Questions:

1. Please list the 10 Adverse Childhood events that were identified in the ACE Study.

2. An ACES score increases the likelihood of a person having three serious drug problems. Please identify these problems.

3. Please supply the three missing items, or blanks in this sentence.

"Each of the 10 categories of ACEs was associated with a _____________ increase in the likelihood of illicit drug use by age ________ and increased the risk of use into __________________".

4. The article concludes "Because ACEs seem to account for one half to two thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of stressful and disturbing childhood experiences ......."

Now write about a real or potential program or intervention that would help a single mother with a toddler reduce the stresses that would result in adverse childhood events for the child.

Explain how this program or intervention would help in a minimum of 100 words.

5. The article concludes "Because ACEs seem to account for one half to two thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of stressful and disturbing childhood experiences ......."

Now write about a real or potential program or intervention that would help a grade school child when there is a substance abusing partner in the home. The intervention would reduce the stresses that would result in adverse childhood events for the child.

Explain how this program intervention would help in a minimum of 100 words.

6. The article concludes "Because ACEs seem to account for one half to two thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of stressful and disturbing childhood experiences ......."

Now write about a real or potential program or intervention that would help an adolescent child in an abusive family who is having difficulty at school. The intervention would reduce the stresses that could result in drug or alcohol use.

Explain how this program intervention would help in a minimum of 100 words.

READ BEFORE ANSWERING:

Excerpts for ADC100-300 Midterm. Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study Shanta R. Dube, MPH*; Vincent J. Felitti, MD; Maxia Dong, MD, PhD*; Daniel P. Chapman, PhD*; Wayne H. Giles, MD*; and Robert F. Anda, MD

This study examined the association between 10 categories of adverse childhood experiences (ACEs): abuse (physical, emotional, or sexual); neglect (physical or emotional); and growing up with household substance abuse, criminality of household members, mental illness among household members, and parental discord and illicit drug use. We then use a cumulative stressor model to examine the relationship between the number of ACEs (ACE score) and the initiation of illicit drug use by three age categories. We assess the relationships between the ACE score and lifetime use of illicit drugs for four successive birth cohorts dating back to 1900, problems with illicit drug use, addiction to illicit drugs, and parental drug use. Finally, we estimate the proportion of each of these three serious problems of drug abuse that are attributable to adverse childhood experiences

RESULTS Characteristics of the Study Population

The study population included 4665 (54%) women and 3948 (46%) men. The mean age ( SD) was 55 years ( 15.5 years) for women and 57 years ( 14.5 years) for men. Seventy-three percent of women and 75% of men were white; 32% of women and 42% of men were college graduates, and another 42% of women and 39% of men had some college education. Only 8% of women and 7% of men had not graduated from high school. The prevalence of each specific ACE was higher for women than men except for physical abuse and physical neglect (Table 1). Sixty-seven percent of re- spondents reported at least 1 of the 10 ACEs; 42% reported 2 or more. Interrelatedness of ACEs When a respondent was exposed to 1 of the ACEs, the probability of exposure to any other category of ACE increased substantially (Table 2). The median probability of exposure to any additional category given exposure to the first was 86.5%; for any 2 additional categories, the median probability was 69.5% (Table 2). . These results suggest that for every increase in the number of ACEs, the likelihood of initiation of illicit drug during early adolescence, mid-adolescence, adulthood, or at any age (lifetime) increases by 40%, 10%, 10%, and 30%, respectively. The ACE Score and Three Serious Drug Use Problems The ACE score increased the likelihood of ever having drug problems, ever being addicted to drugs, and parenteral drug use in a dose-response manner . Thus, there was a 30% to 40% increase in risk for each of the illicit drug problems as the ACE score increased. DISCUSSION Each of the 10 categories of ACEs was associated with a 2- to 4-fold increase in the likelihood of illicit drug use by age 14 and increased the risk of use into adulthood. Because these ACEs rarely occur in iso- lation and tend to be highly interrelated, 30,31,45 We examined their cumulative effect on illicit drug use. We found graded relationships between the ACE score and initiation for our 3 categories of age at initiation; this graded relationship was strongest for initiation by age 14. We also found a strong graded relationship between ACEs and reported problems with drugs, addiction to drugs, and parenteral drug 30% to 40% increase in risk for each of the illicit drug problems as the ACE score increased. ACEs were common with close to two thirds re- porting 1 or more. The number of ACEs to which a

person is exposed had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of ACEs transcends secular changes such as increased availability and type of drugs used, social attitudes toward drugs, and recent massive expenditures and public infor- mation campaigns to prevent drug use. 50,64 Because ACEs seem to account for one half to two thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will neces- sitate serious attention to these types of stressful and disturbing childhood experiences by pediatric prac- tice. Pediatricians play a prominent role as family health advisors during childhood and adolescence development. Pediatricians who identify drug use among their patients must take the time to screen the family for potential forms of abuse, and household dysfunction. As such, recommendations set by the American Academy of Pediatrics, which emphasize the role of the pediatrician in family support pro- grams, will likely facilitate in the evolving efforts to prevent and treat children who have experienced growing up in stressful household environments, and subsequently may reduce the occurrence of illicit drug use and serious drug use problems. 65 Continued medical education programs that provide pediatricians with the skills to assess psychosocial issues in pediatric care will also contribute to these evolv- ing effort