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Researchers have recently begun to understand how a healthy brain develops, particularly in children. A child’s brain adapts to what it sees, hears, and feels. Proper structural growth depends on a loving, nurturing, and stimulating environment, but not all children grow up in such environments. Approximately 1 in 6 adults experiences 4 or more types of ACEs. Early trauma exposure significantly increases the risk for many psychiatric disorders in adulthood, including complex post-traumatic stress disorder (C-PTSD).

What is PTSD?

PTSD stands for post-traumatic stress disorder. The condition was officially recognized in 1980 as exposure to a brief but devastating event. It is usually diagnosed in people who have been exposed to a traumatic event, including:

What Is Complex PTSD?

Complex post-traumatic stress disorder (C-PTSD) was recognized in 1994 as an anxiety condition that involves exposure to a devastating event over an extended period. The main difference between PTSD and complex PTSD is the frequency of the trauma. While a single traumatic event causes PTSD, C-PTSD is caused by trauma that continues for months or even years. Unlike PTSD that can appear at any moment in life, C-PTSD is usually a result of childhood trauma due to:

C-PTSD includes all the core symptoms of PTSD, along with additional symptoms like:

These symptoms can have a significant impact on a person’s life, negatively disrupting their personal, professional, social, and educational life.

What are ACEs?

Some children grow up in a happy and supporting environment where positive relationships help them develop into healthy adults. Other children grow up in dysfunctional environments, affecting how they develop as adults and their future health conditions.

These stressful childhood events are called “adverse childhood experiences,” also known as ACEs.

The first adverse childhood experiences study was conducted at Kaiser Permanente from 1995 to 1997. It found that as the number of stressful events in childhood increase, so did the risk of experiencing a range of health conditions in adulthood.1

Such experiences include:

One study of more than 17,000 Americans found that ACEs affect more than 60% of adults and can contribute to negative adult physical and mental health outcomes.2


There are ten types of ACEs, categorized into three groups.3


Emotional abuse: a parent, caretaker, or another adult insulted, swore at, or severely scared the child.

Physical abuse: an adult pushed, grabbed, slapped, or hit the child.

Sexual abuse: an adult that was at least five years older than the child touched or sexually fondled the child.

Household Challenges

Substance abuse in the home: a household member was a drug user or alcoholic.

Mother treated with violence: a child’s mother was treated violently by the mother’s significant other.

Mental illness in the household: a household member was depressed or mentally ill.

Separation or divorce: the child’s parents were separated or divorced.

Incarcerated household member: a mother or father went to prison.


Physical neglect: a parent or caregiver did not provide the necessities for the child to survive and thrive (food, clothing, shelter, etc.).

Emotional neglect: a parent or caregiver ignored the child’s emotional needs (feeling important, loved, and close to your family).

The Connection Between ACEs and PTSD

When the body goes into fight or flight mode, hormones are released. These neurotransmitters trigger faster breathing and increased heartbeat, along with some other reactions needed to survive. The body goes back to normal once the danger passes.4

However, the bodies of children in constant danger of being attacked rarely go back to normal functioning. Being in a continuous fight or flight mode damages a child’s developing brain.5 The damage can result in a smaller than normal amygdala or hippocampus alongside other changes that can alter a person’s body, brain, nervous system, and entire life.

ACEs Impact on Adult PTSD

An adult whose amygdala was damaged by adverse childhood experiences will be incapable of recognizing danger. They will see danger everywhere and be in a state of constant alertness. This constant fear response fuels adult anxiety disorders, including PTSD.

One study examined the relationship between the types of ACEs exposures and mental health outcomes among reservation-based Native Americans. The study discovered 4 risk behavior/mental health outcomes: post-traumatic stress disorder (PTSD) symptoms, depression symptoms, poly-drug use, and suicide attempt.6

The Connection Between ACEs and C-PTSD

The effects of trauma multiply as the traumatic events continue, whether by repetition of the same event or accumulation of several separate ones.

For example, a child might be exposed to long-term stress caused by ongoing domestic violence or stress caused by domestic violence and parental drug abuse. There appears to be a dose-response relationship between ACEs and the mental outcome for the child.

ACES Impact on Adult C-PTSD

The effect of long-term toxic stress resulting from trauma may not be immediately visible. Symptoms sometimes appear when the child has already reached adulthood.7

Neglect is a common traumatic event that is almost always chronic for the child. It involves the child not having his or her basic needs met, such as food, shelter, or emotional security. Neglect often appears together with abuse and may be exceptionally severe later on into adulthood.

PTSD and Addiction

Endorphin withdrawal is the primary reason why people with PTSD turn to alcohol and drug use. When a person experiences a traumatic event, there is an increase in endorphins in the brain. Endorphin levels remain elevated during trauma to numb the emotional and physical pain of the trauma. After the traumatic event, the body produces fewer endorphins, one of the main chemicals responsible for happiness.

How Are They Linked?

People with PTSD may turn to alcohol or drugs in an attempt to increase their endorphin levels. Over time, they may rely on drugs to relieve their feelings of depression, anxiety, and irritability.

Chronic substance abuse can lead to the person developing a complicated dual diagnosis, or co-existence of a mental health disorder and an addictive disorder. According to the U.S. Department of Veteran Affairs, roughly three-quarters of people who have survived violent or abusive trauma report alcohol use disorders.

ACEs and Addiction

Children who are exposed to chronic stressful events can have disrupted neurodevelopment. As a result, the child’s cognitive functioning or ability to cope with negative emotions may be impaired. Over time, the child may resort to unhealthy coping mechanisms, such as substance abuse, to ease their symptoms.8

How Are They Linked?

ACEs, such as childhood abuse and parental substance abuse, are associated with a higher risk of mental or substance use disorder later in life. Each ACE increased the likelihood of early initiation into illicit drug use by 2 to 4-fold.9

Another study examined the relationship between childhood trauma, substance use, and PTSD. The study found high rates of lifetime dependence on various substances in highly traumatized individuals, including that:10

Individuals that Abused Alcohol
Individuals that Abused Cocaine
Individuals that Abused Heroin/Opiates
Individuals that Abused Marijuana

Addiction Treatment with a Dual Diagnosis of PTSD

PTSD can worsen substance use disorder symptoms and vice versa. For this reason, a dual diagnosis treatment is necessary.


Cognitive-behavioral therapy (CBT) is a critical part of dual diagnosis treatment. This therapy aims to change the way a person thinks and acts.

Trauma-focused CBT applies different psychological techniques so a patient accepts the traumatic event. For example, the patient may try to confront their traumatic event by thinking about their experience in detail. The therapist guides the patient through the experience and helps them cope with distress.

Ultimately, the patient will gain control of their fear by changing their negative thought patterns and replacing them with positive ones. The usual duration of trauma-focused CBT is around 60 to 90 minutes, and the patient attends 8 to 12 weekly sessions. The amount depends on the severity of the trauma.


Eye movement desensitization and reprocessing (EMDR) is a newer type of treatment that has proven effective in the treatment of PTSD. It involves following the movement of the therapist’s finger, making side to side movement, while recalling the traumatic experience.

The science behind the effectiveness of EMDR is that recalling distressing events is often less emotionally upsetting with diverted attention.

Inpatient Treatment

Inpatient treatment programs offer personalized treatment plans for patients to recover from addiction and co-occurring mental health disorders.

Patients battling with co-occurring disorders receive a dual diagnosis treatment plan designed to treat addiction and PTSD. They live on-site and follow a highly structured program that may include:

  • Group counseling
  • Family counseling
  • Medication-assisted treatment (MAT)
  • Experiential and adventure therapy
  • Trauma therapy
  • Aftercare support

Outpatient Treatment

Outpatient treatment is more suitable for patients suffering from a milder case of addiction and mental health disorder. It is also an appropriate level of care for patients in the early stages of dealing with their co-occurring disorders. These patient lives at home and come to a treatment center for therapy sessions or medication.


    1. https://www.cdc.gov/violenceprevention/aces/about.html
    2. https://www.aap.org/en-us/documents/ttb_aces_consequences.pdf
    3. https://www.cdc.gov/violenceprevention/aces/about.html#:~:text=Adverse%20Childhood%20Experiences%20(ACEs)%20are,%2C%20neglect%2C%20and%20household%20challenges
    4. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
    5. https://psychcentral.com/lib/adverse-childhood-experiences-post-traumatic-stress-disorder#1
    6. https://pubmed.ncbi.nlm.nih.gov/25893815/#:~:text=The%20cumulative%20impact%20of%20the,and%20depression%20symptoms%20(57%20%25)
    7. https://www.aap.org/en-us/documents/ttb_aces_consequences.pdf
    8. https://mnprc.org/wp-content/uploads/2019/01/aces-behavioral-health-problems.pdf
    9. https://mnprc.org/wp-content/uploads/2019/01/aces-behavioral-health-problems.pdf
    10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/

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