Adverse Childhood Experiences Study

ACE Pyramid ImageThe Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego[i].

More than 17,000 Health Maintenance Organization (HMO) members who underwent a comprehensive physical examination were also asked to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. The initial phase of the ACE Study was conducted at Kaiser Permanente from 1995 to 1997. More than 17,000 participants completed a standardized physical examination and an ACE survey. No further participants will be enrolled, but the study group is tracking the medical status of the baseline participants.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness, including addiction, leading to poor quality of life,  as well as death. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery.

Compared to persons with no adverse childhood experiences, the risk of heavy drinking, self-reported alcoholism, and marrying an alcoholic were increased twofold to fourfold by the presence of multiple adverse childhood experiences, regardless of parental alcoholism. Subsequent reviews of the study found that the prevention of adverse childhood experiences and treatment of persons affected by adverse childhood experiences may reduce the occurrence of adult alcohol problems[ii]. Adverse childhood experiences seem to account for one-half to two-thirds of serious problems with drug misuse by adolescents[iii].

Children in alcoholic households are more likely to have Adverse Childhood Experiences. The risk of alcoholism and depression in adulthood increases as the number of reported adverse experiences increases. Depression among adult children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having had Adverse Childhood Experiences in a home with alcohol-abusing parents[iv].

Clearly, children that have experienced emotional, physical or sexual abuse in their early childhood are at a severe risk for addiction. To show you how small an amount of abuse is needed to tip the scales of raising a healthy child or an at risk child, read the last series of questions from the ACE Questionnaire, which are highly revealing questions.

  1. Did a parent or other adult in the household swear at you, insult you, put you down or humiliate you?
  2. Did a parent or other adult in the household push, grab, slap, or throw something at you?
  3. Did you often or very often feel that no one in your family looked out for each other, no one felt close to or supported each other?[v]

This survey gives you an idea how delicate and impressionable a young child is.

For a sample of the ACE Questionnaire, click on this link:


References used in this blog:

[i] [i]The Relationship of Adult Health Status to Childhood Abuse and Household Dysfunction“, published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.


[ii] Addict Behav. 2002 Sep-Oct;27(5):713-25.

Adverse childhood experiences and personal alcohol abuse as an adult.

Dube SR1, Anda RF, Felitti VJ, Edwards VJ, Croft JB.

[iii] Pediatrics. 2003 Mar;111(3):564-72.

Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study.

Dube SR1, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF.

[iv] Psychiatr Serv. 2002 Aug;53(8):1001-9.

Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression.

Anda RF1, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, Williamson DF.

[v] Center for Disease Control web site

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