Trauma Is the Gateway Drug – an Ace’s Informed Approach to Substance Abuse Treatment

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Morning Zen Guest Blog Post ~ Wayne Munchel ~

“We treat people’s solutions as problems.” Vincent Felitti MD, the eminent author of the original ACE’s (Adverse Childhood Experiences) study, often makes this point when discussing how we focus on eliminating people’s desperate means of coping, without recognizing their adaptive functions. When addressing substance abuse (the most common method of tolerating overwhelming fear and pain) do we commit the same error of attempting to control the “solution” while largely ignoring the underlying core problems associated with traumatic exposures? For many people with struggling with addictions, substance abuse represents their survival.

The linkage between ACE’s and trauma and substance abuse disorders (SUD’s) is compelling. In his paper, Origins of Addiction, Felitti reports that people who experience 4 or more ACE’s are 500% more likely to abuse alcohol. People who report five ACE’s or more are 7 to 10 times more likely to report illicit drug abuse. A jaw-dropping data point indicates that individuals who survive 6 or more ACE’s are 46 times more likely to be IV drug abusers than people who report no ACE’s. Trauma truly is the “gateway drug” to addictions.

Kanwarpal Dhaliwal and the youth at RYSE (Richmond Youth Services) have amplified the ACE’s pyramid to include the toxic impacts of social conditions and local contexts such as poverty, racism, and historical trauma. This expanded view helps us recognize that it’s not just what has happened to you, but what environmental stressors and social conditions you encounter. As attention has turned to the “opioid crisis”, it would seem to be no coincidence that the communities most affected are beset by high rates of unemployment, poverty, and social isolation. In contrast to the reductive medical model, the ACE’s/trauma-informed approach encompasses neighborhoods as much as neurons, zip codes more than genetic codes.

Some substance abuse programs and mental health agencies have begun integrating the ACE’s questionnaire into their initial assessments. What might be the potential impacts of incorporating enhanced ACE’s informed perspectives into treatment?

Utilizing this broader, trauma-informed lens often seems at odds with the dominant medical model approach to addiction as a disease. Framing problems such as addiction as solely problems within an individual’s disordered neural circuitry are favored. We prefer our solutions to be fast-acting, cheap and to avoid discomforting questions about social conditions. In his book, In the Realm of Hungry Ghosts, Gabor Mate makes the following observation; “We keep trying to change people’s behaviors without a full understanding of how and why those behaviors arise”. A trauma-informed approach to substance abuse and dependence brings the potential of deep healing, not just for individuals but our communities as well.   

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munchelWayne Munchel, LCSW is a leader in mental health programs designed for transition age youth. He was also a founding staff member of The Village, an innovative recovery program located in Long Beach, CA. Mr. Munchel provides training and consultation for services to young people, including trauma informed care and supported employment. 


  1. Nina Jurvanen's avatar
    Nina Jurvanen
    | Permalink
    For people with dissociative identity disorder the experienced traumas do not necessarily show up in the ACE questionnare, because DID develops before the age 5.
  2. Wayne Munchel's avatar
    Wayne Munchel
    | Permalink
    Hi Marcus - you can access ACE's questionnaire at;
    Best wishes
  3. marcus goff jones,'s avatar
    marcus goff jones,
    | Permalink
    How can I access a copy of the ACE Questionnaire. I provide outpatient counseling for members of the LGBT community, including older adults with addiction problems. Almost all of them have experienced tremendous trauma having grown up in a culture where every social institution; their families, schools, government, etc. told them they are severely flawed. Most have lived their lives in the shadows in constant fear of others discovering their sexual orientation. The fear and the shame led them to abuse substances. I know this well, because as a gay male, I to lived with this fear. However, I was able to overcome this struggle with positive supportive friendship and the gift of a 51 year healthy relationship with another male who I love and highly respect.
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