The ACE Score Study: How 10 questions Changed the Way we see Trauma
Mental health topics have exploded into the mainstream in recent years, with trauma being one of the most emphasized topics, and for good reason. But how did so much emphasis get placed on prior negative experiences? The answer is a ten-question assessment being answered by over 9,500 adults in 1998. This assessment measured adverse childhood events, which include divorce, physical/verbal abuse, parents in the household going to prison, being in active addiction, or suffering from a severe mental illness. If you want to see where you would end up on the ACE score, you can take it here: https://www.naadac.org/assets/2416/michael_bricker_acesassessment_ac16_ho.pdf.
The scoring is simple, 1-10, and in this post, we will explore the correlations between ACE scores and various health outcomes. Before going into some of the negative consequences, I want to emphasize that having a high ACE score and receiving empirically supported trauma therapy improves these outcomes. Often, when a client of mine sees their high score and hears the scary outcomes, they feel dejected, which is not the goal of this assessment. The goal is to arm ourselves with a deeper understanding of ourselves so that we can pick the best path forward. If we know what these experiences predispose us to, we can correct them. So do not panic; you can continuously improve your situation if motivated.
We start to see the worst outcomes for individuals with a score of 4 or above. On the physical health side of things, individuals with a high ACE score were 1.6 times more likely to contract STIs, obesity, and physical inactivity. We also see much higher rates of heart disease and liver disease, as well as being more prone to injury. Therapy is a powerful tool for examining the behaviors that result from these adverse experiences that have a maladaptive influence on our behaviors. When a person is experiencing severe psychological pain, they become far more likely to lean on unhealthy coping strategies that cause chronic illnesses.
Now, onto the mental health data. Individuals with an ACE score of 4 or higher had a 4-12-fold increase in depression, substance use disorders, and suicide attempts. The correlation to addiction is what led to my specialization in trauma. My day job is running an intensive outpatient program for chemical dependency, which is just a step below hospitalization. Trauma is ubiquitous at that level of care. So, it is imperative to treat that trauma concurrently with their addiction. It has been amazing to see how much easier an individual’s life gets when the burden of their past gets lighter with quality therapy.
When this study was published, the push for trauma-informed care started as the realization of how common it was for people to have had these experiences and how influential these experiences could be for people. About twelve percent of the participants scored over a four on the assessment, which set the public health officials’ alarms off. This data was a call to action and created an outstanding initiative. However, there is still much work to do regarding education and prevention. It is a near-weekly occurrence that when I ask a patient if they have experienced a traumatic event, they say “no, none,” and then they score a 4+ on the ACE score. Chaos starts to feel normal if it is what we experience daily growing up.
EMDR is how I solve this problem; the results have been excellent—dramatic shifts in self-esteem, reductions in depression/anxiety, and fewer sleep disturbances. Clients can manage their emotions without the compulsive behaviors that compound their suffering. The impact of adverse childhood events on mental health is profound, and knowing that gives us unique tools not only for preventing trauma responses but also for eliminating them when they develop. If you have symptoms that have been deemed “treatment resistant” but have not undergone trauma-informed treatment before, you owe it to yourself to give it a shot. The results that I see are overwhelmingly positive.