Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence

Dube, Shanta R.; Miller, Jacqueline W.; Brown, David W.; Giles, Wayne H.; Felitti, Vincent J.; Dong, Maxia; Anda, Robert F.

doi:10.1016/j.jadohealth.2005.06.006

Cited by 699Child Abuse and TraumaSubstance Abuse Treatment and OutcomesChild Welfare and Adoption

Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence

Dube, Shanta R., Miller, Jacqueline W., Brown, David W., Giles, Wayne H., Felitti, Vincent J., Dong, Maxia, Anda, Robert F.·2006·Journal of Adolescent Health

DOI 10.1016/j.jadohealth.2005.06.006

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Abstract

Purpose Alcohol is the most common and frequently used drug and has the potential to cause multiple deleterious effects throughout the lifespan. Because early age at initiation of alcohol use increases this potential and programs and laws are in place to attempt to delay the onset of alcohol use, we studied the relationship between multiple adverse childhood experiences (ACEs) and both the likelihood of ever drinking and the age at initiating alcohol use.Methods This was a retrospective cohort study of 8417 adult health maintenance organization (HMO) members in California who completed a survey about ACEs, which included childhood abuse and neglect, growing up with various forms of household dysfunction and alcohol use in adolescence and adulthood. The main outcomes measured were ever drinking and age at initiating alcohol use among ever-drinkers for four age categories: < or = 14 years (early adolescence), 15 to 17 years (mid adolescence), and 18 to 20 years (late adolescence); age > or = 21 years was the referent. The relationship between the total number of adverse childhood experiences (ACE score) and early initiation of alcohol use (< or =14 years) among four birth cohorts dating back to 1900 was also examined.Results Eighty-nine percent of the cohort reported ever drinking; all individual ACEs except physical neglect increased the risk of ever using alcohol (p < .05). Among ever drinkers, initiating alcohol use by age 14 years was increased two- to threefold by individual ACEs (p < .05). ACEs also accounted for a 20% to 70% increased likelihood of alcohol use initiated during mid adolescence (15-17 years). The total number of ACEs (ACE score) had a very strong graded relationship to initiating alcohol use during early adolescence and a robust but somewhat less strong relationship to initiation during mid adolescence. For each of the four birth cohorts, the ACE score had a strong, graded relationship to initiating alcohol use by age 14 years (p < .05).Conclusions Adverse childhood experiences are strongly related to ever drinking alcohol and to alcohol initiation in early and mid adolescence, and the ACE score had a graded or "dose-response" relationship to these alcohol use behaviors. The persistent graded relationship between the ACE score and initiation of alcohol use by age 14 for four successive birth cohorts dating back to 1900 suggests that the stressful effects of ACEs transcend secular changes, including the increased availability of alcohol, alcohol advertising, and the recent campaigns and health education programs to prevent alcohol use. These findings strongly suggest that efforts to delay the age of onset of drinking must recognize the contribution of multiple traumatic and stressful events to alcohol-seeking behavior among children and adolescents.

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Adverse childhood experiences are associated with increased likelihood of alcohol use during adolescence and of alcohol abuse as an adult.
“Similar findings have also been reported in humans, where adverse childhood experiences were associated with increased likelihood of alcohol use during adolescence and of alcohol abuse as an adult (Dube, Anda, Felitti, Edwards, & Croft, 2002; Dube et al., 2006; Enoch, 2011).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Dube et al., 2006

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“Using retrospective reports, findings indicated that exposure to such adverse family environments was significantly associated with alcohol use initiation in early adolescence (prior to age 14) and in mid-adolescence (between ages 15 and 17) (Dube et al., 2006), alcohol abuse in adulthood (Dube et al.”
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Authors: Dube, S. R., Miller, J. W., Brown, D. W., Giles, W. H., Felitti, V. J., Dong, M., & Anda, R. F.
Affiliations: Centers for Disease Control and Prevention (US)
Kaiser Permanente (US)
Corresponding author: Dube, Shanta R.
ORCID: Dube, Shanta R.
Miller, Jacqueline W.
Brown, David W.
Dong, Maxia
Venue: Journal of Adolescent Health
Publisher: Elsevier BV
Published: 2006-04
Volume: 38
Issue: 4
Pages: 444.e1-444.e10
ISSN: 1054-139X (ISSN-L)
DOI: 10.1016/j.jadohealth.2005.06.006
OpenAlex: W2128395649
Cited by: 698
References: 43
Citations by year: 2026: 18 · 2025: 44 · 2024: 34 · 2023: 41 · 2022: 47 · 2021: 58 · 2020: 51 · 2019: 41 · 2018: 48 · 2017: 48 · 2016: 54 · 2015: 45 · 2014: 34 · 2013: 31 · 2012: 29
FWCI: 9.94
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Adolescent Health (publishedVersion)
PubMed (publishedVersion)
Funders: Centers for Disease Control and Prevention (TS-44-10/11)
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, alcohol use initiation, adolescent alcohol use, childhood abuse and neglect, household dysfunction, ACE score, dose-response relationship, birth cohort, alcohol prevention programs, health maintenance organization members, California, physical neglect, alcohol availability
MeSH terms: Adolescent, Adolescent Behavior, Adult, Advertising, Alcohol Drinking, Child Abuse, Female, Humans, Life Change Events, Male, Risk Factors, Domestic Violence

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Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence

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