The Relationship Between Adverse Childhood Experiences and the Development of Substance Use
Open Access
- Author:
- Boeckenhauer, Kayleen Ann
- Area of Honors:
- Psychology (Behrend)
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Charisse Nixon, Thesis Supervisor
Carolynn Blaze Masters, Thesis Honors Advisor - Keywords:
- substance use
substance abuse
substance use disorder
adverse childhood experiences
traumatic childhood events
childhood trauma - Abstract:
- Adverse childhood experiences (ACEs) are a set of related traumatic and negative events experienced prior to 18 years of age that may include abuse, neglect, or household dysfunction. ACEs have been shown to have a negative impact on development and are associated with substance use later in life (Brett et al., 2018; Brown & Shillington, 2017; Chandler et al., 2018; Choi et al., 2017; Forster et al., 2018; Shin et al., 2018; Kim et al., 2019; Stein et al., 2017; Lovallo et al., 2018; Wu et al., 2010). A better understanding of the relationship between ACEs and substance use could help guide the current screening and care of individuals who have experienced ACEs and who are, as a result, at risk for developing substance use. The purpose of this systematic review was to better understand the relationship between ACEs and substance use. The systematic review includes three focus areas: studies that discussed types of ACEs (e.g. physical abuse, witnessing domestic violence, neglect) and their relationship to substance use, studies that discussed cumulative ACEs (total number experienced) and the relationship to substance use, and studies that discussed the role of nonmodifiable (e.g. race, gender) and modifiable variables (e.g. resilience, social support) in the relationship between ACEs and substance use. A systematic review was conducted using PubMed, PsycINFO, and CINAHL databases. Adverse childhood experiences OR childhood trauma OR traumatic childhood events AND substance use disorder OR adult substance abuse OR adult substance use, Adverse childhood experiences OR childhood trauma OR traumatic childhood events AND modifiable variables OR nonmodifiable variables OR protective factors OR risk factors were search terms used to identify relevant articles. Four articles were also added after looking through references lists of previously selected articles. Inclusion criteria were that the articles were written in English, published after 2010, and discussed a relationship between adverse childhood experiences and substance use or discussed variables that can affect the relationship between ACEs and negative outcomes. Articles were excluded during the abstract screen if they were duplicates of previously selected articles, they did not mention substance use as a negative outcome of adverse childhood experiences, or did not include a factor that can affect the relationship between ACEs and negative outcomes. A total of twenty articles were included. Findings for specific ACEs and the risk for substance use were mixed. Physical abuse, sexual abuse, witnessing domestic violence, and experiencing others’ substance use or mental illness in the household were the individual ACEs most consistently reported to be positively associated with substance use (Choi et al., 2017; Forster et al., 2018; Fuller-Thomson et al., 2016; Hughes et al., 2019). Cumulative ACEs were associated with a graded risk of substance use such that higher incidence of ACEs were associated with greater incidence of substance use (Brett et al., 2018; Brown & Shillington, 2017; Chandler et al., 2018; Choi et al., 2017; Forster et al., 2018; Shin et al., 2018; Kim et al., 2019; Stein et al., 2017; Lovallo et al., 2018; Wu et al., 2010). ACEs cause physiological changes in the body that leave a person more vulnerable to substance use (Oshri et al., 2018; Lovallo et al., 2018; Fuller-Thomson et al., 2016; Mergler et al., 2018; Wu et al., 2010; Jääskeläinen et al., 2016; Kim et al., 2019). Variables such as social support, adaptive coping strategies, growth mindset, mindfulness, and resilience can reduce the effect of ACEs on negative outcomes (Moses & Villodas, 2017; Brown & Shillington, 2017; Hughes et al., 2019; Burnette et al., 2017; Sheffler et al., 2019; Claro et al., 2016; Brett et al., 2018; Chandler et al., 2018). Nurses and other healthcare professionals should be aware that ACEs are associated with negative outcomes such as substance use. Early screening, trauma-informed care, and interventions to increase social support, positive coping strategies, growth mindset, mindfulness, and resilience can help to lessen the negative impact of ACEs and improve future outcomes.