Trauma is the Gateway to Addiction

The first time I heard the gateway theory of drug use was in the 1960’s in California. My older brother was on the high school debate team and was practicing his rebuttal to the proposition that marijuana use leads to hard drug use. His rebuttal was that mother’s milk leads to drug use, since all the hard drug users had started out on mother’s milk.

There is still talk today about “gateway drugs” which is not surprising since drug use, especially hard drug use (meth, opiates) has sky rocketed in the last decades. What’s behind this surge in drug use?

Going to Pot


Politicians especially like to suggest the gateway theory that pot use leads to heroin or meth. The theory suggests that if we are tough on marijuana then use of harder drugs will decrease. That simply hasn’t happened. The war on drugs seems to have increased the use of drugs. We have seen meth use sweep across the country and opiates have now killed more people than the AIDS epidemic did.

Law enforcement likes the pot gateway theory because being able to bust people for pot possession makes their job easier. So we continue to fill jails with pot and other drug users. Why is punishment not helping? Punishment doesn’t work because trauma, not pot nor mother’s milk, is behind the explosion of drug use in America. That is what the ACE study has revealed.


ACE stands for Adverse Childhood Experiences. The ACE study is a large longitudinal study co-sponsored by the Center for Disease Control (CDC) and Kaiser Permanente. It asks about ten types of negative childhood experiences and then tracks health outcomes.

The ACE study began in California when 17,337 people enrolled in Kaiser Permanente’s (a large managed healthcare provider) volunteered to take the ACE quiz and have their health tracked. About half the volunteers were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and access to good health care through Kaiser Permanente.


The ACE questionnaire is simple. It asks about ten types of adverse experience that occurred before the age of 18 including physical neglect, emotional neglect, intimate partner violence, mother treated violently, substance misuse within household, household mental illness, parental separation or divorce, and incarcerated household member.

Each type of adverse experience is worth one point. You get one point whether the experience happened once or many times. As the ACE points add up so does the probability of drug addiction, suicide, social challenges, and a host of other health problems.

Life Sucks

The results are astounding, that’s why the CDC got involved as a co-sponsor of the study. 62% of the U.S. population have an ACE score of one or higher. According to the CDC, for every additional ACE score, the rate of number of prescription drugs increase six times, and early initiation into illicit drug use increases as well. Suicide risks increase. ACEs in any category increased the risk of attempted suicide by 2- to 5-times throughout a person’s lifespan. Women with high ACEs have more risky sexual behaviors, including early intercourse, having had 30 or more sexual partners, and perceiving themselves to be at risk for HIV/AIDS.

ACEs relate not only to alcohol abuse & illicit drug use, sexually transmitted diseases and suicide but also to:

  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Risk for intimate partner violence
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

ACE related research also shows that trauma predicts difficulty in regulating emotions and behavior, and that children with higher ACE scores struggle to learn and get along in school. Adverse experiences also tend to cluster, meaning that if you have one adverse experience you are likely to have another. Does this mean every alcohol or drug user has a high ACE score? No, there are alcoholics who have low ACE scores. There are also people with high ACE scores who function well. But such people are the exceptions and most with high ACEs can expect a life of poor health, drug abuse, and lower functioning.

It’s Not the Pot

We are still looking for the causes of addiction. We would still like an easy fix like keeping pot out of the hands of children. But the facts are that traumatic experiences, whether in childhood or adulthood, increase depression and anxiety. Trauma intensifies the need for self-soothing.  Trauma leads to the over-use of alcohol and other drugs.  We also need to understand that punishment for drugs increases the rate of addiction because punishment itself is traumatizing.

Next time you hear someone talk about gateway drugs, tell them about the ACE study, and tell them that trauma is behind most addiction. Tell politicians that reducing the stress on families will reduce trauma and drug use, and lower medical costs. Tell them it’s not pot (or mother’s milk) that leads to addiction, it ACEs. Show them the ACE study results. Help them connect the dots between trauma and addiction.