The Adverse Childhood Events [ACE] Survey, Addiction, and Mental Health

February 5th, 2024

By P. Casey Arrillaga, LCSW, LCDC

About 30 years ago, a healthcare organization in Southern California embarked on one of the largest research projects ever done about how much childhood experiences shape a person's health, including addiction and other mental health disorders. In it, they found that by asking just a few questions in a confidential survey, they could start to predict who was at higher risk throughout their lifetime. This blog post will look at not only what this survey asks and what it can tell us, but most importantly, how we use that knowledge to help people change their lives.

The ACE Survey

The name of the ACE survey stands for Adverse Childhood Event, which some refer to as ACEs. In other words, ACEs are things a person might go through as a child that could cause them problems. Many people in the field of addiction and other mental health might call these traumas, even if they aren’t things that the child directly experiences or even considers a problem.

In the first two waves of the ACE study, over 17,000 people were given a confidential survey as part of their healthcare exams. The survey asked a series of questions that covered both difficult events that may have happened before the person was 18 and then various signs of trouble in the person’s current life. Since that time, the survey has continued, which means that there is an ongoing stream of data coming in from tens of thousands of people. This allows researchers to reinforce and refine their findings, making them ever more useful for social scientists and helping professionals.

The adverse events measured by the survey fall into three categories:

Abuse, including emotional, physical, and sexual abuse. The survey asks not only if such things have happened, but then gets detail on the nature of the abuse.

Household Challenges, which includes whether their mother was abused during their childhood, abuse of alcohol and other drugs in the home, someone in the household having mental illness, parents getting separated or divorced, and whether someone in the home was incarcerated. Again, detail was gathered for any questions that were answered “yes.”

Neglect, which includes emotional and physical neglect. As with the other sections, detail was gathered about each type of neglect.

What It Showed

First, the ACE survey showed that most people go through difficulties in their childhood. About two out of three people reported at least one ACE. Close to 20% had three or more.

Besides showing how much stress children go through, the ACE study shows how damaging that stress can be. Of the top 10 causes of death, ACEs are associated with at least 5 of them. Not surprisingly, the more ACEs a person faces, the worse their prospects. Someone with 5 or more ACEs is 6 times as likely to have a problem with alcohol later. Someone with 6 or more has a life expectancy 20 years shorter than average. The higher the number of ACEs, the more likely someone is to experience the following as an adolescent and adult:

  • Alcohol and other drug abuse
  • Anxiety
  • Suicide
  • Depression
  • PTSD
  • Unsafe sex
  • Unwanted pregnancy
  • Complications in pregnancy
  • Death of the fetus
  • Cancer
  • Diabetes
  • Not completing high school
  • Lower income
  • HIV and other STDs
  • Broken bones
  • Concussions/brain injuries
  • Burns

Many of these factors feed off of each other, leading to a rut or downward spiral that can be hard for a person to escape.

There were distinct differences in what men and women answering the survey reported. Women tended to report more ACEs than men, which may say something about willingness to report difficulties as much as anything else. While no one should dispute girls’ vulnerability to abuse, women also reported more about their mothers being abused, alcohol and other drug use by people in the home, parents being separated or divorced, and family members being locked up. Women were almost twice as likely to report that a household member had mental illness. None of these household challenges would seem more likely to happen simply because there were girls in the home, and one would expect that boys who grew up under the same roof to have experienced the same things. Thus, the results suggest that men are less likely to report childhood issues. This might have to do with fear of appearing weak, or it might say that they are less likely to remember the things that happened as being problematic. All of this is good for a helping professional to take into account when working with male clients.

What Can Be Done?

Prevention is the first line of defense. While there is no way to spare children from everything, preventing even one ACE can be a gift that lasts for their entire lifetime. To that end, many government and non-governmental agencies use ACE survey data to drive prevention efforts through education, outreach, and providing resources to those most vulnerable and the professionals who help them.

It is wishful thinking, though, to think that we could catch everything, especially since ACEs often reverberate through generations of a given family. Thus, there is also a great deal of work to be done for those who have experienced ACEs.

This is a large part of what we do at Windmill. Every client answers the basic ACE survey questions in the first few days with us. While a client may show up due to a crisis in their lives or a specific issue they want to tackle, we know that one of the most effective and lasting ways to do so is to find the underlying causes and do as much healing around those while the client is with us. We also show them how to continue this work after they have left our program. In this way, we help them improve not only their lives, but the lives of everyone in their family. When they change how they react to their ACEs, they may help protect future generations.

The Bottom Line

The ACE study is a landmark research project that highlighted how much impact childhood experiences have on a person’s development. It showed that just a few questions about different things a person may have gone through during childhood can help predict health and behavioral outcomes throughout their lifetime, including risk for addiction and other mental health issues. This knowledge can help guide treatment to help a person change those outcomes and thus vastly improve their lives and the lives of those around them.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.

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