Will's Reflections: ACE & Addiction

It’s hard to get enough of something that almost works.
--Vincent Felitti, MD
 

Adverse childhood experience (ACE) grows out of a family system. No member escapes unscathed. Thus it’s not surprising that my older sister, Janice, suffered trauma’s aftereffects along with me.

As a boy I admired Janice. Her concern for me softened the impact of hardship. Unfortunately, in adolescence she gravitated toward risky habits. She drank alcoholically and took so much LSD she suffered a psychotic break at age sixteen.

Despite the obvious downsides to her behavior, I emulated my sister. Janice moved into her own apartment when I was twelve, and soon after I began using marijuana and drinking when I visited her on weekends. By age fifteen I was smoking pot several times a day and drinking several times a week, a pattern that continued for the next decade.

After getting accepted to medical school I gave up pot, given its obvious incompatibility with clinical study. But eliminating marijuana abuse spurred escalation of my drinking. In response, I joined Alcoholics Anonymous (AA) just before starting my internship. That was back in 1987, and aside from a couple of brief relapses the following year, I’ve been sober since. 

AA teaches one to admit vulnerability, correct errors, and foster spirituality. All these steps proved necessary, but I’ve never felt fully at home in the program. The premise of the twelve steps is that alcohol is the root problem. In my case, that just didn’t seem true.

Vincent Felitti (co-architect of the original ACE Study) explains: “the major factor underlying addiction is adverse childhood experiences that have not healed with time.” Although the ACE results weren’t available back in the eighties, I already knew that my upbringing had primed me for chemical dependency. Not only did all my family members drink and use drugs, and not only was I encouraged to participate at an early age, but I felt so fearful and insecure that intoxicants seemed vital. And it appeared obvious that my anxiety and low self-esteem grew directly out of childhood neglect, bereavement, and abuse.

AA helped me break free of addiction. Other twelve step programs, like Alanon and Adult Children of Alcoholics, showed me that many of my difficulties arose not from my own substance problems, but as adaptations to those of my family. I consulted therapists who helped me explore the conflicts in my home of origin and how they undermined my maturation. Often I was prescribed medications, which occasionally proved helpful.

These early programs and therapies moved me forward but dealt with peripheral symptoms, not the central problem. Although I knew intuitively that my difficulties could be chalked up to childhood hardship, my support system focused on discrete conditions like depression, anxiety, or addiction. Consider this alphabet soup, a partial list of my diagnoses: ADD, BAD, BPD, CD, GAD, PTSD. That no single ‘official’ syndrome fit my constellation of symptoms underscores the poverty of this approach.

More recently, clinicians have treated my symptom complex as the predictable result of developmental trauma. Yes, my moods fluctuate, and I’m prone to anxiety and dissociation. But tracing my afflictions back to a single source relieves much frustration. I feel understood for the first time ever.

Janice, I’m sorry to say, never found the help she needed. In 2011 she died of liver failure, the consequence of chronic alcoholism. From what we’ve seen above, the true cause of her premature death was formative trauma.

The ACE study demonstrated that early mortality increases with degree of childhood adversity. Let us be grateful that the study also raises awareness, so those of us who remain can find effective routes to physical and mental wellbeing. 

© 2013, Will Meecham, MD

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