09 Dec 2016
What you should know about Adverse Childhood Experiences and Addiction- a case for Harm Reduction
Do you have a friend or family member, maybe even you yourself, who has struggled with using too much alcohol, drugs, food, cigarettes, or something else? Do you ever think, why can’t they just stop, or why can’t I just stop? I’m not so different then other people who can just stop. Why am I told I’m powerless over this behavior and others are not?
As a therapist and 15+ year veteran of treating tens of thousands of people with addiction and trauma, I felt like there wasn’t enough focus on the practical reasons why people use too much of something or are addicted, or for that matter practical ways they can make changes to become healthier, emotionally and physically. So I changed the way that I approached treatment. Most therapists are familiar with the CDC-Kaiser Adverse Childhood Experiences Study or ACEs https://www.cdc.gov/violenceprevention/acestudy. I recently participated in a training where Vincent Felitti MD, one of the authors of this the largest study on adverse childhood experiences and later life health and well being, described the ACE study. The stunning take away from the training was this:
- ACEs began when a group of medical doctors, not psychologists, were doing a non surgical weight loss clinic study, not an addiction study.
- The original study was done on middle class patients, not on patient from a low socioeconomic background.
- The original study was done to find a way to improve physical health outcomes and it did! just by asking the questions in the primary care office- with a 35% reduction in Dr. visits and an 11% reduction in Emergency room visits.
- As the Adverse Childhood Experience score goes up so does the probability of addictive and risky behaviors
- Someone with an ACEs score of 6 is 4,600% more likely to be an IV drug user then someone with and ACEs score of 0
None of this makes someone powerless. I would argue that it gives the patient, the primary care provider, and the therapist a starting point to build strength and (Vincent J Felitti MD, 1998) (Alice Miller) resilience. Also it makes it untrue to say that this is a disease for which there is no cure. Dr. Felitti said that one of the early patients who he worked with struggled with overeating and when they discussed why, the patient said it “keeps the door closed to the past.” In harm reduction psychotherapy we need to acknowledge that there is a reason why someone utilizes something that, in excess, may not be good for their health and relationships. It serves a purpose for that person.
One of the important points in the take away is that health outcomes were improved just by asking the questions in a regular MD’s office. Dr. Felitti called it “asking and listening,” quoting Dr. Alice Miller on the “Essential role of the enlightened witness.” As therapists we have the opportunity to not only be an enlightened witness but also a partner in the exploration of resilience. In the ongoing nationwide ACEs studies the CDC is focusing on prevention, and on a state level some studies are interested in resilience. The Minnesota Department of Health defines it like this- “the result of a dynamic set of interactions between a person’s adverse experiences and his or her protective factors. This interaction is what determines the developmental path towards health and well–being or towards illness and dysfunction. No child is magically resilient or invulnerable to ACEs, just as no individual child is automatically doomed in the face of ACEs. These protective factors can include a person’s own biological and developmental characteristics. But protective factors can also include characteristics of the family, community, and systems that mitigate the negative impacts of ACEs.” http://www.health.state.mn.us/divs/cfh/program/ace/resilience.cfm
The Person who wants to make a change to a healthier lifestyle can make that change. The therapist and the Primary Care Provider are there to help the person find practical ways to get there. For many people with a high ACEs score, it is more challenging, but it is certainly doable. A harm reduction in psychotherapy approach doesn’t coerce or shame someone into wanting to stop a harmful behavior, but instead honors strengths that the person brings with them. (Minnesota Department of Health)
