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Cited by 305Child Abuse and TraumaSubstance Abuse Treatment and OutcomesChild Welfare and Adoption

Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review

Open access
Leza, Leire, Siria, Sandra, López-Goñi, José J., Fernández-Montalvo, Javier·2021·Drug and alcohol dependence
DOI 10.1016/j.drugalcdep.2021.108563
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Abstract

BACKGROUND The long-term negative effects of adverse childhood experiences (ACEs) and their impact on physical and mental health has been widely studied. However, research about the relationship between ACEs and substance use disorder (SUD) diagnosis in adolescence and adulthood is still scarce. Therefore, this scoping review was conducted to collect the existing research findings to explore the relationship between the experience of ACEs and the diagnosis of SUD later in life. METHODS The PsycINFO, Medline, Scopus, Web of Science, and Cochrane Library databases were searched. After identifying the records based on eligibility and exclusion criteria, 12 studies were finally selected for inclusion. RESULTS Most of the studies were conducted in the USA with adult male and female participants. All studies were cross-sectional in nature and assessed ACEs retrospectively. The main conclusions of the studies were that there is a higher prevalence of ACEs in the population with SUD than in the general population, and a positive association between ACEs and the development and severity of SUD in adolescence and adulthood. CONCLUSIONS It is difficult to make comparisons between studies and to draw solid conclusions because of the lack of standardized criteria for evaluating ACEs and due to the heterogeneity in the substance types examined. More research is needed to fully elucidate the underlying mechanism of the relationship between ACEs and SUD.

Integrity signals

Registry

Crossref · 10.1016/j.drugalcdep.2021.108563

Cites

69 of 69 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

22 of 43 cited sources checked · 14 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Some of the included studies have linked specific types of ACEs with an increased risk of SUD.

    “In this sense, some of the studies have linked specific types of ACEs with an increased risk of SUD (Fuller-Thomson et al., 2016;Gomez et al., 2018;Kiburi et al., 2018;Levenson, 2016).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Fuller-Thomson et al., 2016 source
    • cites Gomez et al., 2018 source
    • cites Kiburi et al., 2018 source

      The Discussion links specific ACEs to greater substance use: emotional abuse to tobacco use and physical abuse to current cannabis use. But this study examined associations among patients who already had substance use disorders, so its findings do not establish an increased risk of developing a disorder. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    People in treatment for an addiction have a higher prevalence of ACEs than the general population.

    “In fact, people in treatment for an addiction have a higher prevalence of ACEs than the general population.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Chandler et al., 2018 source
    • cites Philogene-Khalid et al., 2020 source

      The Discussion says people with substance use disorders experience ACEs at a disproportionate frequency, and the Results report that 91% of this study’s participants had at least one ACE. But the Methods describe participants recruited during medical hospitalization, not people in addiction treatment, and the paper does not directly compare their ACE prevalence with that of the general population. No page numbers were available in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Stein et al., 2017 source

      The Discussion reports that people with opioid use disorder entering a detoxification program had substantially higher ACE scores than those in general-population studies; nearly half had four or more ACEs, versus 15.5% in one community-based study. This supports the comparison for the study sample, but not the broader claim about people in treatment for any addiction. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    The relationship between ACEs and subsequent SUD development might be partially mediated by a coping mechanism or a self-mediation strategy through which victims deal with feelings associated with childhood maltreatment.

    “The relationship between ACEs and subsequent SUD development might be partially mediated by a coping mechanism or a self-mediation strategy throughout which victims deal with their feelings associated with childhood maltreatment (Huang et al., 2011).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Huang et al., 2011 source

      The Discussion proposes that substance use may be a coping or self-medication strategy for feelings associated with childhood maltreatment. But the Limitations section says the study did not investigate drug abuse or dependence in young adulthood, so it does not establish this mechanism for subsequent SUD development. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Protective factors moderate the effects of ACEs, buffering their negative outcomes.

    “Recent research has suggested that protective factors moderate the effects of ACEs buffering their negative outcomes (Crouch et al., 2019;Liu et al., 2020;Moore & Ramirez, 2016).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Crouch et al., 2019 source
    • cites Liu et al., 2020 source
    • cites Moore & Ramirez, 2016 source
  • Premisecitation

    Having a history of ACEs might increase the risk of developing SUD.

    “Thus, having a history of ACEs might increase the risk of developing SUD (Buckingham & Daniolos, 2013;Dube et al., 2002;Khoury et al., 2010;Wendland et al., 2017).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Buckingham & Daniolos, 2013 source
    • cites Dube et al., 2002 source
    • cites Khoury et al., 2010 source
  • Classified as probably not a substantial claim. 15
  • May combine two claims. 18

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PRISMA-ScR was used, and a 22-item checklist was considered to follow the recommendations in each phase of the process.

    “Moreover, to adjust the methodology to the guidelines for conducting and publishing scoping reviews, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used, and a 22-item checklist to follow the recommendations in each phase of the process was considered (Tricco et al., 2018).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Tricco et al., 2018 source

      Section 3.7 identifies PRISMA-ScR as a checklist with 20 items plus two optional items, supporting the cited checklist's identification and count. The Introduction distinguishes guidance for conducting scoping reviews from PRISMA-ScR's purpose as a reporting guideline; it does not present the checklist as recommendations for conducting each phase of a review. The source also cannot verify the citing authors' statement that they used it. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These findings are consistent with research that has supported the relationship between ACEs and further negative health consequences in the general population.

    “These findings are consistent with research that has supported the relationship between ACEs and further negative health consequences in the general population (Buckingham & Daniolos, 2013;Cicchetti & Handley, 2019;Felitti et al., 1998;Hughes et al., 2017).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Buckingham & Daniolos, 2013 source
    • cites Cicchetti & Handley, 2019 source

      Section 7 (Allostatic load; page unavailable) links childhood maltreatment to later emotional and physical difficulties, including depression, substance use, inflammation, and cardiovascular disease. The paper supports the relationship for child maltreatment, but the cited passages do not establish it for ACEs broadly in the general population. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Felitti et al., 1998 source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The scoping review methodology proposed by Arksey and O'Malley (2005) and Levac et al. (2010) was used.

    “In this study, the scoping review methodology proposed by Arksey and O'Malley (2005) and Levac et al. (2010) was used.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Arksey and O'Malley (2005) source
    • cites Levac et al. (2010) source

  • May combine two claims.

    Findingcitation

    The High/Multiple ACEs group was significantly associated with increased alcohol-related problems and with tobacco use in young adulthood compared to the Low ACE group.

    “The High/Multiple ACEs group was significantly associated with increased alcohol-related problems and with tobacco use in young adulthood compared to the Low ACE group.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Shin et al., 2018 source

  • May combine two claims.

    Findingcitation

    Having experienced ACEs was associated with a higher likelihood of a past-year AUD and TUD diagnosis.

    “Having experienced ACEs was associated with a higher likelihood of a past-year AUD and TUD diagnosis.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Rhee et al., 2019 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One study (8.3%) was carried out with an adolescent population, and the rest were conducted with adult participants (91.7%, n=11).

    “One study (8.3%) was carried out with an adolescent population, and the rest were conducted with adult participants (91.7%; n = 11).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 12 included studies revealed either a positive association between the presence of ACEs and an SUD diagnosis or a higher prevalence of ACEs among people in treatment for SUD than in the general population.

    “The main conclusions of the studies were that there is a higher prevalence of ACEs in the population with SUD than in the general population, and a positive association between ACEs and the development and severity of SUD in adolescence and adulthood.”
    • Also stated in: § 3.5. Association Between ACEs and SUD · plain
      “The 12 studies revealed either a positive association between the presence of ACEs and an SUD diagnosis or a higher prevalence of ACEs among people in treatment for SUD than in the general population.”
    • Also stated in: § 4. Discussion · plain
      “All the studies reported either a positive association between ACEs and a later diagnosis of SUD or a higher prevalence of ACEs among people in treatment for SUD than in the general population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The number (between three and 13) and the types of ACEs evaluated in the included studies are extremely diverse, which leads to the impossibility of comparing results and obtaining homogeneous conclusions.

    “The number (between three and 13) and the types of ACEs that have been evaluated in the studies are extremely diverse, which leads to the impossibility of comparing results and obtaining homogeneous conclusions.”
    • Also stated in: § Abstract · plain
      “It is difficult to make comparisons between studies and to draw solid conclusions because of the lack of standardized criteria for evaluating ACEs and due to the heterogeneity in the substance types examined.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The scoping review included 12 studies.

    “12 studies were finally selected for inclusion.”
    • Also stated in: § 3.1. Study Selection · plain
      “Twelve studies were finally eligible for inclusion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The sample sizes of the included studies ranged from 30 to 21,554 participants, with ages ranging from 15 to 85 years.

    “The sample sizes ranged from 30 to 21,554 participants, with ages ranging from 15 to 85 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Fuller-Thomson et al. (2016) concluded that SUD was more strongly associated with the more invasive forms of direct violence in childhood, such as sexual and physical abuse, than with witnessing domestic violence.

    “Additionally, Fuller-Thomson et al. (2016) concluded that SUD was more strongly associated with the more invasive forms of direct violence in childhood, such as sexual and physical abuse, than with witnessing domestic violence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fuller-Thomson et al., 2016 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The majority of the included studies included both men and women (83.3%, n=10); two studies (16.7%) included only men, and none included only women.

    “The majority of the studies included both men and women (83.3%; n = 10); two studies (16.7%) included only men, and none of them included only women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All included studies were cross-sectional and assessed ACEs retrospectively.

    “All studies were crosssectional in nature and assessed ACEs retrospectively.”
    • Also stated in: § 3.2. Characteristics of the Included Studies · plain
      “All of the studies were cross-sectional and retrospectively assessed ACE.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most of the included studies were conducted in the United States (66.7%, n=8), followed by Asia (16.7%, n=2), Canada (8.3%, n=1), and Africa (8.3%, n=1).

    “Most of the studies were carried out in the United States (66.7%; n = 8), followed by Asia (16.7%; n = 2), Canada (8.3%; n = 1), and Africa (8.3%; n = 1) (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Exposure to household dysfunction was associated with a 2-fold increased risk of SUD, but exposure to abuse was not significantly associated.

    “Exposure to household dysfunction was associated with a 2-fold increased risk of SUD, but exposure to abuse was not significantly associated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Number of ACEs was positively associated with the severity of recent drug use and negatively associated with age of drug initiation.

    “Number of ACEs was positively associated with the severity of recent drug use and negatively associated with age of drug initiation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Discrepancies between reviewers were resolved by discussions until a consensus was reached.

    “Discrepancies between reviewers were resolved by discussions between reviewers until a consensus was reached.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The search strategy and systematic search of the literature were developed with the help of an experienced information technician along with input from the project team.

    “The search strategy and the systematic search of the literature were developed with the help of an experienced information technician along with input from the project team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol of this scoping review was registered on the Open Science Framework (OSF) prior to searching for relevant studies.

    “The protocol of this scoping review was registered on the Open Science Framework (OSF; https://osf.io/wfycs)prior to searching for relevant studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This is an emerging research focus, and the findings are still inconclusive.

    “All of them were published between 2016 and 2020, which means that this is an emerging research focus, and the findings are still inconclusive.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent reviewers reviewed the titles and abstracts of all papers at level 1 of screening, and the full texts at level 2.

    “At level 1 of screening, two independent reviewers of the research team reviewed the titles and abstracts of all the papers obtained from the electronic database search.At level 2 of screening, the full texts of the papers were reviewed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Interrater reliability was calculated by Cohen's kappa for level 1 and level 2 screening.

    “Interrater reliability for the 123 results obtained in level 1 of screening and the six results in level 2 of screening was calculated by Cohen's kappa.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The lack of a unique criterion for assessing ACEs across studies indicates that the results should be interpreted cautiously.

    “However, the lack of a unique criterion for assessing ACEs across studies indicates that the results should be interpreted cautiously.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The interrater reliability was 0.98 for level 1 screening and 1.00 for level 2 screening.

    “The interrater reliability (Cohen's kappa statistic) for level 1 of screening was 0.98, and that for level 2 of screening was 1.00.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The retrospective self-report design of the 12 included studies could have underreported ACEs and biased the results of each study and of this scoping review.

    “The retrospective design of the 12 studies to self-report ACEs could have underreported these experiences and biased the results of each study and of this scoping review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    None of the included studies were conducted in a European country, preventing comparison of results with that region.

    “Finally, none of the studies were conducted in a European country, leading to the impossibility of comparing results with this region.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Early adversities are associated with SUD risk in later adulthood, although only for some ACE classes.

    “Early adversities are associated with SUD risk in later adulthood, although only for some ACE classes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kim et al., 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

27 of 27

  • The authors state this as an assumption.

    Recruiting a sample from an addiction treatment programme assumes the presence of an SUD diagnosis.

    “and/or to carry out the study recruiting a sample from an addiction treatment programme (which assumes the presence of a diagnosis).”

  • The paper relies on this without support.

    The prevalence of ACEs among people in treatment for SUD is high.

    “Due to the high prevalence of ACEs among people in treatment for SUD, it is crucial to continue evaluating the mediating mechanisms between specific types of ACEs and SUD diagnoses and the course of these patients in SUD treatment.”
2 of 2

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Related

Authors
Leza, L., Siria, S., López-Goñi, J. J., & Fernández-Montalvo, J.
Affiliations
Universidad Pública de Navarra (UPNA) (ES)
ORCID
Venue
Drug and alcohol dependence
Publisher
Elsevier BV
Published
2021-04
Volume
221
Pages
108563
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2021.108563
OpenAlex
W3127853237
Semantic Scholar
dc7a4fbbfbd932f5cf222f41e88285a778e0ee33
Cited by
305
References
71
Citations by year
2026: 64 · 2025: 62 · 2024: 93 · 2023: 57 · 2022: 21 · 2021: 8
FWCI
5.95
Type
journal article
Language
en
Open access
Licence
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
  • Academica-e (Universidad Pública de Navarra) (submittedVersion, cc-by-nc-nd)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Safety Research › Child Welfare and Adoption
Keywords
adverse childhood experiences, substance use disorders, adolescent substance use
MeSH terms
Adverse Childhood Experiences, Adolescent, Adult, Child, Cross-Sectional Studies, Female, Humans, Male, Mental Health, Retrospective Studies, Prevalence, Substance-Related Disorders

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