The ACE questionnaire: what your ACE score means for addiction

In this article

1. What is the ACE questionnaire?
2. What does your ACE score mean?
3. Why the ACE score matters for addiction
4. If your score suggests trauma is driving your substance use
5. What to do with your ACE score
6. Questions people ask

In a CDC survey of 25 US states in 2015 to 2017, 60.9% of adults reported at least one ACE and 15.6% four or more. A high score is not a diagnosis, but in large studies it goes with more drinking and drug problems. Renewed Life Center in Lakeside, Cape Town, treats the addiction and the trauma under it on one plan, over a standard two months.

What is the ACE questionnaire?

The ACE questionnaire, also called the ACEs test or the adverse childhood experiences test, counts how many of ten kinds of abuse, neglect and household trouble you lived through before the age of 18. It came out of the CDC-Kaiser Permanente ACE Study, which the CDC describes as one of the largest investigations of childhood abuse and neglect and later-life health.

The first paper, by Felitti and colleagues in 1998, asked 9,508 adults about seven categories. A 2003 study by Dube and colleagues used the ten-category score that most ACE tests use today. The ACE score is the total number of categories, not the number of times something happened: a childhood with daily beatings and one with a single incident both score one point for physical abuse.

The 10 ACE categories and how common they are

Emotional abuse is the most common ACE, reported by 28.0% of adults in a 2026 analysis of 1,002 studies covering 2,592,879 adults in 102 countries (Madigan and colleagues, Lancet Public Health). Answer yes or no for each category, thinking of your life before 18:

What does your ACE score mean?

Your ACE score shows how much adversity you lived through, and in large groups higher scores go with higher risk: people with 4 or more ACEs had a 4- to 12-fold higher risk of alcoholism, drug abuse, depression and suicide attempts than people with none (Felitti and colleagues, 1998). There is no official pass mark, but There is no official pass mark on the ACEs questionnaire, but 4 or more is the line most research uses for a high score.

Is the ACE score a diagnosis?

No. ACE screening gives a count, and it cannot tell you what will happen to you as one person. Following 2,009 young people in Britain to age 18 and 918 people in New Zealand to age 45, Baldwin and colleagues found ACE scores had poor accuracy in predicting an individual’s later health problems (JAMA Pediatrics, 2021). A high score does not decide your future, and a low one does not protect you. What the score does well is open a conversation about where your drinking, anxiety or anger may have started.

Why the ACE score matters for addiction

The ACE score matters for addiction because the link in the research is strong and graded: in Dube’s 2003 study of 8,613 adults, people with 5 or more ACEs were 7 to 10 times more likely to report illicit drug problems than people with none, and each ACE raised the chance of starting drugs early 2 to 4 times. The authors estimated that ACEs account for one half to two thirds of serious problems with drug use. A high ACE score does not make anyone weaker or less moral: many people are managing a stress response that formed in a childhood they never chose.

A 2017 meta-analysis of 37 studies and 253,719 people found 4 or more ACEs raised the odds of problematic alcohol use by more than three to six times and problematic drug use by more than seven (Hughes and colleagues, Lancet Public Health). The pattern is familiar to anyone who has sat in a treatment group. A child who grew up on alert often never learned to calm down, and alcohol, pills and drugs do that job fast. People with a high score found something that worked, until it started costing more than it gave.

If your score is high and you drink every day, do not stop suddenly on your own: the NHS warns that stopping suddenly can be very dangerous when you are dependent on alcohol. Message us and we will tell you whether you need a medical detox, and arrange it.

If your score suggests trauma is driving your substance use

If trauma is driving the drinking or drug use, treatment has to work on both at once, because taking the substance away leaves the old pain with nothing to hold it down. That is why willpower alone so often fails: it is aimed at the drinking or drug use, not at what the substance was doing for you. NIDA advises treating a mental health condition at the same time as the addiction, and that is how Renewed Life Center is built: the addiction and the trauma, depression or anxiety under it are treated in one place, on one plan.

Ruby Weber, our psychologist, has more than 20 years in the addictions field with South African and international clients and a particular interest in how trauma feeds addiction; she leads the psychological side of our dual diagnosis work. For trauma we use EMDR, which NICE and the WHO recommend for post-traumatic stress, and Kerry Dominie-Williams, our TRE practitioner, teaches Tension and Trauma Release Exercises for what the body still holds. Schema therapy goes after the patterns learned in childhood that keep the using going, and DBT gives skills for the feelings that used to send you to the bottle. A psychiatrist selects medication where it is needed. Beside you are people who know the road: John Roberts has 39 years in recovery, and Nikki Edwards, our Programme Director and Clinical Manager, has 11. For a high score, that means the past is treated alongside the drinking or drugs, by people who work with both every day.

What dual diagnosis treatment looks like for trauma survivors

The first month is residential: you live at the centre, get safe and steady, with detox if needed under 24-hour nursing supervision, and therapy every weekday, including individual sessions typically three times a week. The day starts at 07:00 with a morning group, a one-to-one session and groups until four, and ends with a 12-step meeting. The second month goes deeper into what the drinking or drugs were covering, which for a high ACE score is usually where the real work is. Our standard stay is two months, and every discharge includes a written relapse-prevention plan built for your home.

Families take part too, through a support group every Wednesday at 18:00 on Zoom. For many people with a high score, family is part of the story, and the group gives them a place to learn what the treatment is doing.

For therapists and social workers

If you have taken a client through the ACE questionnaire and their drinking or drug use has outgrown weekly sessions, send us the picture. A clinical assessment happens within three days, admission can be immediate and typically happens within three days of first contact, and we work with you on the handover back home.

What to do with your ACE score

Take the score to someone who can do something with it. The first conversation with us is free, confidential and takes 20 to 40 minutes by WhatsApp, video or phone; tell us your score, what you drink or use, and what has happened when you tried to stop. We are paid directly, so no scheme decides how long you stay, and the fee for your programme comes in writing the same day.

International clients, including from the UK and the US, are a primary focus for us. Treatment costs around €3,000 to €4,000 a month, we meet you at Cape Town airport and take you back when you leave, and flights are booked separately.

Childhood is the hardest thing to put into a first message, and you do not need to tell the whole story at once. Send us your score and one line about why you took the test. More on how mental health and addiction are treated together in why dual diagnosis treatment matters, and on body-based trauma work in somatic therapy.

Questions people ask

Sources

1. Felitti et al., American Journal of Preventive Medicine, 1998
2. Dube et al., Pediatrics, 2003
3. Hughes et al., Lancet Public Health, 2017
4. Madigan et al., Lancet Public Health, 2026
5. Baldwin et al., JAMA Pediatrics, 2021
6. CDC, MMWR Vital Signs, November 2019; CDC, About the CDC-Kaiser ACE Study
7. NHS, Alcohol misuse treatment
8. NIDA, Co-occurring disorders; NICE NG116; WHO guidance on mental health care after trauma, 2013

This article is general information, not medical advice.