What’s New in Psychology?
Adverse Childhood Events and Substance Use Disorders
Jim Windell
Adverse childhood experiences, commonly referred to as ACEs, are potentially traumatic events that occur in childhood. Among ACEs are experiencing violence, abuse, or neglect; witnessing violence in the home or community; and having a family member attempt or die by suicide.
As many as 64 % of Americans, according to a recent survey experienced at least one ACE before turning 18 years old. The consequences of ACEs is that the effects often extend into adulthood and may include harmful behaviors, such as using alcohol and drugs. However, new research, recently published in the journal Nature Human Behavior, shows that individuals exposed to ACEs are at increased risk of developing mood, anxiety, and substance use disorders. In part, the substance use disorder risk is related to the use of alcohol or drugs to self-medicate mood and anxiety disorders.
A research group led by Henry Kranzler, M.D., a professor of Psychiatry and the director of the Center for Studies of Addiction in the Perelman School of Medicine at the University of Pennsylvania, examined associations among ACEs, mood or anxiety disorders, and substance dependence in 12,668 individuals. Forty-two point five percent were Black and 42.1 percent were white. The researchers compared two primary hypotheses: one involving self-medication (using substances to cope with trauma) and one having to do with substance-induced psychiatric disorders (mental health issues caused by substance use).
Results showed stronger support was found for the self-medication hypothesis, suggesting that interventions focusing on coping skills and emotional resilience may help reduce the risk of future mental health issues in children exposed to ACEs.
“Earlier intervention is key,” says Rachel Kember, MSc, Ph.D., an assistant professor of Psychiatry at the University of Pennsylvania and study co-author. “The findings provide a better understanding of how it may be best to intervene based on an individual’s specific needs.”
The study found that genetic factors also play a role, with some individuals having a higher genetic predisposition for developing substance use, mood, or anxiety disorders. The interaction between genetic risk and childhood adversity influences the development of mental health disorders, highlighting the importance of understanding different pathways and designing early interventions to promote emotional regulation and coping skills.
According to Kranzler, there are multiple entry points: “These findings suggest that multiple pathways lead to mental health conditions after exposure to childhood adversity.”
“Given these results, it's crucial to prioritize efforts to reduce children's exposure to early traumatic experiences,” adds study co-author Christal Davis, Ph.D., a postdoctoral fellow at the Corporal Michael J. Crescenz VA Medical Center (VAMC). “This would enhance access to protective factors, which could prevent the need for future mental health interventions.”
The axiom “kids are resilient” continues to be tested, and sometimes broken, as the world continues to adapt to the impact of remote learning, stunted social-emotional development, and a spectrum of issues weighing on children during the past few years. That spectrum includes the impact of ACEs on children across the country. According to the Centers for Disease Control and Prevention, three in four high school students reported experiencing at least one ACE during the pandemic and were more likely to report poor mental health or suicidal behavior.
Other research has shown that adverse childhood experiences can influence negative behavior into adulthood, as well as detailing the significant economic impact of ACEs. One recent study put the national economic burden of ACEs-related adult health conditions at $14.1 trillion annually ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years), or $88,000 per affected adult annually and $2.4 million over their lifetime.
Dr. Kranzler says that greater priority should be placed on both reducing children’s exposure to early traumatic experiences and increasing their access to protective factors. For example, safe, stable, and nurturing relationships, positive friendships and peer networks, and supportive school environments that promote learning and socialization, may help prevent the need for future mental health interventions.
Though Kranzler and his team expressed caution since more data are necessary to chart firmer next steps due to the novelty of the dataset the team analyzed, their findings represent a first step.
“The findings underscore the need for efforts to prevent or intervene early with individuals who experience adverse childhood events, as they have the potential to prevent or limit the development of a variety of psychiatric disorders, including substance dependence,” Kranzler concludes.
To read the original study article, find it with this reference:
Kranzler, H. R., Davis, C. N., Feinn, R., Jinwala, Z., Khan, Y., Oikonomou, A., ... & Kember, R. L. (2024). Gene× environment effects and mediation involving adverse childhood events, mood and anxiety disorders, and substance dependence. Nature Human Behaviour, 1-12.
