What factors help to explain the association between childhood adversity and substance use?

What is it about?

There is a lot of literature confirming a relationship between exposure to childhood adversity (e.g. abuse, neglect, violence in the home, mental illness in the home) and elevated substance use and disorder. There are many interacting factors at the individual, interpersonal, and societal level that help to explain why this relationship exists. This systematic review searched the literature for longitudinal studies that tested mediators or moderators of the association between childhood adversity and substance use in young adulthood. The 50 longitudinal studies synthesised in this review found that a large proportion of the association between childhood adversity and substance use in young people was mediated and/or moderated by other individual, interpersonal, and community-level risk and protective factors. Among the factors with the best quality evidence, childhood adversity was associated with increasing externalising behaviour, anger, using substances to cope with negative emotions/thoughts, and post-traumatic stress symptoms, which in turn were associated with increased substance misuse and an earlier age of substance use initiation. Conversely, childhood adversity was associated with lower parental support and attachment, which were associated with more harmful substance use outcomes. Greater levels of parental monitoring reduced the strength of the association between ACEs and substance use.

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Photo by Mika Matin on Unsplash

Photo by Mika Matin on Unsplash

Why is it important?

These mediators or moderators represent potential targets that can be used in interventions to prevent harmful substance use among those exposed to childhood adversity. For example, interventions that can equip people with coping strategies that don't involve substances, reduce externalising behaviour, anger, and post-traumatic stress symptoms could help to prevent harmful substance use for those exposed to childhood adversity. Improving relationships with a safe parent may also be protective against harmful substance use for these young people.

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