Bad news-good news: Each additional ACE increases opioid relapse rate by 17%; each ACE-informed treatment visit reduces it by 2%

Aopioids2Photo by Ian Sheddan via Flickr Creative Commons
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It’s no surprise that serious childhood trauma can lead people to use opioids. In the absence of healthy alternatives and an understanding of how experiences — such as living with a parent who’s alcoholic or depressed, divorce, and being constantly yelled at when you’re a kid — can make your adult life miserable, opioids help many people cope with chronic depression, extreme anxiety and hopelessness.

But a new study has shown the significance of ACEs and ACEs-science-informed treatment: Each additional type of adverse childhood experience increases a person’s risk of relapse during medication-assisted opioid treatment by a whopping 17 percent. And each visit to a clinic that integrates trauma-informed practices based on ACEs science reduced the relapse rate by two percent, which can carry a person perhaps not to zero, but to a minimal risk of relapse.

“This research clearly shows the lasting impact that ACEs (adverse childhood experiences) can have,” says Dr. Karen Derefinko, lead author and assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, and director of the National Center for Research of the Addiction Medicine Foundation. “I think it’s the first research to connect ACEs to relapse.”

Researchers from the University of Tennessee Health Science Center and the University of Memphis also found that more than half (54%) of people in a rural Tennessee opioid clinic relapsed, and the highest relapse rate was on the first visit. Almost half of the 87 people who participated in the study had an ACE score of four or higher — the average was 3.5, which is remarkably high. The study, “Adverse childhood experiences predict opioid relapse during treatment among rural adults”, appears in the September 2019 issue of the journal, Addictive Behaviors, and was published online last week.

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Dr. Karen Derefinko

“This study will help practitioners understand the importance of providing trauma-informed treatment,” says Derefinko. “Because of the stigma associated with drug use, it’s hindered health care workers’ understanding of why people use drugs and has led to an assumption that they’re bad people. This shows that trauma-informed care and providing resources does impact how well people can do. It’s also validating for patients and gives them a lot of hope.”

 

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The myth of motive in mass shootings

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Photo: Vernon Bryant, Dallas Morning News

Almost the first thing you hear out of the mouths of police after a mass shooting is: “We’re looking for a motive.”

In Gilroy, CA, the FBI is investigating the shooting at the Gilroy Garlic Festival as domestic terrorism. In El Paso, TX, police are describing the shooting as a possible hate crime and act of domestic terrorism, and focusing on the manifesto written by the shooter. Police in Dayton, OH, are still looking for a motive for why 24-year-old Connor Betts murdered nine people in 30 seconds.

But if we want to prevent shootings, asking about motive will just get you a useless answer to the wrong question. Police might feel as if they have an explanation for why 19-year-old Santino William Legan murdered three people, and why 21-year-old Patrick Crusius murdered 22 people. But motives don’t explain the roots of why those three young men, or any other mass shooters or bombers, foreign or domestic, start their journey as innocent babies and end up on a road to killing people. And in those roots, are our solutions.

If you use the lens of the science of adverse childhood experiences, the answer reveals itself, and usually pretty quickly.

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Talking ACEs and building resilience in prison

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They’re the forgotten, the 2.3 million people in US prisons. The overwhelming majority of them have experienced significant childhood trauma. Before you click out of here, this isn’t another boo-hoo story, as some of you might describe it, about the dismal state of our corrections system, for inmates and guards alike. (Oh, yes, it is profoundly dismal.) This is a story about how one tiny part of it isn’t so dismal, and actually addresses head-on the fact that most (91 percent) of the approximately 2.3 million prisoners will finish their sentences and go home. To your neighborhood. So….wouldn’t you want the prisons to help these guys and gals so that they, and by definition, we, come out happier and more well-adjusted than when they went in?

Well, yea-uh.

Ok. Just in case you glossed over it, let’s go back to that sentence about childhood trauma. It is precisely why the 2,300 inmates at Washington State Penitentiary in Walla Walla, Wash., ended up there. Over the last 20 years some profound, intense research revealed that people who have a lot of childhood adversity have seven times the risk of becoming an alcoholic, 12 times the risk of attempted suicide, twice the risk of cancer and heart attacks. They’re more violent, more likely to be victims of violence, have more broken bones, more marriages, and use prescription drugs more often than people who have no childhood adversity. And those are just the few drops in the bucket of how childhood trauma affects people’s lives.

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Those who separate immigrant children from parents might as well be beating them with truncheons

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Central American asylum seekers, including a Honduran girl, 2, and her mother, are taken into custody near the U.S.-Mexico border in June in McAllen, Texas.

They all agree. Physicians for Human Rights. American Medical Association. American Academy of Pediatrics. American Psychiatric Association. National Association of Pediatric Nurse Practitioners. 

Separating children from their parents or caregivers hurts children. Between April 19 and May 31, nearly 2,000 children were separated from their parents. As Celeste Fremon reported in WitnessLa,  that number has now passed 2,300 children (and is increasing by more than 60/day), with another 11,000 locked up in everything from large cages to a converted Walmart. 

“To pretend that separated children do not grow up with the shrapnel of this traumatic experience embedded in their minds is to disregard everything we know about child development, the brain, and trauma,” says a petition signed by more than 9,000 mental health professionals and 172 organizations.

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ACEs science can prevent school shootings, but first people have to learn about ACEs science

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David Hogg, a senior at Marjory Stoneman Douglas High School, speaks at a rally calling for more gun control. Photo by Jonathan Drake / Reuters

After 17 people, mostly teens, were shot and killed by another teen last week in Parkland, FL, what seems to be a real movement is growing, propelled by kids devastated by their friends’ deaths and wanting to prevent such a massacre from ever happening again.

Their rallies and marches and lie-downs probably won’t have much effect in the short-term, as some of the Parkland teens learned as they witnessed — and some of them wept during — today’s lightning vote by state lawmakers along party lines to end debate on an assault weapons ban, which killed any further consideration of the bill in the Florida legislature’s current session.

But their persistence can make a difference in the long run, especially if they — and we — widen this to include the dozens of kids shot on the streets of Chicago or Camden or in other communities every week. We can even broaden the approach to include the 200 people, including many children, who died in Syrian air strikes in the last two days, because the roots and solutions are the same.

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Book review: “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity” by Dr. Nadine Burke Harris

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Dr. Nadine Burke Harris debuted her book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, at the Philadelphia Free Library this evening in a talk and book signing.

This first stop in an ambitious book tour that crisscrosses the country reflects a mission that Burke Harris has pursued for nearly a decade: to spread the knowledge about the science of adverse childhood experiences, and about how people can use this knowledge to help solve our most intractable problems. (Her TED Talk has nearly 3.5 million page views.)

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‘Christmas Crime’ injects humor into a difficult subject

Sarah Ann Masse forwarded this just before Christmas, but I didn’t see it until after. Nevertheless, even though it has a holiday theme, it’s still worth watching, because We Are Thomasse have added a very clever twist — and wonderful clarity — to the sexual harassment and abuse issues that have surfaced over the last few months.

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We can’t stop sex harassment by firing or incarcerating our way out; we can stop it by using ACEs science

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So, Harvey Weinstein has gone to ground, along with Charlie Rose, Matt Lauer, and Kevin Spacey, to name a few, and they’re likely never to work in their chosen fields again. This week, federal Appeals Court Judge Alex Kosinski retired after 15 women, including former clerks, accused him of sexual misconduct. Do a search for “sexual harassment” and stories about dozens of men across a variety of professions appears.

Sexual harassment is everywhere – all professions, including higher education, and all walks of life (see the NYTimes article about women who work in Ford’s Chicago plants). The U.S. Equal Employment Opportunity Commission says that 60% of women report having experienced sexual harassment. That’s 45 million women. Forty-five million. And a much smaller, but still in the millions, number of men have also been sexually harassed by their male or female bosses.

The solutions so far — Fire them! Jail them! Destroy them! — might garner some headlines and short-term satisfaction. The solutions certainly fit our traditional approach of using blame, shame and punishment to attempt to change human behavior.

But we can’t fire or imprison our way out of this — it’s too big and too complex. Here’s why:

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Wisconsin aims to be first trauma-informed state; seven state agencies lead the way

Here in California, many people think that it’s only liberal Democrats who have a corner on championing the science of adverse childhood experiences (ACEs) and putting it into practice. That might be because people who use ACEs science don’t expel or suspend students, even if they’re throwing chairs and hurling expletives at the teacher. They ask “What happened to you?” rather than “What’s wrong with you?” as a frame when they create juvenile detention centers where kids don’t fight, reduce visits to emergency departments and shrink teen pregnancy rates….among many other things.

Because they do all this and more by abandoning the notion of trying to change people’s behavior by punishing, blaming or shaming them, and instead using understanding, nurturing and healing, some people might think this approach belongs to the purview of one political party.

Mmmmmm….Not so fast.

To paraphrase Tonette Walker, the First Lady of Wisconsin, married to Republican Governor Scott Walker, who was a GOP presidential candidate in 2016:

That’s ridiculous.

Her exact words were: “It’s ridiculous that people say this is a Democratic or Republican issue. We all care about issues concerning families and children. We all care about the outcome of people’s lives, no matter who you are.”

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New Orleans Mayor Mitch Landrieu’s address on removal of four Confederate statues

This 22 minutes is definitely worth the time. New Orleans Mayor Mitch Landrieu eloquently describes why New Orleans removed the statues, which weren’t erected immediately after the Civil War to honor the fighters, but to remind all who passed by the statues about white supremacy.

Here’s the text from the YouTube page on which this video appears:

On Friday, May 19, 2017, Mayor Mitch Landrieu delivered an address about the City of New Orleans’ efforts to remove monuments that prominently celebrate the “Lost Cause of the Confederacy.” The statues were erected decades after the Civil War to celebrate the “Cult of the Lost Cause,” a movement recognized across the South as celebrating and promoting white supremacy.

There are four prominent monuments in question. The Battle of Liberty Place monument was erected by the Crescent City White League to remember the deadly insurrection led by white supremacists against the City’s racially integrated police department and government. The Jefferson Davis statue on Jefferson Davis Parkway, the P.G.T. Beauregard equestrian statue on Esplanade Avenue at the entrance to City Park, and the Robert E. Lee statue at Lee Circle.

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