coming to terms with the very things written in this article.
    Can’t express to you enough how true it is, all of it.
    Especially treating the addicted person with respect.
    It makes so much difference in the way one feels about our future, and the possibility of actually staying sober.
    Keep up the good work.
    Again, thank you.

    Like

  88. I love this work. I have a high ACE score and I’m an addict with 27 years of sobriety from drug/alcohol addictions but very newly sober around people addictions that have nearly killed me.

    One piece missing from this work is that structural oppression creates violence in the lives of children and adults. Racism, economic injustice, sexism — one need not have the police pull you over and harass you to feel the terrorism of police violence every day. My ex grew up in the neighborhood where Mayor Goode dropped the bomb on a house of Black critics of the system, killing 11 people including 5 children and destroying 60 adjacent homes. This terrorism left an indelible mark — moreso than her mother’s frantic and sometimes violent parenting, which was a desperate attempt to keep her ‘in line’ and out of harms way.

    ACE scores as you have designed them do not explain the current opioid epidemic. But the massive redistribution of wealth in the US and the foreclosure of employment options for white workingclass people does. The crack epidemic can be similarly explained — but unlike today, there was no empathy whatsoever for crack addicts — because, racism. And all of that addiction was characterized as ‘poor character’ and ‘poor choices’. Add structural violence to the ACE scale and it will have much more powerful explanatory value. AND rather than focusing solely on individual therapy, it may move the nation to consider how sick the hoarding of resources and the ‘blaming’ of people on the receiving end of structural violence makes our society.

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  89. Pingback: Addiction doc says: It’s not the drugs. It’s the ACEs – adverse childhood experiences | Treating Addiction in the Primary Care Safety Net

  90. Pingback: Addiction crisis and Real progress  – thisinsanesanity

  91. I could not agree more. This is what we practice in our clinic every day. My colleague and I developed a trauma informed care training using the neuroscience of addiction and trauma, including ACE’s data, as the framework for why it’s so important. We’ve done this training for the last three years mainly in primary care offices. We insist all staff, including providers, be present for the training. We get the same feedback every time, “This totally changes how I think about addiction and some of our difficult patients. And will definitely change how I act .” We get these same comments from a variety of staff, including physicians. We also incorporate MAT into and discuss the impact it has on recovery, again using science data and math as we call it.

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  92. This is not an original idea!! As a trauma therapist, this us certainly a “no brainer”. What I’ve found working in the trauma world, lots if providers are not “trauma-informed” & dismiss the adverse affects of trauma. It only seems like an original idea because he’s just now “clueing in”.

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    • You are correct. For many of us working in this space it can perhaps be seen as a “duh.” The more important thing is the realization by the rest of the healthcare world that this matters. Even within my own profession as a LCSW I continually meet colleagues who don’t know anything about ACEs or trauma informed care or addiction. No matter what our profession we are all in it for the patient first and the more we work together and share information the better care our patients get.

      Like

    • Sorry to be late to the party but glad to be here.
      Let’s work together as healers to get the word out.
      Thanks for your observation about which I agree 100%.

      Like

  93. Bravo! I attended one of these trainings years ago in my quest for CE. Makes so much sense! I have worked with this client population for 30 years. First as a substance abuse counselor now as a life coach with a speciality in behavioral health. From my experience, there is an underlying trauma that supports self-medicating with compulsive / addicting behaviors. I work holistically addressing mind, body, emotions, and spirit. And I bring in my yoga teacher training. This can have profound affects on trauma reduction.

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  94. I am not an addict but 2 out of my 4 children are opiate. Addicts I really need help for them i have sent thousands of dollars on methadone. Clinics a little success for a bit but back to square 1 again. Because my daughter is an addict I’m. Taking care of her 2 youngest. Children they are 6 and 8 I love them and love caring fir them but I am 64 years old and now work 40 plus hours a week and really need another job for financial. Reasons please what can I do to help. Them my other 2 children are successful

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    • Mary, Raising our grandchildren – the children of addicts – is very complicated and stressful, on top of the stress of having addict children. If you don’t know this already, there are many FB support groups that are private (closed) where you can connect with others doing the same. There are millions of us, not only in the US, but all over the world. You most definitely are not alone. I’m doing the same and send you big hugs. If you are interested, search ‘grandparents raising grandcildren’ on FB. xo

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  95. Pingback: On why our pathogenic credit creation system creates pathogenic disconnected and addicted selves – Bichara Sahely's Blogs

  96. I am expecting the trauma levels in our country to skyrocket due to the disrespect now being shown through rhetoric, legislation, deregulation and massive tax cuts targeted to health care and social services. Rampant hopelessness, fear and lack of compassionate services is changing the very culture and character of our country.

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  97. Pingback: Why Traumatic Stress is NOT a disorder! – Emerging From The Dark Night

  98. This is one of the best articles I have read in a long time. I am in recovery from opiate addiction and also have several mental health diagnoses, including PTSD, and also have an autoimmune disease. I agree with everything here. When I went to treatment the first time, it was all about just getting off drugs, no therapy around the reasons why I used drugs. The second time i went, I intentionally sought out a treatment center that focused on my past trauma and healing my mental health issues. I knew that if I didn’t learn healthy ways to manage them, that I would die from my drug use. I’m so glad that these important, critical issues are being seen in a different light. Thank you for posting!

    Liked by 1 person

  99. In my experience working with children with early relational trauma and attachment issues, and now adults with substance use or “addictions” – I could not agree more! I see it as the same neurobiology! Substance use is an external means to regulate their dysregulated nervous system that they failed to have regulated during early childhood. The most effective treatment would be to focus on the underlying problem – not the drug use which is just the presenting symptom at the top of the iceberg. Very encouraging to read your post!

    Liked by 2 people

  100. Pingback: ACE’s Too High: People Do Recover!

  101. Great article. I’ve worked in addiction medicine for more than 40 years and I’m glad these ideas are finally catching on.

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