Substance Abuse & Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Adverse Childhood Experiences

The Adverse Childhood Experiences Study

Adverse childhood experiences (ACEs) are stressful or traumatic experiences, including abuse, neglect and a range of household dysfunction such as witnessing domestic violence, or growing up with substance abuse, mental illness, parental discord, or crime in the home. ACEs are strongly related to development and prevalence of a wide range of health problems, including substance abuse, throughout the lifespan.

When children are exposed to chronic stressful events, neurodevelopment can be disrupted. Disruption in early development of the nervous system may impede a child’s ability to cope with negative or disruptive emotions and contribute to emotional and cognitive impairment. Over time, and often during adolescence, the child adopts coping mechanisms, such as substance use. Eventually, this contributes to disease, disability and social problems, as well as premature mortality. Figure 1. depicts the lifespan impact of ACEs.

the ace pyramid
Figure 1. The ACE Pyramid

Over the past 15 years, many studies have examined the relationship between ACEs and a variety of known risk factors for disease, disability, and early mortality. The original ACE study began in 1995 and was conducted by the Centers for Disease Control and Prevention (CDC), in collaboration with the health maintenance organization Kaiser Permanente.*i More than 17,000 Kaiser patients completed a confidential survey containing questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors. (Felitti et al, 1998). Participants were mostly middle class, white adults with health insurance. Here’s what the study revealed:

  • ACEs are common. For example, 28% of Kaiser participants reported physical abuse and 21% reported sexual abuse. Substance abuse and mental illness of a parent and divorce or separation were also common events.
  • ACEs cluster. Almost 40% of the Kaiser sample reported two or more ACEs and 12.5% experienced four or more. Because ACES cluster, many subsequent studies now look at the cumulative effects of ACES rather than the individual effects of each.
  • ACEs have a dose-response relationship with many health problems. Participants in the ACE Study were followed over time. Findings demonstrated that a person’s cumulative ACE score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance use and abuse. Also, many ACE-related problems tend to be co-morbid or co-occurring.

Since the launch of the initial ACE Study, numerous other studies with different populations have been conducted with similar results.

Developed under the Substance Abuse and Mental Health Services Administration’s Center for the Application of Prevention Technologies contract (Reference #HHSS277200800004C).

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