Why ‘Just Say No’ does not work

 One of the most influential studies in the world of public health began almost by chance.

In the 1980s, Dr. Vincent Felitti was trying to understand why patients were dropping out of his obesity clinic program. So he developed a questionnaire for patients to get to the root of the problem.

He began asking patients things like “How much did you weigh in first grade?” “How much did you weigh when you started high school?” “How old were you when you married?”

Then one day, he misspoke. Instead of asking about age on this particular question, he asked a patient, “How much did you weigh when you became sexually active?”

“40 pounds,” she replied.

She had been sexually abused by her father at four years old.

He began asking other patients about their experiences with sexual abuse and other childhood trauma, and found there was in fact a correlation with his patients’ obesity problems. He wondered what other diseases and conditions were affected by negative childhood experiences.

The CDC got involved, and the study expanded to include other negative health outcomes from a list of the 10 most prevalent childhood traumas. It was named the CDC-Kaiser Adverse Childhood Experience (ACE) Study.

From 1995 to 1997, more than 17,000 people were surveyed about their childhood experiences. People were anonymously asked if they had experienced emotional abuse, physical abuse, sexual abuse, if their mother was treated violently, if they had experienced household substance abuse, if they had grown up with a mental illness in the household, if their parents had separated or divorced, if a household member had been incarcerated, or if they had experienced emotional or physical neglect.

These weren’t patients who you might expect to have these kinds of backgrounds, either. These were mostly middle-aged, upper- and middle-class white people from San Diego.

The study found that 50 percent of the population had one or more of the adverse childhood experiences; 16 percent had four or more.

This brings a whole new meaning to the now-famous quote “Be kind, for everyone you meet is fighting a hard battle.”

The more ACEs you have, the more at risk you are for a slew of negative mental and physical health outcomes. Which turns any traditional prevention effort, especially in the substance abuse field, on its head.

If an adolescent is turning to substances because they want to forget and they don’t want to feel the negative emotions that comes from dealing with these childhood experiences, how can we simply tell them to “Just say no,” to drugs and alcohol?

But just as there are these experiences that we know now lead to negative outcomes, so there are positive experiences that help offset them, so we can still have balanced members of society.

The Search Institute published a list of “40 developmental assets” that help correct the course of a young person’s life. This list includes things like family support, a caring school, or even just the perception that adults in the community value youth.

Which assets can you implement in a youth’s life?