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What Connects the Dots? Impact of ACEs, CSEC and Trauma on Teen Alcohol and Drug Abuse

January 17, 2017 Presentation for Communities That Care of Greater Downingtown

Downingtown Area School District, 570 Trestle Bridge Rd., Downingtown PA Presenter: Clara Whaley Perkins, Ph.D., Life After Trauma Organization (LATO), Founder

The purpose of this paper is to increase awareness about the relationship between Adverse Childhood Experiences (ACEs), Commercial Sexual Exploitation of Children (CSEC), Trauma, and teenage alcohol and drug abuse. The issue of how experimentation differs from abuse or addiction will be touched on within this context.

What Connects the Dots?

The Downingtown Area School District 2015 Pennsylvania Youth Survey (1) presents a comprehensive view of the overall risk factors for a young person becoming involved in drug use, delinquency, dropping out of school and/or violence. It identifies the situations that promote high risk and includes:

Environmental factors such as community norms favorable toward drug use, poor family management, or a friend’s use of drugs,

Behavioral factors such as academic failure, rebelliousness, gang involvement, or interacting with antisocial peers, and

Attitudinal factors such as attitudes favorable toward antisocial behavior and drug use.

Suggested in this analysis are interpersonal factors. That they are not spelled out is not surprising, given the difficulty involved in quantifying complex interactions between human beings. Nevertheless, it is the interpersonal factors that lie below the surface of the environmental, behavioral, and attitudinal factors. These factors are responsible for driving up the risk factors, which impact teens’ use of drugs, delinquency, dropping out of school, and/or violence.

What Connects the Dots?

The line that separates those teens that are experimenting with substances, from those who become substance abusers, is often seen in retrospect.

“Just a phase I was going through,” is how some adults talk about their excessive use as teens. It’s a perspective that these adults find easy to arrive at, if they are currently content to have an occasional drink or two. Suffice it to say that their number of ACEs were low, and that their lives today are manageable.

For others, the relationship between a high number of ACEs, the trauma that comes with it, and vulnerability to addiction is clear. For some other people, CSEC and complex trauma is just a stone’s throw away. This trajectory is so predictable, that mental health workers who work with teens who are attempting to survive and recover from commercial sex exploitation automatically look for their ACEs, trauma and addiction.

The research that has informed our understanding of the problems associated with Adverse Childhood Experiences (ACEs) was a decade-long ongoing collaboration led by Vincent J. Felitti, M.D. and Robert F. Anda, M.D. MS. (2) It is the largest scientific research project of its kind to date. Today we understand that ACEs cut across all socio-economic strata.

ACEs include:

Emotional Abuse

Physical Abuse

Sexual Abuse

Emotional/Physical Neglect

Domestic Violence – Battered Mother

Single Parent Homes – Due to Separation /Divorce/Death

Substance Abuse – One or Both Parents

Incarcerated Parent or parents

Parent or parents Suffering From Mental Illness

Parent or parents Suffering From Chronic Illness

The Philadelphia Expanded ACE Study (3) conducted a follow-up study and created five new expanded ACEs that are “Community Level” indicators:

Experiencing discrimination or racism

Witnessing violence

Living in an unsafe neighborhood

Living in foster care

Experiencing bullying

The response to ACEs is stress. The potential is strong for a series of ACEs to culminate in trauma.

Trauma is not an event itself; it is a response to a stressful experience in which a person’s ability to cope is dramatically undermined.

The prevalence of trauma is evident, in that more than 5,000,000 U.S. children experience extreme traumatic events. More than 2,000,000 per year witness domestic or community violence (The Child Trauma Academy) (4)

Trauma can be a single event, a connected series of events, or chronic lasting stress.

Trauma is under-reported and under-diagnosed.

The Center For The Developing Child At Harvard (5) has found that the environment physically changes the brain.

Trauma affects the pre-frontal cortex of the developing brain. The pre-frontal cortex is responsible for planning, organizing, regulating attention, decision making, moderating behavior, personality expression, motivation and mood. Or, to put it another way, the effect of trauma on a child is that they find it hard to concentrate and pay attention. They have trouble learning new information because the accumulative effect of the ACEs and stress is taking a toll on their brain. They are getting in trouble. They are not doing well in school. There are problems at home. They begin to lose interest in going to school, and/or begin to look for a way out of their situation. They are prone to experiment with alcohol and drugs, because it is socially acceptable. At first, they do it because it’s fun and feels good, but later they come to realize that it numbs them to the pain of their lives. These children are often identified as “at risk.”

There is another scenario that many people are not aware of. On January 8, 2017, the New York Times (6) published an article titled: “OPIOID TIDE From Coast to Coast.” It described a young woman, age 24, who is struggling with addiction. “…Curled up on the couch in her mother’s living room in this well-to-do suburb north of Boston, [she] reflected on her life: her low self-esteem despite model-worthy good looks; her many lies to her family; how she had pawned her mother’s jewelry and had sex with strange men for money to pay for drugs…tears spilled from her eyes. She wiped them with the cuff of her sweater, which covered track marks and a tattoo that said “freedom”- her goal, to be unshackled from the prison of addiction. [She] had been a popular honors student. But she developed anorexia. Alcohol was next. By 21, she was hooked on heroin...In 2015, she was arrested on charges of prostitution…”

What Connects the Dots?

LATO’s docudrama, “In Our Backyard: Protecting Our Children from Human Trafficking,” (7) was co-produced with The Philadelphia High School for the Creative and Performing Arts. This film was made because teens are more apt to listen to a message when they hear it from other teens. It is the centerpiece of our Teen Prevention Project. Our hope is that this film will help prevent teens from being lured into commercial sexual exploitation, because recovery from trauma created by CSEC is extraordinarily difficult. It takes years, and some never recover their lives. Prevention of CSEC and the trauma it causes is imperative. Often, kids did not abuse drugs until they became trapped in CSEC. At LATO, we are striving to provide an opportunity for every child between the ages of 12-17, and every parent, teacher, counselor, and youth worker, to understand how CSEC can cause trauma and addiction, and to see our film.

What Connects the Dots?

Grooming for CSEC begins early in a child’s life with unresolved ACEs. The most frequent age of entry into the commercial sex industry in the U.S. is between 12-15 years old.

At the International Trauma Conference in Boston in 2014, a representative of the National Child Traumatic Stress Network reported that 50% of victims meet their predators over the internet. That same year, The PEW Research Center (8) reported that 92% of teens go online daily, and 24% of teens go online “almost constantly.”

At LATO’s 2nd Annual Conference in 2016, Michelle Morgan, an Assistant U.S. Attorney who prosecutes individuals charged with human trafficking in the State of Pennsylvania, spoke about sex trafficking. A participant in the audience asked, “What percentage of victims of sex trafficking are snatched off the street?”

Ms. Morgan’s response was: “I have not prosecuted one,” thus dispelling a common assumption about how girls and boys are coerced into sex trafficking.

In her comments, she stated:

  1. Pimps easily lure their victims, either in person at places frequented by teenagers or over the Internet, through promises of love and money.

  2. Teenaged girls are especially vulnerable to this message, and the grooming period is typically extremely short.

  3. It is easy to start a pimping business. It requires very little working capital, is very lucrative, is safer than drug dealing, and allows pimps to utilize a constantly renewable resource: the body of a teenager.

Delivering our program to teens, their caregivers, counselors, and the public in general, though our Teen Prevention Project, and at our annual conference, scheduled this year on March 24 at Temple University, is how we connect the dots. We persevere to get the word out, because at LATO we are clear that:

Lack of awareness gives the process its cover.


1. 2015 Pennsylvania Youth Survey, Downingtown Area School District -

2. ACE Study Publications, September, 2010 -

3. Philadelphia ACE Research Committee -

4. Stress, Trauma and Post-traumatic Stress Disorders in Children -

5. Young Children Develop in an Environment of Relationships -

6. OPIOID TIDE from Coast to Coast, New York Times, Jan. 8, 2017 -

8. Teens, Social Media & Technology Overview, 2015 -

Paper written for Communities That Care of Greater Downingtown

Downingtown Area School District, 570 Trestle Bridge Rd., Downingtown PA

Presented on January 17, 2017

Dr. Clara Whaley Perkins, Founder of LATO

© 2017

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