Research shows that there is a strong, lifelong correlation between adverse childhood experiences (ACEs) – including abuse and neglect – and a broad range of health issues, including substance misuse. In a policy brief, the Campaign for Trauma-Informed Policy and Practice reports a recent study that finds “over 80% of the patients seeking treatment for opioid addiction had at least one form of childhood trauma, with almost two-thirds reporting having witnessed violence in childhood.”
The development of at least one play to address the incidence of ACEs, and their impact on the development of substance use disorders, is therefore a very important component of an effective prevention strategy. The goal is to better-understand, halt and/or reduce the extent to which ACEs influence the development of or lead to substance use disorders. (We want to acknowledge that addressing ACEs themselves will require a long-term, multidisciplinary approach that focuses on childhood, since that is when the trauma usually occurs.)
Example: “Seeking Safety” addresses trauma-related problems and substance use at the same time. It is the most evidence-based model for people with both trauma and addiction.
Goals and Objectives
The development of one or more plays that address the impact of ACEs on the development of substance use disorders is a very important component of a community strategy for prevention. The goal is to halt or reduce the extent to which ACEs leads to substance use disorder or that influences the development of such disorders. It could be argued that policies and programs directly aimed at reducing the prevalence of ACEs is in itself an aspect of prevention strategies in as much as we have seen the high correlation with substance use disorder.
Objectives for each such initiative under the play could be structured to reduce the propensity for substance use disorder by a specified percentage within a specified time period for a particular set (cohort) of people having a common ACEs scoring.
Theory of Change
A significant number of studies have strongly concluded that reducing exposure to adverse childhood experiences will reduce the likelihood of a person developing a substance use disorder. Well-documented programs that can have this effect include: home visiting, parenting assistance, parent/child interaction therapy and others that focus on the reduction of ACEs. 39 The theory of change is that by offering evidentiary-based programs that reduce the number of ACEs, the likelihood of fostering the development of a substance use disorder is lessened.
Another relevant theory applies to the design of treatment programs for current addicts. By improving the resilience of those having an experience leading to a substance use disorder, the perpetuation of this condition can be reduced or eliminated.