February 23, 2016
Re: Addiction is a disease
Dear Senator Merkley,
I applaud your efforts to address the problem of opioid addiction in a humane and compassionate manner. Clearly, intelligent, preventive approaches that address the various contributing factors for misuse of opioids are needed. One contributor which is often overlooked is childhood trauma. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), adverse childhood cxperiences are a significant risk factor for substance use disorders and can impact prevention efforts. As a resident of Portland's Old Town/Chinatown, I see daily the terrible effects of such early adversity, in the form of homelessness, addiction, and mental illness.
According to SAMHSA, Adverse Childhood Experiences (ACEs) include various forms of abuse and neglect, as well as household dysfunction such as witnessing domestic violence or having mentally ill or incarcerated family members, or caretakers who themselves have substance use disorders. ACEs are strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse. Vincent Felitti of Kaiser Permanente and Robert Anda of the Centers for Disease Control and Prevention conducted a landmark investigation into the lifelong health effects of adverse childhood experiences, beginning in 1995. A 2003 analysis of the ACE Study data by Shanta Dube of the CDC, along with Drs. Felitti, Anda, and others, estimated that "ACEs seem to account for one half to two thirds of serious problems with drug use", and that each ACE increased the likelihood of early initiation into illicit drug use 2- to 4-fold. The authors concluded that "progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences".
Similar trends have been shown for the relationship between ACEs and prescription drug use, early initiation of alcohol use, adult alcoholism, and cigarette smoking. More information on ACEs and substance use disorders can be downloaded from http://www.samhsa.gov/capt/sites/default/files/resources/aces-behavioral-health-problems.pdf. The CDC's briefing on the effects of childhood adversity can be found at http://stacks.cdc.gov/view/cdc/6978.