In Secondhand Drinking, Alcohol Misuse, Prevention Resources, ACEs | Trauma Informed

Awareness about the impacts of Adverse Childhood Experiences (ACEs) – often referred to as childhood trauma – on a person’s health is gaining traction. ACEs and their impacts were first identified in the ground breaking CDC-Kaiser Permanent Adverse Childhood Experiences (ACE) Study, “one of the largest investigations of childhood abuse and neglect and later-life health and well-being.”

And why talk about ACEs here? Because of their connection to a person developing a drinking (or other drug use) problem and/or a person’s exposure to the negative impacts associated with secondhand drinking, two possible outcomes identified in the ACEs Study.

About the Adverse Childhood Experiences | ACEs Study

The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors. The CDC continues ongoing surveillance of ACEs by assessing the medical status of the study participants via periodic updates of morbidity and mortality data.

According to “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study,” Felitti, VJ, et al., American Journal of Preventative Medicine, May 1998;14(4):245-58:

Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. 

More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. The number of categories of adverse childhood exposures showed a graded relationship (meaning the more ACEs, the greater the negative health impacts) to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.

According to the CDC’s About the CDC-Kaiser ACE Study website > Major Findings:

The Study showed that as the number of ACEs increases so does the risk for the following*:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

*This list is not exhaustive. For more outcomes see selected journal publications.

What Adverse Childhood Experiences | ACEs Do to Worker Performance

The primary physical and emotional health impacts of ACEs (often referred to as childhood trauma) on an individual are related to toxic stress. These can include: depression, anxiety, headaches, chronic shoulder/muscle/back pain, migraines, stomach disorders, sleep problems, skin conditions, developing a substance misuse disorder, and a host of other physical and emotional ailments.

As for the workplace impacts — findings reported in “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance,” Anda, R.F., et al., The Permanent Journal, 8(1), 30-38, showed:

Chronic back pain in the workforce is estimated to cost US businesses as much as $28 billion per year;5 depression and its work-related outcomes—absenteeism, reduced productivity, and medical expenses—are estimated to cost as much as $44 billion per year;6 and chemical dependency is estimated to cost $246 billion per year.7 These massive losses occur despite existence of workplace safety programs and the most expensive system of medical care in the world.8

To be clear – the above is not a direct connection to ACEs-related toxic stress, however many of the above are manifestations of ACEs-related kinds of toxic stress. The following illustrates how this connection works:

©2004 The Permanente Journal Winter; 8(1):30-38


Additionally, according to “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance,” Anda, R.F., et al., The Permanent Journal, 8(1), 30-38,

Our findings suggest that employers and HMOs have both the need and the opportunity to work together against the long-term effects of childhood abuse and household dysfunction. Exposure to such adverse circumstances is likely to lead to massive financial expenditures for health care as well as to economic losses attributable to poor work performance. Adverse childhood experiences are a source of many problems—somatic manifestations of health and social problems—treated by occupational medicine specialists. The traditional search for organic causes of illness and injury among workers is expensive for employers, who must pay higher insurance premiums for their workers. In addition, this traditional process is expensive for health care organizations, because much of such medical care is ineffective or inefficient: diagnostic procedures are used without sufficient understanding of the common psychosocial origins of symptoms, multiple office visits and specialty referrals are used in repeated efforts to resolve the same problem, and drugs are prescribed to little or no effect. Most important, workers suffer when their health problems and health-related social problems remain unresolved. If even a small fraction of the economic and human resources currently spent on these conventional approaches was used to identify and address the root origins of these problems in the workforce, we could reasonably expect to find more effective ways to improve worker health, well-being, and performance [emphasis added].

What Employers Can Do to Raise Employee Awareness of ACEs

I suggest you make the following article available, Got Your ACE Score? It contains information on the ACE Study, the ACE Questionnaire (so an employee can determine their ACE score), and links to key information.

Raising awareness about Adverse Childhood Experiences (ACEs) – often referred to as childhood trauma – and the ACEs Study in the workplace offers companies and agencies an incredible three-fold opportunity to:

  1. help employees understand the root origins of their physical and emotional health concerns (ACEs) in general and as they relate to their alcohol misuse and/or secondhand drinking-related physical and emotional health impacts (if applicable),
  2. reduce the ACEs-related impacts on worker performance and thus improve the workplace environment and company/agency bottom line, and
  3. help a company or agency become trauma informed — meaning to understand how trauma (ACEs, childhood trauma) affects a person, an effect that can be reversed once understood and treated.
Lisa Frederiksen
Lisa Frederiksen has a 39-year career in executive management, consulting, speaking, training and writing and is the founder of and SHD Prevention. She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. Lisa is the author of hundreds of articles and eleven books, including, "Addiction Recovery: What Helps, What Doesn't," "Secondhand Drinking: The Phenomenon That Affects Millions," and “If You Loved Me, You’d Stop!” She is a national keynote speaker with over 25 years speaking experience, consultant, trainer, and frequent guest on radio, TV, and Internet radio shows.
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