“…Evidence has shown that poor substance use treatment outcomes, such as relapse, challenges with comorbid mental illness, and lower levels of improvement in treatment, are associated with high ACE prevalence ( Sacks et al, 2008 , Derefinko et al, 2019 , Rosen et al, 2002 , Farrugia et al, 2011 , Kumar et al, 2016 ). The literature on trauma and parenting has consistently found that high levels of ACE are also linked to increased parenting stress, insecure parent–child attachment, negative parenting behaviors, and fear and confusion surrounding discipline ( Slesnick and Zhang, 2016 , Herbell and Bloom, 2020 , Moe et al, 2018 ). Like many other consequences of experiencing numerous ACEs, these outcomes could be attributed to the dysregulation and hyperactivity of the stress response that is developed when significant adversity occurs ( Lê-Scherban et al, 2018 ).…”