An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

Abstract

Background and Objectives A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy. Methods Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized. Results Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.

The adverse childhood experiences—International questionnaire in clinical and at‐risk samples worldwide: A systematic review (part II)

“…In this vein, the literature suggests that ACEs are themselves social determinants of several health outcomes (Hughes et al, 2017; Scully et al, 2020), counting more than 200 systematic reviews on the topic registered in PROSPERO. Existing reviews mostly document connections with single physical (e.g., diabetes; Zhu et al, 2022) and mental health (e.g., substance misuse; Grummitt et al, 2022) outcomes or psychological constructs (e.g., empathy; Cerqueira & Almeida, 2023), or intervention outcomes such as adherence (Draxler & Ruppar, 2022). Given the higher distribution of at‐risk and clinical populations in low‐ and middle‐income countries (Lund et al, 2010; Slone & Mann, 2016), research on ACEs connections with a broad range of psychological and health outcomes in these populations would geographically cover these countries first.…”

Age, β-endorphin, and sex dependent effects of maternal separation on locomotor activity, anxiety-like behavior, and alcohol reward

“…Early life stress is a major risk-factor for behavioral and health disorders in adults, including anxiety, PTSD, depression, and suicidality ( Chang et al, 2019 ; Hadwen et al, 2022 ; McKay et al, 2022 ). For example, adverse childhood experiences predict the severity of substance use disorders ( Dube et al, 2006 ; LeTendre and Reed, 2017 ; Grummitt et al, 2022 ) and a parental substance use disorder is a prevalent form of childhood adversity ( van Draanen and Aneshensel, 2022 ) reflecting a transgenerational cycle of suffering. Childhood adversity also predicts more frequent and severe anxiety symptoms in adults ( Hayward et al, 2020 ; King, 2021 ).…”