Addiction psychiatrist Stephen Delisi, MD, explains why the ACE questionnaire is a game-changer for addiction prevention and early intervention The evidence continues to mount demonstrating a strong correlation between adverse childhood experiences (ACEs) and substance use disorders in adulthood. Together magazine caught up with Hazelden Betty Ford's Stephen Delisi, MD, to learn about the link between childhood trauma and addiction, and the implications for reaching and helping more people before the disease takes hold. What is the ACE questionnaire, and why was it designed? The 10-question survey was developed as part of the groundbreaking Adverse Childhood Experiences Study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente in the mid-1990s. Researchers set out to determine whether childhood experiences of neglect, emotional or physical abuse, or other challenges at home had an effect on a person's health and well-being in adulthood. More than 17,000 individuals were surveyed in the original ACE Study, and related data gathering and analysis continue today. So we have decades of investigation and evidence to inform our efforts. What does the research on early adversity show? Simply put, exposure to trauma in childhood can have a tremendous, lasting impact on our health and the quality of our lives. As a person's ACE score increases on a scale of zero-10, so does the potential for developing physical, behavioral and mental health disease in adulthood. The increased risk for substance use disorders is dramatic. Compared with people who have zero ACEs, individuals with at least one ACE are two to four times more likely to start using alcohol or other drugs at an early age. A person with an ACE score of five or higher is seven to 10 times more likely to experience addiction than someone who hasn't experienced childhood trauma. Increased risks for depression, suicide and all types of chronic illness are likewise substantial. An ACE score of six or more is associated with a 20-year reduction in life expectancy. Why such a strong correlation? What's going on? We have growing evidence that exposure to trauma can alter the structure and function of the developing brain. More specifically, adverse childhood experiences can lead to reduced or delayed development of the brain's prefrontal cortex where judgement and emotional regulation are controlled. Changes in the brain's limbic regions associated with addiction and psychiatric illnesses have been noted as well. Evidence also shows that the experience of childhood trauma can alter the immune system, affect stress-response functions and even change biochemical processes at the DNA level. You can see how this evidence has major implications in understanding the origins of disease in terms of nature-versus-nurture. We’re not looking at an either/or scenario anymore. Our newest inquiries explore how both nature and nurture are involved. How can this knowledge inform addiction prevention and early intervention efforts? Knowing what we know, why wait until signs of trouble appear before screening for risk factors? The ACE survey is not yet a standard of care in pediatric medicine, but it would be fairly simple to deploy more widely. Other strategies call for greater collaboration across our health care, social services and education systems—initiatives around access to quality child care or mental health services, for example. The former president of the American Academy of Pediatrics describes ACEs as the single greatest unaddressed health threat facing our nation. We have the evidence and the tools to do better for our children, our families and our future—now. Listen to more from Dr. Delisi Visit HazeldenBettyFord.org/Podcasts to learn about the implications of ACEs for treatment effectiveness. Psychiatrist Stephen Delisi, MD, is the medical director of professional education solutions for the Hazelden Betty Ford Foundation. A nationally recognized clinician and trainer on recovery-oriented systems of care, implementation of evidence-based treatments and integrated services for co-occurring mental health disorders, Dr. Delisi brings an empowering, person-centric approach to his work at the forefront of addiction prevention, intervention and treatment.