Alcohol and Vicodin entered Rebecca's life at age 12.

She grew up seeing her dad use both. She picked up the substances herself after her dad's best friend sexually abused her. Her abuser killed himself once the truth came out, and she felt she was to blame.

She dealt with it the same way her dad did.

“I grew up around alcohol,” the 46-year-old Butler woman recalls. “I grew up with alcoholism. And I grew up with addiction.”

Rebecca is her real first name, but The Eagle is not publishing her last name to protect her identity.

She's about a year-and-half into her recovery. Addiction ran most of Rebecca's life. Today, in her long-sought sobriety, it's clear to her that her path toward addiction began as a child.

Defining ACEs

To the world of social work, an account of Rebecca's early life reads like someone ticking off boxes on a checklist. That checklist generates something called an ACEs score, or an adverse childhood experiences score. ACEs scores are used by social workers to quantify a range of childhood adversities into a number that can be compared and applied in scientific research.

The Centers for Disease Control and Prevention defines Adverse Childhood Experiences, or ACEs, as “potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide.”

But beyond childhood trauma, the CDC further said ACEs also include aspects of a child's environment that can undermine their sense of safety, stability, and bonding. This can include growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling, or other member of the household.

Using the vast amount of academic research available, one can tally the number of ACEs impacting a child like Rebecca and use it to estimate their odds of everything from mental illness, career wages or substance-abuse problems.

Adverse Childhood Experiences have been linked to risky health behaviors, chronic health conditions, low life potential, and early death in adults.

For instance, one study from the CDC's National Center for Chronic Disease Prevention and Health Promotion study found that ACEs scores are so indicative of adult drug abuse that “the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use.”

Impact of ACEs

Rebecca's story has examples of several ACEs.

Her childhood directly impacted by drugs, sexual abuse and violence, she's still unraveling the effects of those adverse childhood experiences today.

Growing up, her family operated two bars, so she would hang out in a bar before and after school.

Back then, Rebecca's family lived in Belle Vernon, a small town south of Pittsburgh along the Monongahela River. She describes the town as having a bar on every corner and a particularly difficult fight against opioids.

Rebecca understands today how her now-deceased father's alcoholism went hand-in-hand with painkillers.

“I watched my dad and others take pain pills like candy,” Rebecca said.

Her brother caught most of their dad's physical abuse, of which there was plenty. His drunken rages were dangerous. In fact, Rebecca said her grandparents didn't speak to anyone in her branch of the family for a long time because during one binge her dad beat up her grandfather, his father.

“You never knew which dad was coming home, if it was the happy drunk or the mean drunk,” Rebecca recalled. “There were times we slept with our coats on in case we had to leave.”

Rebecca remembers wanting to leave her situation behind, to not have to deal with her existence. She chased, as she put it, “anything that got me out of me.”

To that end, her dependence on drugs and alcohol surged as she grew older.

Addiction-fueled lows

After Vicodin came Percocet. Later on came Oxycodone and Opana, another type of painkiller. Life kept spiraling, and eventually Rebecca was snorting heroin and abusing anything she could find.

Addiction fueled many lows in Rebecca's life. She received an “other-than-honorable discharge” from the U.S. Army.

Another low arrived a little over two decades ago. She was raising her 3-year-old daughter, the child of another woman's husband.

“I was driving down the road, and I had my daughter in the car seat,” Rebecca said. “And she's screaming. I'm mad at her, 'cause she's yelling at me. And I turn around, and her car seat is completely on its side. I didn't even buckle her in.”

Whether it was a moment of clarity or a moment of defeat, Rebecca couldn't shake that image.

“I took her to my parents' house, dropped her off and never looked back.”

Motivation to get clean

At the Ellen O'Brien Gaiser Addiction Center, an inpatient nonprofit treatment facility in Butler, it's not unusual for more than half of the female clients to have young children, according to Heather Truchan, clinical lead for women's programs at the center. Many of the men do, too.

“We have gotten many women where the only thing motivating them to get clean is their kids,” Truchan said.

Kelly O'Connell, Gaiser's clinical supervisor for all programs, agreed, adding that it isn't uncommon for center newcomers to feel like Rebecca did in that cataclysmic moment.

“A lot of the time when they come in, they feel like horrible parents,” O'Connell said. “They feel like they don't even deserve to be parents.”

Linda Franiewski, the center's executive director, explained how the cyclical nature of addiction can be observed in their center. Franiewski battled addictions similar to Rebecca, and got sober at the Gaiser center years ago.

Some parents of patients aren't allowed on site because they're still actively using, even as their now-adult children recover.

“Women who are parents now, with little kids,” Franiewski said, further explaining the cycle. “We have kids that were in their shoes who are now adults in treatment. It adds a whole other level to the counseling, because it's all they've ever known.”

For the first time since that low point, Rebecca met her daughter earlier this year. She's 24 now, and she has a son of her own. Rebecca has yet to meet her grandson but hopes she will.

Rebecca's parents took in her daughter and raised the child, just as they had raised her. She doesn't know for sure, but she thinks the two took steps to do better by their granddaughter.

Rebecca's father died a few years ago. She learned he was taking methadone at the time of his death, and has wondered since whether her dad sought to beat addiction himself.

“For as active as he was in (my daughter's) life, it does make me think that he might have been better,” Rebecca said. “I don't know how long he was on, and I'll never know. But I do feel that maybe she was the reason why he was around as long as he was.”

Landmark ACEs study

Still, Rebecca's daughter grew up with several ACEs herself.

In 1998, the American Journal of Preventive Medicine published what's now seen as an original landmark study on ACEs. Its primary author was Vincent Felitti.

Felitti and his team developed questionnaires asking adults whether they experienced any of the following seven childhood problems: psychological abuse, physical abuse, sexual abuse, violence against their mother, a household member who abused substances, or one with mental illness, or who had been imprisoned. The studies also asked about their current and past experiences.

Those with four or more ACEs boxes checked, as compared to those with none, were four-to-12 times more likely to experience alcoholism, drug abuse, depression or attempt suicide.

They were two-to-four times as likely to have more than 50 sexual partners and a sexually transmitted disease.

“We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults,” researchers reported in the study.

Rebecca's journey

There were a couple more low points for Rebecca. She came about as close to death as one can before finding her way.

When she was using, she tried to kill herself three times, all within about two months.

The first was an overdose.

“I was in a coma for nine days,” Rebecca said. “I died.”

Second, she swallowed too many Xanax. That, too, failed.

The third hit hard. She drank herself stupid and walked to a bridge, then jumped. The fall wasn't enough to kill her, but just nearly so as she hit the water beneath hard. She was pulled to shore and flown in an emergency helicopter to Allegheny General Hospital in Pittsburgh.

“The doctor said 'Do you realize how lucky you are?” Rebecca recalled. “I said 'Lucky? Lucky is if I wasn't dealing with this right now. Lucky would be if I was dead.'”

That, she said, still wasn't enough.

The last fall from sobriety saved Rebecca. She remembers standing before Allegheny County Judge Kelly Bigley in a Pittsburgh courtroom.

“She asked me if I was going to do it (recovery) this time,” Rebecca said. “I lied and I said 'Yeah, I'm going to do it.' I left that courthouse and I went and got drunk and high for an entire weekend.”

Salvation dawned on her as she came to from the weekend bender. She awoke and spotted broken glass on the floor. She wasn't sure what the shards were from, but she identified with it.

“I remember thinking, that's what you are,” she said. “You are worthless. That's when I fell upon my knees. From that moment forward, I wanted to live.”

Rebecca's story from there is a climb. She reached out to Washington County's Drug and Alcohol program, which connected her to Donna Jenereski, director of Butler County's equivalent program.

She moved to Butler and found a church, support groups, and sobriety. When a job at a nursing home tempted her with easy access to drugs, she quit and found another.

'What life looks like'

Rebecca is calm today. Sit with her, and she talks slowly and carefully, her eyes looking slightly up and past her companions as she cringes over all she used to do.

She credits spirituality with much of her recovery. That, and nature. She walks the Butler-Freeport Community Trail frequently just to enjoy the peace.

One afternoon, Rebecca sat still on her back porch and watched as bluebirds fluttered up beside her. She felt like she was seeing them for the first time in her life.

“I've probably seen bluebirds before. I'm 46 years old; I had to see them sometime,” Rebecca said. “But to see things clearly now, to take that moment and realize, 'Wow this is what life looks like.' It's not all 'woe is me. I'm the victim.'

“Life is a beautiful, beautiful thing, and there are so many things to just sit, be still in the moment, and be thankful for.”