Substance Abuse & Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Adverse Childhood Experiences

The Relationship of ACEs to Substance Use and Related Behavioral Health Problems

Research has demonstrated a strong graded (i.e., dose-response) relationship between ACEs and a variety of substance use-related behaviors, including:

  • Early initiation of alcohol use. For states, tribes, and jurisdictions focusing on underage drinking, these results suggest the importance of addressing ACEs as one component of preventing underage drinking, as responses to underage drinking may not be effective unless they help youth recognize and cope with stressors of abuse, domestic violence and other adverse experiences (Dube et al, 2006)
  • Problem drinking behavior into adulthood (Dube et al, 2002)
  • Increased likelihood of early smoking initiation (Anda et al, 1999)
  • Continued smoking, heavy smoking during adulthood (Ford et al, 2011)
  • Prescription drug use (Anda et al, 2008)
  • Lifetime illicit drug use, ever having a drug problem, and self-reported addiction (Dube et al, 2003)

Research has also demonstrated a strong graded relationship between ACEs and related behavioral problems, such as the following:

  • Increased risk of suicide attempts, including attempts by men and women, as well as attempts during adolescence and adulthood (Dube et al, 2004).
  • Lifetime depressive episodes (Chapman et al, 2004).
  • Sleep disturbances in adults (Chapman et al, 2011)
  • Sexual risk behaviors (Hillis et al, 2001)
  • Teen pregnancy (Hillis et al, 2004)


« Previous Section | Next Section »