Examining the pathways from adverse childhood experiences to substance use

J Affect Disord. 2025 Jan 15:369:1209-1214. doi: 10.1016/j.jad.2024.10.090. Epub 2024 Oct 23.

Abstract

Background: Adverse childhood experiences (ACEs) are traumatic events that occur early in life and can have lasting effects on health and well-being. Previous research has linked ACEs to substance use in adulthood, but there is limited research on the underlying mechanisms or pathways of this relationship. This study explores whether depression mediates the relationship between ACEs and current substance use among U.S. adults.

Methods: Data were obtained from the 2021 Behavioral Risk Factor Surveillance System (n = 30,978). Generalized Structural Equation Modeling was used to examine the links between ACEs, cigarette, e-cigarette, and marijuana use while adjusting for sociodemographic characteristics.

Results: Approximately 71 % of respondents reported experiencing at least one ACE. The findings show that depressive disorders mediate the relationship between ACEs and current substance use among U.S. adults. There was a significant indirect effect of ACEs on current cigarette use (OR = 1.13, 95 % CI [1.10, 1.16]), e-cigarette use (OR = 1.17, 95 % CI [1.12-1.22]), and marijuana use (OR = 1.22, 95 % CI [1.13, 1.33]) through the mediator of depressive disorders. Additionally, the most pronounced effects were found among those aged 18-24 years for cigarette use (OR = 1.32, 95 % CI [1.11, 1.56]), e-cigarette use (OR = 1.22 [1.09, 1.36]), and especially marijuana use (OR = 1.52 [1.18, 1.96]).

Conclusion: These findings suggest that depression may be a key pathway from negative experiences during childhood to certain types of substance use in adulthood, particularly among young adults.

Keywords: Adverse childhood experiences; Cigarette; Depression; E-cigarette; Marijuana.

MeSH terms

  • Adolescent
  • Adult
  • Adverse Childhood Experiences* / statistics & numerical data
  • Behavioral Risk Factor Surveillance System
  • Cigarette Smoking / epidemiology
  • Cigarette Smoking / psychology
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Female
  • Humans
  • Male
  • Marijuana Use / epidemiology
  • Marijuana Use / psychology
  • Middle Aged
  • Risk Factors
  • Substance-Related Disorders* / epidemiology
  • Substance-Related Disorders* / psychology
  • United States / epidemiology
  • Young Adult