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How do Adverse Childhood Experiences effect my patients?

posted May 7, 2017, 6:19 AM by Thomas Stern
Poor socioeconomic status is blamed for a lot of healthcare disparities.  Poor people are more likely to be sick.  There are many theories as to why this happens.  Poverty is cited as a risk factor for mental health issues, substance abuse, and obesity.  You fix poverty and the rest of the problems will follow.  Seems logical.  What is painfully obvious is that throwing money at the problem does not work. Poverty is certainly not an absolute condemnation for further poverty.  There are so many great American stories of people starting off poor and becoming billionaires. Many of them site their childhood poverty as an inspiration for hard work. Why does poverty impair some and inspire others?

My personal belief has been that the amount of money a family has in the bank does not predict the outcome of a persons life.  I am certain part of this belief comes from the fact that I was raised by a behavioral pediatrician who was heavily influenced by a mentor who was trained by Anna Freud. I had discussions about Freud's theories with my dad as a teenager. Freud believes the unconscious mind influences behavior. He also recognized that early childhood trauma influences adult behavior.  Because of this early influence I believe that if children are neurologically normal and you keep them safe, provide basic needs (shelter, food, clothing) and an emotional connection they will become well adjusted adults. I don't think it matters how much money you have in your bank account. My residency consisted of training in internal medicine and pediatrics.  These concepts were never discussed in my residency.  They were never discussed in my pulmonary or sleep training.  I considered them  opinions.

For the first time this week I learned of the Adverse Childhood Experiences Study  .  This study was first published in 1998 and proves that adverse childhood events such as abuse, neglect or mental illness in the home when you are a child dramatically increase the risk for chronic health problems as an adult including smoking, sleep disturbances, obesity and substance abuse. You can calculate an ACE score here. Reading this study triggered a mix of emotions in me.  It was satisfying to learn my own conclusions were accurate.  I felt even more thankful for growing up with my parents.  I felt hopeful that I may be able to have more of an impact on my patients who are not able to quit smoking or have chronic insomnia.  I am absolutely terrified because there are very few medical providers who are adequately trained to deal with these issues.  I am heartbroken to think that this many people in our society suffered as children. I feel guilty because I have blamed people with some of these health conditions for their predicament because I did not know how to help them.

I strongly encourage everyone to read the article on addictiion on this web page. The physician who is interviewed suggests addiction shouldn’t be called “addiction”. It should be called “ritualized compulsive comfort-seeking” because these people are seeking comfort to help them deal from their past experiences.  He is not referring just to illegal drugs.  He treats all addictions including addictions to drugs, food, gambling and sex but most of his patients are addicted to drugs.  Over 90% of his patients addicted to opioids have an ACE score of 3 or higher.  Over 90% of patients in an eating disorders clinic in which he works suffered sexual trauma.  How differently would our society treat drug addiction if we approached the patients as terrified victims rather than blame them for what they do?


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