A systematic review (1) looking at the chain between adverse childhood experiences (ACEs) and substance abuse has highlighted the major reasons why 25% those with ACEs go on to misuse substances.
By analysing the results from 50 papers looking at those links, so the authors sought to seek solutions – what can be done to stop ACEs leading to substance misuse in an individual?
In this article we will summarise the findings of the research and look at the solutions the authors suggested.
Systematic reviews attempt to synthesise the findings of other research by highlighting trends in the data presented. In this case, of 415 papers put forward, the authors assessed 50 that met the criteria for inclusion.
Those with substance misuse problems were aged 10-24 and the ACE must have occurred from birth up to the age of 18. The adverse childhood experience will have included:
The thinking behind this research is that substance use is a third step after the ACE, with a mediating or moderating experience resultant from the ACE. For instance, a close and happy family could prevent substance misuse from occurring due to bullying at school.
On the other hand, parental neglect could lead to the child joining a gang and the gang encouraging substance misuse among its members.
If such second steps could be identified, then these could be spotted by professionals dealing with them (perhaps a teacher, sports coach or social worker) and then steps taken to help the child. As a result, they may not find their way into substance misuse as an outlet later in life.
In the next sections, we will highlight what trends the systematic review showed from existing research on the matter.
The term ‘intrapersonal’ for the purposes of this article are psychological and behavioural factors that include depression, anger and aggression. In the next section we will look at interpersonal factors, and the section after, parenting and community factors.
Internalising reactions include depression and anxiety. Nearly all those who had ACEs experienced depression. Depression is strongly linked to the child or young adult seeking to self-medicate with alcohol or drugs.
Where anxiety or a fear response was triggered by the adverse experience, this wasn’t so strongly linked to substance misuse. The authors suggested that a phobic response would make the individual less likely to come into contact with substances as they would be less inclined to meet those who could provide them.
Post-traumatic stress symptoms were strongly linked to substance use later down the line. Individuals responded to issues such as flashbacks by self-medicating with alcohol or drugs.
Where anger was the result of an adverse experience, this was perhaps the most problematic symptom. Anger is one of the most strongly linked mediating factors to substance misuse, and once the person has developed a misuse disorder, has the poorest recovery outcomes.
It generally comes with other mental health problems that have developed in the individual as they become angry at the world.
Only one paper in this review looked at the links between substance misuse and suicidal ideation. As with most of the other intrapersonal factors except anxiety, suicidal ideation was strongly linked to substance misuse.
As will be seen in the next section, an individual who has become more impulsive and has less emotional self-regulation, is more likely to develop a substance use disorder.
These aspects of their personality may have come from something they were born with such as ADHD or autism, but may be exacerbated by their childhood experiences.
In the last section we looked at symptoms that the individual may have as a person that are linked to eventual substance use. In this section we will look at the world in which the individual moves and what may then lead to a substance use disorder.
The concept of the ‘deviant peer’ was raised in this article, which can include gangs and groups of individuals who have themselves developed poor coping strategies including substance misuse.
Many children and adolescents ‘fall into the wrong crowd’ as they seek acceptance, protection, and a need for belonging.
Commonly though not exclusively, young people end up among deviant peers in part due to parental neglect. If they have personality traits such as impulsivity and poor emotional self-regulation, so they are more likely to end up in the wrong crowd too, and then develop a substance use disorder.
The systematic review showed that the individual with an adverse childhood experience and a poor relationship with their parents may develop a substance use disorder.
This could be due to a ‘personality clash’ between parent and child or due to genuinely poor and neglectful parenting.
Conversely, the individual who has strong family relations is more likely to overcome their difficulties and is less likely to develop a substance use problem.
Where a parent has a mental health problem or a substance use problem themselves, the research showed strong links between this and later substance use in the individual.
However, if another parent does not have such issues then they could help prevent the substance use disorder from appearing in the child as they grow up.
Poor educational attainment is strongly associated with later substance use disorders. Similarly, where the child is either moved between schools a lot during their academic career, this can lead to substance use problems.
Bad school experiences can also create the ACEs we look at in this article. This includes bullying and social isolation that can deeply affect the child’s psychology and in some cases cause acute depression and suicidal ideation.
In the next section looking at solutions, we will show that schools can play a big role in intervening and helping steer the individual away from eventual substance misuse.
This research showed that if the individual is part of a good community that looks out for its members, they are less likely to fall. This might be the provision of youth clubs, sporting facilities and other areas that interest the child as they grow up.
A tight religious community can keep an eye on its growing members and guide them through their difficulties too.
So far, we have highlighted where the individual can fall. What can prevent these from leading to substance use?
When the mother is pregnant, both parents should undergo any mental health or substance misuse treatment so they are in as healthy a state as possible when the child is born. Community midwives can guide the parents to appropriate services.
Two programmes were highlighted in this systematic review – Circle of Security (2) and Triple P (3).
Circle of Security focuses on attachment theory and the importance of communication between the child and parent from the very start of the child’s life. A secure attachment between child and parent is key for later development as the child learns trust and gains confidence as they grow up.
Triple P, or Positive Parenting Programme, is a highly regarded parenting skills programme with plenty of research backing good outcomes for the child. It is designed to prevent and treat behavioural problems in childhood. Such early intervention can prevent later substance misuse.
Two very good intervention programmes were identified in this research – PreVenture (4) and HEARTS (5).
PreVenture is a programme aimed at promoting good mental health and reducing or eliminating substance misuse among adolescents. It consists of workshops for groups of teens that teach long-term goal-setting and coping strategies for dealing with the ACEs they face.
Healthy Environments and Response to Trauma in Schools (HEARTS) is a three-tier programme designed to help students tackle trauma. It is introduced to the whole school (Tier 1), to school staff (Tier 2) and to individual students experiencing trauma (Tier 3), and is designed to help the student tackle trauma at an early stage.
By helping the child become resilient at an early age, and then developing coping skills as they grow older, so the issues they face are less likely to lead to substance misuse problems.
In working closely with them even before the adverse experience occurs and then throughout their lives, so they are less likely to resort to substance use to self-medicate for their feelings.
1. Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252815
2. Circle of Security – http://www.parentsandchildren.co.uk/circle-of-security.html
3. Triple P https://www.triplep.net/glo-en/find-out-about-triple-p/triple-p-in-a-nutshell/
4. PreVenture example of this programme can be found here https://www.preventure.ca
5. HEARTS Research looking at this programme https://psycnet.apa.org/record/2016-06431-001
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
