Adverse Childhood Experiences Linked to Substance Use Disorders

Research asked patients about difficult experiences in their childhood

The study, undertaken by researchers at the Medical University of South Carolina (MUSC) and published in the American Journal of Drug and Alcohol Abuse, is the latest to examine the connection between adverse childhood experiences (ACEs) and substance abuse later in life. ^[1]

During the study, 565 adults, dependent on either cocaine, opioids, cannabis, or tobacco but not seeking treatment, filled out the Adverse Childhood Experiences (ACE) questionnaire. The questionnaire asks participants if, before the age of 18, they experienced physical, emotional, or sexual abuse; physical or emotional neglect; or household dysfunction, such as the loss of a parent to divorce or death, mental illness, substance abuse, or incarceration of a household member, or domestic violence directed at the mother. ^[2]

Results confirm link between youthful adversity and addiction


Previous research has found that ACEs predispose individuals to physical and mental illness, including substance abuse. ^[3] This effect is dose-dependent: the more ACEs an individual reports, the more frequently they use illicit substances, the more likely they are to develop addiction, and the more likely they are to escalate to injecting drugs. ^[1] Those who experience five or more types of adversity in childhood are seven to ten times more likely to use illicit drugs and develop substance use disorders. ^[4]

Additionally, higher numbers of ACEs are associated with a greater risk of relapse after substance abuse treatment. Among patients with opioid addictions, every additional ACE increases the risk of relapse after treatment by 17%. ^[5]

The MUSC study confirmed that childhood trauma predisposes individuals to substance abuse. Most substance abusers in the study reported at least one ACE and more had four ACEs, indicating severe childhood adversity, than had none. ^[1]

“People with more ACEs are more likely to present with SUD and have a negative treatment experience,” said study co-author Erin Martin, a neuroscience doctoral candidate at MUSC. ^[6]

Women are more likely to experience childhood adversity and more likely to “telescope” to addiction

Martin’s study, co-led by Aimee McRae-Clark, professor of psychiatry and neuroscience at MUSC, considered the impact of ACEs on substance abuse by men and women, with the aim of informing gender-specific treatment approaches.

Previous research has shown that women are overrepresented among Americans who experienced severe childhood adversity, defined as four or more ACEs. In the the MUSC study, women had mean ACE scores of 2.859 while men averaged 1.98. Women were four times as likely to report sexual abuse compared to men. ^[1]

While more men experience drug addiction than women, this research suggests women are more vulnerable to the influence of ACEs in addiction. It may also offer an explanation for why women are more likely to rapidly escalate from substance use to addiction, a phenomenon called telescoping.

Certain adverse experiences are linked to cocaine and opioid abuse

The research also uncovered correlations between certain types of adversity and specific substances of abuse.

Participants with cocaine use disorder were more likely to report emotional or physical abuse and neglect, while those with opioid use disorder were more likely to report household dysfunction.

Overall, individuals in the cocaine and opioid arms of the study had higher ACE scores than those in the tobacco and cannabis cohorts. 

“The use of more highly stigmatized drugs may be associated with worse childhoods," Martin said. ^[6]

This connection may be because people who have experienced severe childhood adversity have a higher tolerance for the risks associated with these substances, including overdose, exposure to adulterants such as fentanyl, infections due to injection, arrest, and prosecution, the study’s authors suggest, pointing to research that shows ACEs have been associated with poor emotional regulation and impulsive behavior. ^[1]

Addiction treatment should account for trauma

This research suggests that ACEs need to be accounted for in substance abuse treatment, especially among at-risk populations, including women. This may include treatment approaches that target emotional dysregulation and other consequences of childhood trauma, the study proposes. These approaches may prevent the negative outcomes and relapses often seen in individuals with childhood trauma seeking substance abuse treatment.

“ACEs can inform future treatment directions,” said McRae-Clark. “Trauma-focused interventions are important.”

However, “there is so much work to be done,” she added. “There is no one-size-fits-all model.” ^[6]