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Chronic Pain: The Evolution of How We View It

Chronic Pain: The Evolution of How We View It

In recent years, the incidence of chronic pain has reached epidemic proportions. Unfortunately, there is a long history of discrimination related to pain, which has not only spurred controversy, but it has also changed the way we—and our doctors—approach its treatment.

Pain: the fight or flight effect

Pain, in and of itself, is a necessary part of life. Pain warns us about danger. It prevents us from doing things that our bodies were not meant to do. It signals injury and illness and, ultimately, it  keeps us from doing more harm.

In this sense, pain is a good thing. We need it to survive. It is imprinted on our DNA and, like an animal, we instinctively know that when we feel pain, we’re doing something wrong.

This model, however visceral it may be, is no longer the only construct of pain. In today’s society, we are increasingly sedentary. In many cases, we live in environments that are filled with airborne pathogens, we consume highly-processed foods, and put other things in our bodies, like drugs, that are not meant to be there. This situation has led to widespread nutritional imbalance, an epidemic of disuse syndromes, and a general decline in health due to inflammatory and immune conditions.

The global pain epidemic: where it really hurts

Without getting any more technical, these are contributing factors to the worldwide pain phenomenon, and it’s not going to get better any time soon.

For the pain sufferer, this is a mitigating issue that often drives them to seek relief. Some may attempt to self-medicate, and some may seek medical intervention, but in many cases, the exact cause of the pain is unknown.

Though there have been significant advances made in the medical profession in terms of how we understand pain and what treatments work best, those who suffer from the worst kinds of pain often receive little or no relief; this sort of approach, in itself, is a product of the modern age.

As doctors have become better acquainted with new philosophies on pain physiology, the various subtypes of pain, and options for treatment, they are confronted with an ever-increasing regulatory framework that continues to strengthen in response to the fallout of the pain epidemic – namely, overprescribing of pain medications and the resulting addictions that can, understandably, be seen as a state of emergency.

Whereas once, pain was an issue to be taken seriously, it is now often dismissed by the very people who have the power to heal it.

What is chronic pain?

There are, in general, two types of pain. Acute pain is the kind that is felt when we injure ourselves, from a burn, a fall, an injury, a strain – something tangible. It is a situation where you can say “I did this, and it hurt.” The pain can be attributed to something specific. Usually, if you look after it appropriately—set the broken bone, put ice on it, take a Tylenol—the pain will subside, and eventually, the hurt will heal.

Chronic pain is different than acute pain. For anyone who does not suffer from it, it may be challenging to understand. Chronic pain lingers even after the injury has healed. Sometimes, it has no connection to an injury at all, but even when it does, it is often seen as vague and unbelievable, a stigma that is neither new nor modern, at all.

Take, for instance, the case of “railway spine,” a 19th-century phenomenon that was related to injuries sustained (you guessed it) on trains. In this situation, patients presented themselves with multiple pain issues and complaints, but since no visible injuries could be found, doctors were hesitant to treat the pain. The railroads, of course, were then reluctant to provide compensation for the victims. After all, if you can’t see what’s causing it, maybe it doesn’t exist.

Sound familiar?

How we approach chronic pain today

Sadly, in many cases, this perception has not changed. People who suffer from legitimate pain, such as whiplash from a car accident, or spinal injury, will often be disregarded, leading the patients either to suffer needlessly or seek other alternatives, some in the form of physical therapy and alternative treatments, and some in the form of drugs, like opioids, that provide at least some relief.

The opioid conundrum

The unfortunate thing about opioid painkillers is not that they don’t work, but that they are not meant to be used for an extended period. For acute pain, they can be very helpful, such as in the days following a bad injury, or while recovering from surgery.

However, opioid tolerance builds up quickly, and pretty soon, the user will find they aren’t doing nearly as good a job as they once did. The pain from the injury might be gone, but the brain continues to tell the body that it still exists, resulting in cravings for more drugs and eventually turning into an addiction.

A more sustainable approach to chronic pain

Today, we know more about the psychology of chronic pain. We know that certain stimuli trigger pain flares and that, in many cases, it is possible to control pain in ways that do not involve opioids.

Some of the ways we approach chronic pain today include:

Counseling

As stress, anxiety, and depression are chronic pain triggers, evidence shows that counseling helps to mitigate pain. Through techniques such as mindfulness, cognitive behavioral therapy, and self-hypnosis, many lifelong sufferers of chronic pain have found relief.

Physical therapy

In many cases, chronic pain was precipitated by an injury. Once the injury healed, the pain continued. Physical therapy can help by strengthening the joints and muscles around the area of pains, leading to better support and less pain. For example, many who suffer from lower back pain have found relief through core-strengthening exercises like yoga, tai chi, and Pilates.

Increased physical activity

Beyond physical therapy, increased physical activity has also proven to be very helpful for chronic pain. The simple act of walking for 15 to 20 minutes a day can vastly improve both the pain response and general mood. When your mood is better, the pain decreases as well.

Changes in diet

Eating a lot of highly processed foods and sugar can exacerbate an array of chronic diseases, including diabetes, obesity, and conditions that are related to inflammation, like multiple sclerosis, arthritis, lupus, uveitis, and Crohn’s disease. Studies show that changing the diet to eliminate processed foods and substitute fresh fruits, vegetables, whole grains, and healthy fats can reduce chronic pain and inflammation.

The role of medications in chronic pain intervention

Chronic pain is a complex subject. No one solution can be applied to its relief, and medicine still plays a vital role.

Depending on the cause of the pain—if one is identified—tens machines, nerve blockers, steroid injections, stem cell treatments, and medications that target neural receptors should also be considered as front-line therapeutic options.

If the objective is to live independently without pain, there may yet be a long road ahead. However, working closely with a care team that includes alternative practitioners such as chiropractors, acupuncturists, physical therapists, massage therapists, and psychologists, relief is within reach.

There is no question that the perception of chronic pain in the medical field must change. With access to the latest research and a multitude of proven intervention options close at hand, there is no reason why we can’t all get better.

Are you suffering from chronic pain? We can help. Reach out today to get started.

 

Medication Assisted Treatment in Long Beach

Medication Assisted Treatment in Long Beach

Recovery from drug and alcohol dependency is never easy, and no one treatment is going to be appropriate for every patient. For this reason, we take an individual approach to each case to develop a treatment plan that is tailored to immediate needs and designed to bring about the best possible results.

Medication-assisted treatment Long Beach

Medication-assisted treatment, also known as MAT, is just one of a combination of approaches we use in our Long Beach facility. To get past the most challenging stages of detox and recovery from opiates/opioids, benzos, and alcohol addiction, medication is very helpful in providing additional support when needed.

Though we advocate complete abstinence and always work toward that goal, responsible use of medications can make a significant difference in recovery. All medications are strictly controlled, monitored, and administered by our doctors to ensure that it is helping and not contributing to difficulties in other areas of treatment.

As a component of a recovery program, MAT is combined with intensive therapy, behavior-based therapy, group therapy, and family therapy, with the ultimate goal of abstinence as soon as the patient is ready.

Types of medication-assisted therapy

There are several types of medications that have been approved for use in MAT. In determining a course of treatment, we take a whole-person approach to ensure that every aspect of recovery is addressed appropriately.

MAT for opioid and alcohol addiction

Opioid MAT can include drugs such as methadone, suboxone, buprenorphine, or naltrexone, but they all work a little differently.

For example, methadone is a synthetic opioid that has long been used as a frontline intervention in treating opioid addiction. The dose is then gradually tapered until there is no physical dependency. Today, methadone is no longer a preferred therapy in opioid treatment as many patients find it as difficult to stop using it as they do the opiates they were addicted to in the first place.

Suboxone or naltrexone are often preferred in MAT as they relieve the symptoms of withdrawal but do not produce the same euphoria that the patient was getting from the drug of choice. This has been found to reduce the risk of relapse, and it helps the patient take full advantage of the therapy they will receive in recovery. Naltrexone is effective in blocking the sedative and euphoric effects of opioid intoxication. Naltrexone has also been effective in MAT for alcohol dependency.

Suboxone is a combination of naltrexone and buprenorphine. While both of these substances inhibit the “high” addicts experience from opioids and alcohol, they still can cause physical dependency. As a result, it is important for us to monitor their use to be sure they are supporting, rather than hindering, recovery.

Accessing medication-assisted treatment in Long Beach

If you or a loved one is struggling with an addiction, we encourage you to reach out right away. Along with providing comprehensive counseling, individualized therapy programs, and medication assisted treatment, we are committed to helping you find hope as you regain control of your life.

Reach out today to get started. We are always here to help.

 

Anxiety and the Increase in Benzo Use

Anxiety and the Increase in Benzo Use

Benzodiazepines, also known as benzos, are commonly prescribed to combat anxiety and sleep disorders like insomnia. In the last fifteen years, benzo use has been steadily rising, and along with it have come higher death rates, notably when these drugs are used in combination with opiates or opioids.

One in four people who are prescribed benzodiazepines will abuse them

According to a study published by the National Institute on Drug Abuse, 30.5 million American adults use benzodiazepines, representing between four and six percent of the population. Of those, about 17 percent overuse, or take them for uses other than they were intended.

A short-term solution

Generally, benzodiazepines are never recommended for long-term use, and rarely without an adjunct therapy, like psychiatric counseling or cognitive behavioral therapy. If taken as prescribed, and only for a short duration of treatment, they help address issues such as anxiety, seizures, and insomnia. They are also used in conjunction with treatment for alcohol addiction to ease tremors and other symptoms.

Some commonly prescribed benzos include:

  • Klonopin (clonazepam)
  • Xanax (alprazolam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)
  • Ativan (lorazepam)
  • Restoril (temazepam)
  • Halcion (triazolam)
  • Serax (oxazepam)

Because they are not as strictly controlled as opioids, they are often easy to obtain from a doctor. However, in about 20 percent of cases that result in benzo abuse, users get them from a friend or family member.

Because they are so effective at relieving anxiety, they can become highly addictive, leading some to look no further for a solution to their problem.

Benzo use is on the rise

As life becomes more hectic, fast-paced, and stress-filled, benzos can become a quick fix that eventually turns into a habit. While many doctors recognize that there are many non-drug interventions that can be more effective over the long term, the fact remains that prescriptions for benzodiazepines have doubled over the past 20 years.

Living in the age of anxiety

Anxiety, panic, and fear are very real in this day and age, and not just to those with a diagnosed mental illness. The pressure to perform at work, to engage in social media, or to over-achieve in school can be enough to drive anybody over the edge.

If an individual is not encouraged to seek an alternative treatment, taking a pill now and then may seem harmless enough. If it helps us cope with the constant barrage of noise we are faced with every day, it might seem like a godsend – at least, at first.

Ironically, the symptoms of benzo overuse are much the same as the symptoms for which they are prescribed. Anxiety, insomnia, headaches, dizziness, weakness – all of these can manifest as a result of benzo withdrawal. Symptoms can last anywhere from a few days to several months, and prolonged withdrawal is not uncommon, sometimes years after the drugs have been discontinued.

Getting help for benzo dependency

Recovering from benzo dependence is not something you should attempt on your own. With the right interventions and treatments, it is possible to put it behind you and take back control of your life – and learn how to cope with your anxiety.

If you or a loved one is struggling with a benzo dependency, we can help. Reach out today to get started.

Bipolar Disorder Symptoms and Treatment

Bipolar Disorder Symptoms and Treatment

Bipolar disorder is a serious condition that affects anywhere from three to ten percent of adults in America. According to a study conducted by the World Health Organization, bipolar is the sixth leading cause of disability in the world, putting it right up there with diabetes and heart disease.

It is a lifelong condition that is, in most cases, treated very effectively with medications and other forms of cognitive therapy. However, it can be dangerous if left undiagnosed and untreated, leading to significant challenges that can affect just about every aspect of life. It may make it difficult to hold a job, and personal relationships can become challenging. The important thing is to recognize its potential and seek treatment as soon as possible.

Symptoms of Bipolar Disorder

Though it is characterized by extreme behavior and polarizing mood swings that range from deep depression to manic, emotional highs, people with bipolar don’t always experience it the same way. The symptoms can be unpredictable, causing great distress to the individual and others in their life.

Symptoms of bipolar disorder can include one or many of the following:

Mania/Hypomania

Though mania and hypomania are different in the way they present, they have the same symptoms, for the most part. Hypomania is less severe, but can still cause significant problems at work, at school, and in life in general.

A manic or hypomanic episode includes three or more of these characteristics:

  • Abnormally jumpy
  • Increased energy and agitation
  • Euphoria, characterized by an exaggerated sense of self-confidence
  • Grandiose ideas about one’s own power and abilities
  • Sleeplessness
  • Unusually talkative to the point where others can’t keep up
  • Thoughts racing
  • Inability to concentrate or focus
  • Risky, impulsive behavior (promiscuity, gambling, overspending)
  • Severe cases may present delusions or hallucinations

Depressive episodes

A major depressive episode will cause notable challenges in completing routine day-to-day tasks and activities. It may be difficult to find the energy to go to work or school or to participate in social activities.

A major depressive episode is determined if the individual shows five or more of these symptoms:

  • Depressed mood, feeling sad, hopeless, or irritable
  • Loss of interest in the things they usually love to do
  • Sudden loss or increase of appetite resulting in weight loss or weight gain
  • Oversleeping or insomnia
  • Restlessness
  • Slow to respond to stimuli
  • Low energy or extreme fatigue
  • Feelings of hopelessness or worthlessness
  • Excessive feelings of inappropriate guilt
  • Inability to think, concentrate, or make decisions
  • Suicidal thoughts, talk, or attempts

The different types of bipolar disorder

Bipolar I is the most commonly diagnosed type of bipolar disorder. Characterized by mixed episodes—both manic and depressive, the individual generally experiences more manic than depressive episodes but may cycle between the two.

Bipolar II does not generally have extreme manic episodes and instead is identified more by periods of severe depression and hypomania.

Cyclothymia is a milder form of bipolar characterized by cyclic mood swings that are far less severe or long-lasting than a full-blown manic or major depressive episode.

Mixed episodes refers to an individual that has symptoms of both polarities, usually in rapid sequence or rapid cycling.

Co-occurring bipolar disorder

In some cases, symptoms of bipolar disorder can be present because they share characteristics with other mental health conditions. For instance, borderline personality disorder, and even ADHD share many traits with bipolar, such as extreme mood swings, lack of impulse control, inability to focus, euphoria, and depression.

Additionally, abusing certain types of drugs, like methamphetamine and others, can cause very similar manifestations.

While there may be mental health issues present, it is not always black-and-white when it comes to diagnosing bipolar. This is why it is so critical to obtain a diagnosis from a qualified health professional who is well-versed in mental health, and bipolar in particular. Having a proper diagnosis ensures that the treatment and medications prescribed are appropriate for the individual and may help them get their life back on track much more quickly.

Other behavioral conditions may manifest or worsen with bipolar. These conditions include eating disorders, alcohol or drug abuse, attention deficit disorder (ADD or ADHD), or chronic health issues like endocrine disorders (thyroid problems, for example), heart disease, diabetes, and obesity. If these issues are allowed to continue untreated, they can present a significant barrier to successful treatment.

Knowing when to see a doctor

In many cases, the person who has bipolar disorder will not recognize the symptoms. They won’t realize how much their emotional instability is affecting those around them, and they may blame it all on outside influences.

Some may actually enjoy the euphoria that comes with their manic episodes and not want them to end. Unfortunately, these episodes are often followed by a severe depression that may last for days at a time, leaving the individual in distress and possibly leading to a range of financial, legal, or relationship problems in their day-to-day life.

If you or a loved one is experiencing signs and symptoms of bipolar disorder or any other mental health issue, it is critical that you see a doctor right away. Unfortunately, bipolar does not resolve itself; however, many highly effective interventions can control the symptoms and help you get back to a happy, productive life.

When to seek emergency care

One of the biggest dangers of bipolar disorder is suicidal thoughts and behaviors. If you or a loved one is having suicidal thoughts, call 911 immediately or go directly to an emergency room. If you don’t have ready access to emergency services, there are suicide hotlines, both local and national, that can help you through the crisis.

The number for the National Suicide Prevention Lifeline is 1-800-273-8255, and it can be accessed from anywhere, any time of the day or night.

Treatments for Bipolar Disorder

Fortunately, many therapies and interventions treat bipolar disorder effectively. The trouble is, many people do not receive a diagnosis until they are in crisis. Statistically, only 25 percent of people receive an accurate diagnosis within three years of seeking help.

Once diagnosed, however, success rates are encouraging, with up to 85 percent of patients reporting a positive outcome.

Frontline interventions include medication, cognitive behavioral therapy, family therapy, and psychotherapy, but treatment protocols vary significantly from person to person.

Medication therapy for bipolar

Medication therapy can be frustrating for some, as it often takes some trial-and-error to achieve balance. Adjustments are made along the way and often involve a combination of medications to address the symptoms.

One of the more frustrating things that patients report about bipolar medication is the side effects they have to endure. Fatigue, weight gain, nausea, tremors, diarrhea, kidney problems, loss of appetite, and a feeling of emotional numbness are often reported. Because of this, many who struggle with bipolar may attempt to stop taking the medication in an attempt to feel better. Unfortunately, this usually lands them back in the same crisis that they were experiencing before they sought treatment.

Though there are new, advanced medications available that report fewer side effects, it’s really about what works best to manage symptoms. Not all drugs will work well for all people, so it is critical to monitor symptoms and follow the advice of your doctor until you find the right balance.

Bipolar treatment Long Beach

Are you or a loved one struggling with symptoms of bipolar disorder? Bipolar treatment in Long Beach is just a call away. Reach out today to get started or to learn more about how we can help.

Chronic Pain and Pelvic Floor Physical Therapy: Queer MEDucation

Chronic Pain and Pelvic Floor Physical Therapy: Queer MEDucation

Most people utilize physical therapy for orthopedic purposes, however, physical therapy has so much more to offer. Roots CPR‘s Functional Restoration Director, Dr. Michael Zabala Aquino, PT, DPT, also the founder of Deconstruct Health, sat down with Kerin “KB” Berger, medical professional and educator for LGBTQI + nonbinary. Dr. Aquino discusses his mission to alleviate the barriers that exist for the queer community, particularly queer people of color and transgender/gender nonconforming individuals, through the use of physical therapy and whole body wellness.

 

About the Podcast:

Queer MEDucation is a platform to educate medical professionals and the general population on LGBTQI+GNC health care. Please enjoy a series of expert interviews featuring medical providers, mental health professionals, advocates, and community members.

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Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

Adverse Childhood Experiences (ACE): How they Affect Health and Well-being

In past articles and our most recent article on trauma, we have mentioned the impact that Adverse Childhood Experiences, or ACEs, can have on an individual. While it wasn’t long ago that we figured it out, there is a great deal of research supporting the notion that one of the key contributing factors to substance abuse, mental health and other behavioral disorders is childhood trauma. Adverse Childhood Experiences, known widely as ACEs, are common and seemingly passive experiences that one may have as a child, that, when occurring repeatedly or in combination, have a devastating impact on a person’s development and long-term health.

When an Adverse Life Event takes place during one’s life in later adolescence or as an adult, the connection for the survivor to make between the traumatic experience and their future issues can be clear. Whether it’s a singular “Big T” trauma or a series of less severe “Little T” traumatic events, the link between these experiences and a person’s behaviors can often be made easily. For example, a 58-year-old man who recently went through a divorce, was laid off and then lost his house, might make the connection between these experiences and his increased drinking and isolation.

However, the link between ACEs and mental health or substance abuse issues that develop later in life can be more difficult, for a couple of reasons. For one thing, the mental health or substance abuse issues often don’t surface until years, or even decades, after the Adverse Childhood Experience occurs. What starts as general family dysfunction, divorce, neglect, or abuse may seem relatively normal through childhood and even into adulthood. The early signs and symptoms of a greater issue often manifest themselves as isolation, lack of trust, avoidance and other social and emotional issues before they ever develop into substance abuse or severe mental illness.

What are ACEs?

The notion of Adverse Childhood Experiences, or ACEs, began with the research of the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study. The study was conducted between 1995 and 1997 and studied nearly 17,000 Kaiser patients in a San Diego Health Clinic[1]. Patient health was studied through physical exams and surveys of current health and behaviors, while they also completed surveys about childhood experiences. What this groundbreaking study was looking at was the link – which was not understood at the time – between childhood trauma and physical, mental and emotional health later in life.

The ten childhood experiences they were looking at were:

Childhood abuse

1.     Emotional Abuse

2.     Physical Abuse

3.     Sexual Abuse

Childhood neglect

4.     Physical Neglect

5.     Emotional Neglect

Household challenges

Growing up in a household were there was:

6.     Substance abuse

7.     Mental Illness

8.     Violent Treatment of a mother or step-mother

9.     Parental Separation/divorce

10.  An incarcerated household member

 

Participants in the study were then given an ACE Score between 0 and 10, the total sum based on how many of the 10 types of adverse experiences they reported experiencing.

The Findings of the CDC-Kaiser ACE Study

The ACE Score, from 0 to 10, is used to assess cumulative childhood stress – now sometimes referred to as “Little T” trauma or by association with this study – a person’s “ACEs”. One of the clearest and most widely understood finding of the study was that Adverse Childhood Experiences (ACEs) are more common than one might think, or thought at the time. More than half (52%) of the participants from the original CDC-Kaiser study reported having at least one ACE, and more than 1 in 5 (20%) reported exposure to 3 or more ACEs, while another 6.2% reported 4 or more exposures[2].

The most prevalent of the categories of childhood exposure was substance abuse in the household (25.6%); the least prevalent exposure category was evidence of criminal behavior in the household (3.4%)[3]. Another finding was that the susceptibility of a person’s exposure to multiple ACE categories, as the relationship between single categories of exposure was significant. If someone reported any single category of exposure, the probability of exposure to any additional category ranged from 65%–93%; and then not surprisingly, the probability of more than two additional exposures ranged from 40%–74%[4].

The key finding of the study as it related to health outcomes, and which changed the way we understood childhood trauma, was that as one’s ACE Score increases, so does the risk for serious diseases and conditions, including:

  • Alcoholism and alcohol abuse
  • Illicit drug use
  • Depression and other mental health issues
  • Suicide attempts
  • Health-related quality of life
  • Smoking
  • Chronic disease
  • Heart and liver disease
  • Poor academic achievement
  • Poor work performance and financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • STDs and unintended pregnancies
  • Risk for sexual violence and intimate partner violence

The increased risk for these negative health outcomes and well-being are dramatic. Compared to someone with an ACE Score of 0, a person with an ACE Score of 4 or more is:

  • 18 times as likely to have attempted suicide
  • Twice as likely to have had two or more weeks of depressed mood in the past year
  • Nearly 5 times as likely to have ever used illicit drugs
  • More than 11 times as likely to have ever inject drugs
  • More than 5 times as likely to be an alcoholic

How are ACEs Linked to Health Issues?

There is a large and growing body of research about how childhood stress and trauma affect brain development, brain chemistry and, thus, the regulation of the body’s emotional, stress and fear response systems are impacted. Repeated stress and activation of these systems of the brain dramatically alter the formation of myelinated axons and the amygdala, the part of the brain that activates the autonomic nervous system (ANS) and releases hormones like adrenaline and cortisol into the body. If you’re walking through the woods and see a bear approaching, or you see a kid walking into oncoming traffic, the activation of this system is very effective in increasing your heart rate, opening your airways, and increasing blood flow to your organs and muscles, and away from certain parts of the brain.

However, if the stress response system is activated every night by the sound of your dad coming home, or the sight of your mom reaching for a bottle of alcohol, your body and brain are hit with the same fight-flight-freeze response. The repeated activation of this system take a toll on your vital organs as well as your brain’s ability to regulate emotions and responses to triggers. When the body produces too much of, or stops producing, the natural chemicals to sooth or excite you, it is very common for people to turn to external stimuli to compensate this: depressants like alcohol and benzodiazepines, stimulants like cocaine and methamphetamine, or even behaviors like gambling and sexual intercourse.

Exposure to abuse and neglect also impact the prefrontal cortex, the part of the brain responsible for high level cognition and controlling impulse, and the nucleus accumbens, the brain’s pleasure-reward center which releases the body’s natural dopamine. The nucleus accumbens was first discovered in 1954 by two scientists when rats became addicted to pressing a lever that activated this part of the brain. The role of the nucleus accumbens and its connection to the amygdala and hippocampus[5] have great implications in the study of psychiatric disorders, substance abuse and addiction, obsessive compulsive disorder and Tourette’s Syndrome, and more studies are being conducted.

Dose-Response Relationship

The CDC-Kaiser study also found a “dose-response” relationship between ACEs and negative health and well-being outcomes across a person’s lifetime. A dose-response relationship is one where as the dose or intensity of the trigger increases, so does the intensity of the maladaptive behavior or response. For example, the more a person is exposed to abuse or neglect, the more severe the negative health outcomes will be.

Follow-Up Studies

Dr. Nadine Burke-Harris

One of the most notable cases of these results in action was the work of Dr. Nadine Burke-Harris, a pediatrician in San Francisco who was originally unaware of the CDC-Kaiser ACE Study. She noticed when she began working in a hospital in Bayview-Hunter’s Point, a low-income area of the city riddled with addiction and violence, that there was an abnormal number of children being referred to her for Attention Deficit Hyperactivity Disorder (ADHD). One of her colleagues made her aware of the ACE Study, which led her down a path of studying her patients’ exposure to trauma and how the brain and body were impacting their health. She subsequently started the San Francisco Center for Youth Wellness, where Dr. Burke-Harris made it routine to screen children for their ACE Score to better understand the risk factors of these youth across their lifetime.

See her TED Talk on How Childhood Trauma Affects Health Across a Lifetime:

Behavioral Risk Factor Surveillance System (BRFSS)

In 2009, the CDC began collecting annual ACE data through the Behavioral Risk Factor Surveillance System (BFRSS) from voluntary respondents telephonically. It is now the longest-running phone survey in the world. The BFRSS asks questions modified from the original ACE Study, from people across 32 states, using randomly dialed numbers. The data collected from the BRFSS are:

All ACE questions refer to the respondent’s first 18 years of life.

  • Abuse1
    • Emotional abuse: A parent or other adult in your home ever swore at you, insulted you, or put you down.
    • Physical abuse: A parent or other adult in your home ever hit, beat, kicked or physically hurt you.
    • Sexual abuse: An adult or person at least 5 years older ever touched you in a sexual way, or tried to make you touch their body in a sexual way, or attempted to have sex with you.
  • Household Challenges
    • Intimate partner violence:2 Parents or adults in home ever slapped, hit, kicked, punched or beat each other up.
    • Household substance abuse: A household member was a problem drinker or alcoholic or used street drugs or abused prescription medications.
    • Household mental illness: A household member was depressed or mentally ill or a household member attempted suicide.
    • Parental separation or divorce: Parents were ever separated or divorced.
    • Incarcerated household member: A household member went to prison.

The findings of the BFRSS are similar to that of the original CDC-Kaiser ACE Study:

  • More than two-thirds of the participants reported at least one adverse childhood experience
  • More than 1 in 5 reported exposure to 3 or more ACEs

Similarly, they also found a dose-response relationship with ACE Scores correlated to an increase in the following:

  • Myocardial infarction
  • Asthma
  • Mental distress
  • Depression
  • Smoking
  • Disability
  • Reported income
  • Unemployment
  • Lowered educational attainment
  • Coronary heart disease
  • Stroke
  • Diabetes

Treatment of Childhood Trauma

Understanding the role that adverse childhood experiences (ACEs) play in brain development and prevalence of addiction, mental illness and life-threatening diseases is a pivotal precursor to addressing these issues. Identifying and acknowledging the root of the issues is an important step in the recovery process, and only once a person can work through the lasting effects of exposure to Adverse Childhood Experiences can they truly recover. Because of the way these experiences embed themselves in our brain and body, the process of resolving them can take months or even years, but even the most complex trauma can be resolved with enough time and commitment.

Despite the acceptance of this research in the medical field, behavioral health professionals have been slower to integrate the identification and treatment of trauma into practice. It is important for someone who has been exposed to these adverse childhood experiences to find help at trauma-focused treatment programs like Roots Through Recovery, who utilize evidence-based approaches like Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing (SE), Mindfulness-Based Stress Reduction (MBSR), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and expressive approaches like music and sound therapy, trauma-focused yoga, and art therapy.

EMDR at Roots Through Recovery

Resources:

[1] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[2] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[3] Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[4] https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext

[5] https://www.eurekalert.org/pub_releases/2014-05/cafn-itp052114.php