This blog is based on a conversation I had with my wife several years ago. As a social worker, she worked for an agency in Memphis, TN which had a contract with the city school system to perform assessments on children in grades K through 12 who were at risk of dropping out. Although she never told me names or specific details, she did say that virtually all of the children she interviewed had suffered some form of abuse. Furthermore, some of the children she interviewed were already strung out on either alcohol or some illicit drug.
Evidence suggests that there is a correlation between childhood trauma, or adverse childhood events (ACEs) and the increased likelihood of using maladaptive coping strategies, leading alcoholism and drug abuse.
Sebalo et. al. (2023) performed a meta-analysis of 88 articles, most of which did show results that ACEs led to negative outcomes, particularly alcohol and drug use. The following table is adapted from Table 2 of their article:
| Result | Correlation with ACEs | Number of studies |
| Psychological distress mediated the effect of ACEs on alcohol use and dependence | Positive | 1 |
| Alcohol use alone | Positive | 18 |
| Alcohol use by females, not males | Positive | 1 |
| Drug use alone | Positive | 16 |
| Cannabis alone | Positive | 5 |
| Alcohol and cannabis | Positive | 6 |
| Alcohol and drugs | Positive | 15 |
| Alcohol and cannabis | Negative, suggesting resilience | 1 |
| Alcohol alone | Negative, suggesting resilience | 1 |
| Drugs | None | 1 |
| Opioids and stimulants but not alcohol or cannabis | Positive | 1 |
| Alcohol, cannabis, hard drugs | Positive | 1 |
Perhaps chronic stimulation of the hypothalamus-pituitary gland-adrenal cortex (HPA) axis is the link between ACEs and negative outcomes.
The HPA axis
ShelleyAdams, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons
Imagine the following scenario, occurring many years ago, when our ancestors lived in small bands in the African savannah:
We are with our extended family, sitting peacefully, eating your meal, when suddenly all of you see a very large, hungry tiger approaching your village. All of you become frightened, and BEFORE you make the decision to stand your ground and fight the tiger or flee, your HPA axis will become activated, leading to what is called the “fight or flight” response:
- The hypothalamus will secrete Corticotrophin Releasing Hormone (CRH). The target of this hormone is the nearby anterior pituitary gland;
- When stimulated by CRH, the anterior pituitary gland will produce and release adrenocorticotropic hormone, or ACTH into the bloodstream. The target of ACTH is the cortex of the adrenal glands, which sit atop each of the kidneys;
- The cortex of the adrenal glands will secrete two groups of hormones, those being the mineralocorticoids and the glucocorticoids. The mineralocorticoids, mostly aldosterone, regulate salt and water metabolism in the body, whereas the glucocorticoids, mostly cortisol, will suppress the inflammatory response and increase the release of glucose into the blood stream. The physiological changes induced by mineralocorticoids and glucocorticoids prepare the body to expend the energy required for either “flight or flight”, as well as suppress responses to injury;
- By traveling the bloodstream to the hypothalamus, cortisol suppresses the continued release of Corticotrophin Releasing Hormone, thus allowing the body to return to a relaxed state after the emergency or stressful stimulus has passed.
In this scenario, the stressful situation is both relatively short-lived and resolved.
What happens, however, if the life situation continues to be chronically stressful, as might be expected with children experiencing physical, emotional, or sexual abuse? One of the consequences is the down-regulation of cortisol receptors in the hypothalamus, so that the increased concentration of cortisol in the blood, which would normally suppress the continued activation of the HPA axis, fails to “turn it off”, so that the individual remains in a constantly hypervigilant, stressed state.
As indicated above, a significant number of studies have shown no increased risk of alcoholism or drug misuse following a history of adverse childhood events. Therefore, whether hyperstimulation of the HPA axis induces or reduces the risk of alcoholism or drug misuse depends on other factors, such as genetic predisposition of the individual, the type of childhood events, and the timing of these adverse childhood events.
Giardano, A.L. 2021. Why Trauma Can Lead to Addiction. Psychology Today.
Sebao, I.; Konigova, M.P.; Vnukova, M.S.; Anders, M. Ptacek, R. 2023. The Association of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review. Substance Abuse: Research and Treatment 17:1-21, DOI: 10.1177/11782218231193914.
Addictions and Recovery 