Adverse childhood experiences and substance-related outcomes in adolescents and adults: a systematized review with structured narrative synthesis and exploratory meta-analysis
DOI:
https://doi.org/10.70577/dr8esp98Keywords:
adverse childhood experiences; childhood trauma; substance-related disorders; child abuse; addiction; relapse.Abstract
Introduction: Adverse childhood experiences (ACEs), including childhood trauma, have been associated with multiple substance-related outcomes. Heterogeneity in exposures, populations, metrics, and potentially dependent publications limits a single global estimate and supports a domain-based synthesis. Objective: To critically synthesize observational evidence on adverse childhood experiences and substance use disorder, initiation, use patterns, relapse, craving, severity, and psychiatric comorbidity in adolescents and adults. Methods: A systematized review of publications from January 1, 2016 through August 17, 2026 was conducted using PECO criteria, DOI-level auditing, control of dependence across publications, methodological appraisal, and domain-based narrative synthesis. The audit identified 200 unique DOIs; 187 publications were retained in the evidence map and 13 were excluded. The analytical corpus comprised 75 reports with documented and audited methodological appraisal. No literature-wide pooled effect was estimated. A secondary exploratory meta-analysis combined three independent samples from Kristjansson et al. (2016) using REML and modified Knapp-Hartung inference. Results: Risk of bias in the analytical corpus was moderate in 39 reports, low-moderate in 21, moderate-high in 12, and high in 3. Positive associations predominated for substance use disorder diagnosis, earlier initiation, use patterns, and severity, while null and attenuated findings after adjustment were also retained. The exploratory meta-analysis showed positive associations for alcohol, nicotine, cannabis, stimulants, and opiates. Conclusion: Adverse childhood experiences are a relevant marker of vulnerability to substance-related outcomes, but clinical and methodological heterogeneity argues against a single global effect and supports domain-specific interpretation.
Downloads
References
Abajobir, A. A., Najman, J. M., Williams, G., Strathearn, L., Clavarino, A., & Kisely, S. (2017). Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study. Psychiatry Research, 256, 21–31. https://doi.org/10.1016/j.psychres.2017.06.017 DOI: https://doi.org/10.1016/j.psychres.2017.06.017
Ai, A. L., Moore, J., Petscher, Y., & Lemieux, C. M. (2026). Pathways between childhood mistreatment/victimization, posttraumatic stress, and lifetime substance use disorders among Latinx nationwide. Psychological Trauma: Theory, Research, Practice, and Policy, 18(1), 210–219. https://doi.org/10.1037/tra0001758 DOI: https://doi.org/10.1037/tra0001758
Arabshahi, A., Mohammad-Beigi, A., Mohebi, S., & Gharlipour, Z. (2023). Prediction of addiction relapse based on perceived social support and childhood trauma. Addiction & Health, 15(4), 253–259. https://doi.org/10.34172/ahj.2023.1434 DOI: https://doi.org/10.34172/ahj.2023.1434
Barker, T. H., Hasanoff, S., Aromataris, E., Stone, J. C., Leonardi-Bee, J., Sears, K., Klugar, M., Tufanaru, C., Moola, S., Liu, X.-L., & Munn, Z. (2026). The revised JBI critical appraisal tool for the assessment of risk of bias for analytical cross-sectional studies. JBI Evidence Synthesis, 24(3), 401–408. https://doi.org/10.11124/JBIES-24-00523 DOI: https://doi.org/10.11124/JBIES-24-00523
Bougelet, E., Deffaa, M., Türkmen, C., Kiefer, F., Vollstädt-Klein, S., & Gerhardt, S. (2024). The role of perceived stress in the relation between childhood maltreatment and severity of alcohol use disorder: A mediation analysis. European Addiction Research, 30(6), 347–356. https://doi.org/10.1159/000539711 DOI: https://doi.org/10.1159/000539711
Broekhof, R., Nordahl, H. M., Tanum, L., & Selvik, S. G. (2023). Adverse childhood experiences and their association with substance use disorders in adulthood: A general population study (Young-HUNT). Addictive Behaviors Reports, 17, 100488. https://doi.org/10.1016/j.abrep.2023.100488 DOI: https://doi.org/10.1016/j.abrep.2023.100488
Bryant, D. J., Coman, E. N., & Damian, A. J. (2020). Association of adverse childhood experiences (ACEs) and substance use disorders (SUDs) in a multi-site safety net healthcare setting. Addictive Behaviors Reports, 12, 100293. https://doi.org/10.1016/j.abrep.2020.100293 DOI: https://doi.org/10.1016/j.abrep.2020.100293
Capusan, A. J., Gustafsson, P. A., Kuja-Halkola, R., Igelström, K., Mayo, L. M., & Heilig, M. (2021). Re-examining the link between childhood maltreatment and substance use disorder: A prospective, genetically informative study. Molecular Psychiatry, 26, 3201–3209. https://doi.org/10.1038/s41380-021-01071-8 DOI: https://doi.org/10.1038/s41380-021-01071-8
Carliner, H., Keyes, K. M., McLaughlin, K. A., Meyers, J. L., Dunn, E. C., & Martins, S. S. (2016). Childhood trauma and illicit drug use in adolescence: A population-based national comorbidity survey replication—adolescent supplement study. Journal of the American Academy of Child & Adolescent Psychiatry, 55(8), 701–708. https://doi.org/10.1016/j.jaac.2016.05.010 DOI: https://doi.org/10.1016/j.jaac.2016.05.010
Chaudhary, V., Kaushik, A., Devi, N. K., Jain, S., & Saraswathy, K. N. (2025). Adverse childhood experiences as predictors of alcohol and tobacco addiction risk among college students in Delhi-NCR, India. Scientific Reports, 15, 32333. https://doi.org/10.1038/s41598-025-16079-1 DOI: https://doi.org/10.1038/s41598-025-16079-1
Cohen, J. R., Menon, S. V., Shorey, R. C., Le, V. D., & Temple, J. R. (2017). The distal consequences of physical and emotional neglect in emerging adults: A person-centered, multi-wave, longitudinal study. Child Abuse & Neglect, 63, 151–161. https://doi.org/10.1016/j.chiabu.2016.11.030 DOI: https://doi.org/10.1016/j.chiabu.2016.11.030
Collazos, K. S. G., Havanur, A., De Santis, J., Baral, A., & Vidot, D. C. (2024). Adverse childhood experiences as precursors to cannabis use in adulthood: A systematic review. Child Abuse & Neglect, 154, 106889. https://doi.org/10.1016/j.chiabu.2024.106889 DOI: https://doi.org/10.1016/j.chiabu.2024.106889
Copeland, W. E., Halvorson-Phelan, J., McGinnis, E., & Shanahan, L. (2023). Adult mental health, substance use disorders, and functional outcomes of children resilient to early adversity. American Journal of Psychiatry, 180(12), 906–913. https://doi.org/10.1176/appi.ajp.20230038 DOI: https://doi.org/10.1176/appi.ajp.20230038
Derefinko, K. J., Salgado García, F. I., Talley, K. M., Bursac, Z., Johnson, K. C., Murphy, J. G., McDevitt-Murphy, M. E., Andrasik, F., & Sumrok, D. D. (2019). Adverse childhood experiences predict opioid relapse during treatment among rural adults. Addictive Behaviors, 96, 171–174. https://doi.org/10.1016/j.addbeh.2019.05.008 DOI: https://doi.org/10.1016/j.addbeh.2019.05.008
Erga, A. H., Ushakova, A., Elstad, M., Fodstad, E. C., & Belfrage, A. (2024). The relationship between self-reported childhood maltreatment and mental health in substance use disorders: A 6-year retrospective analysis. Journal of Dual Diagnosis, 20(3), 210–222. https://doi.org/10.1080/15504263.2024.2338799 DOI: https://doi.org/10.1080/15504263.2024.2338799
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8 DOI: https://doi.org/10.1016/S0749-3797(98)00017-8
Forster, M., Rogers, C. J., Benjamin, S. M., Grigsby, T., Lust, K., & Eisenberg, M. E. (2019). Adverse childhood experiences, ethnicity, and substance use among college students: Findings from a two-state sample. Substance Use & Misuse, 54(14), 2368–2379. https://doi.org/10.1080/10826084.2019.1650772 DOI: https://doi.org/10.1080/10826084.2019.1650772
Gerhardt, S., Eidenmueller, K., Hoffmann, S., Bekier, N. K., Bach, P., Hermann, D., Koopmann, A., Sommer, W. H., Kiefer, F., & Vollstädt-Klein, S. (2022). A history of childhood maltreatment has substance- and sex-specific effects on craving during treatment for substance use disorders. Frontiers in Psychiatry, 13, 866019. https://doi.org/10.3389/fpsyt.2022.866019 DOI: https://doi.org/10.3389/fpsyt.2022.866019
Gonçalves, P. D., Duarte, C. S., Corbeil, T., Ramos-Olazagasti, M. A., Sussman, T., Talati, A., Alegria, M., Canino, G., Bird, H., & Martins, S. S. (2023). Adverse childhood experiences and risk patterns of alcohol and cannabis co-use: A longitudinal study of Puerto Rican youth. Journal of Adolescent Health, 73(3), 421–427. https://doi.org/10.1016/j.jadohealth.2023.04.010 DOI: https://doi.org/10.1016/j.jadohealth.2023.04.010
Grummitt, L., Barrett, E., Kelly, E., & Newton, N. (2022). An umbrella review of the links between adverse childhood experiences and substance misuse: What, why, and where do we go from here? Substance Abuse and Rehabilitation, 13, 83–100. https://doi.org/10.2147/SAR.S341818 DOI: https://doi.org/10.2147/SAR.S341818
He, J., Yan, X., Wang, R., Zhao, J., Liu, J., Zhou, C., & Zeng, Y. (2022). Does childhood adversity lead to drug addiction in adulthood? A study of serial mediators based on resilience and depression. Frontiers in Psychiatry, 13, 871459. https://doi.org/10.3389/fpsyt.2022.871459 DOI: https://doi.org/10.3389/fpsyt.2022.871459
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4 DOI: https://doi.org/10.1016/S2468-2667(17)30118-4
Hughes, K., Bellis, M. A., Sethi, D., Andrew, R., Yon, Y., Wood, S., Ford, K., Baban, A., Boderscova, L., Kachaeva, M., Makaruk, K., Markovic, M., Povilaitis, R., Raleva, M., Terzic, N., Veleminsky, M., Włodarczyk, J., & Zakhozha, V. (2019). Adverse childhood experiences, childhood relationships and associated substance use and mental health in young Europeans. European Journal of Public Health, 29(4), 741–747. https://doi.org/10.1093/eurpub/ckz037 DOI: https://doi.org/10.1093/eurpub/ckz037
Kisely, S., Mills, R., Strathearn, L., & Najman, J. M. (2020). Does child maltreatment predict alcohol use disorders in young adulthood? A cohort study of linked notifications and survey data. Addiction, 115(1), 61–68. https://doi.org/10.1111/add.14794 DOI: https://doi.org/10.1111/add.14794
Ko, C.-H., Lu, Y.-C., Lee, C.-H., & Liao, Y.-C. (2024). The influence of adverse childhood experiences and depression on addiction severity among methamphetamine users: Exploring the role of perseveration. Frontiers in Psychiatry, 15, 1382646. https://doi.org/10.3389/fpsyt.2024.1382646 DOI: https://doi.org/10.3389/fpsyt.2024.1382646
Kristjansson, S., McCutcheon, V. V., Agrawal, A., Lynskey, M. T., Conroy, E., Statham, D. J., Madden, P. A. F., Henders, A. K., Todorov, A. A., Bucholz, K. K., Degenhardt, L., Martin, N. G., Heath, A. C., & Nelson, E. C. (2016). The variance shared across forms of childhood trauma is strongly associated with liability for psychiatric and substance use disorders. Brain and Behavior, 6(2), e00432. https://doi.org/10.1002/brb3.432 DOI: https://doi.org/10.1002/brb3.432
LeTendre, M. L., & Reed, M. B. (2017). The effect of adverse childhood experience on clinical diagnosis of a substance use disorder. Substance Use & Misuse, 52(6), 689–697. https://doi.org/10.1080/10826084.2016.1253746 DOI: https://doi.org/10.1080/10826084.2016.1253746
Levitin, M. D., Shmulewitz, D., Levine, E., Skvirsky, V., Lev-Ran, S., Kor, A., & Mikulincer, M. (2026). The unique contributions of adverse childhood experiences to increases in post-traumatic stress symptoms and problematic substance use after trauma exposure. Scientific Reports, 16, 6870. https://doi.org/10.1038/s41598-026-37883-3 DOI: https://doi.org/10.1038/s41598-026-37883-3
Leza, L., Siria, S., López-Goñi, J. J., & Fernández-Montalvo, J. (2021). Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review. Drug and Alcohol Dependence, 221, 108563. https://doi.org/10.1016/j.drugalcdep.2021.108563 DOI: https://doi.org/10.1016/j.drugalcdep.2021.108563
Li, D., Wang, D., Tian, Y., Chang, Z., Chen, J., Jia, L., Fu, F., Wang, X., & Zhang, X.-Y. (2025). Interactions between depressive symptoms, childhood trauma, and drug craving in Chinese men with methamphetamine use disorder: A network analysis. Journal of Psychoactive Drugs, 1–11. Advance online publication. https://doi.org/10.1080/02791072.2025.2474747 DOI: https://doi.org/10.1080/02791072.2025.2474747
Lotzin, A., Grundmann, J., Hiller, P., Pawils, S., & Schäfer, I. (2019). Profiles of childhood trauma in women with substance use disorders and comorbid posttraumatic stress disorders. Frontiers in Psychiatry, 10, 674. https://doi.org/10.3389/fpsyt.2019.00674 DOI: https://doi.org/10.3389/fpsyt.2019.00674
Luciani, K. R., Johal, P. K., Chao, T., Thiessen, K. A., & Schütz, C. G. (2024). Adult self-reported childhood maltreatment types are associated with treatment satisfaction and alcohol relapse in patients with comorbid substance use and mental health disorders. The American Journal on Addictions, 33(5), 516–524. https://doi.org/10.1111/ajad.13535 DOI: https://doi.org/10.1111/ajad.13535
McCabe, S. E., Hughes, T. L., West, B. T., Evans-Polce, R. J., Veliz, P. T., Dickinson, K., McCabe, V. V., & Boyd, C. J. (2020). Sexual orientation, adverse childhood experiences, and comorbid DSM-5 substance use and mental health disorders. The Journal of Clinical Psychiatry, 81(6), 20m13291. https://doi.org/10.4088/JCP.20m13291 DOI: https://doi.org/10.4088/JCP.20m13291
McCabe, S. E., Hughes, T. L., Beal, S., Evans-Polce, R. J., Kcomt, L., Engstrom, C., West, B. T., Veliz, P., Leary, K., McCabe, V. V., & Boyd, C. J. (2022). Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US. Child Abuse & Neglect, 123, 105377. https://doi.org/10.1016/j.chiabu.2021.105377 DOI: https://doi.org/10.1016/j.chiabu.2021.105377
McDonagh, D., de Vries, J., & Cominskey, C. (2023). The role of adverse childhood experiences on people in opiate agonist treatment: The importance of feeling unloved. European Addiction Research, 29(5), 313–322. https://doi.org/10.1159/000532005 DOI: https://doi.org/10.1159/000532005
Meadows, A. L., Strickland, J. C., Hyder, S. M., Basconi, R. C., Stull, M. E., Wagner, F. P., Nguyen, M. N., Rayapati, A. O., & Rush, C. R. (2024). Adverse childhood experiences and early initiation of substance use: A survival analysis. The International Journal of Psychiatry in Medicine, 59(2), 218–231. https://doi.org/10.1177/00912174231195751 DOI: https://doi.org/10.1177/00912174231195751
Mills, R., Kisely, S., Alati, R., Strathearn, L., & Najman, J. M. (2017). Child maltreatment and cannabis use in young adulthood. Addiction, 112(3), 494–501. https://doi.org/10.1111/add.13634 DOI: https://doi.org/10.1111/add.13634
Mogollón-Canal, O. M., Villamizar-Carrillo, D. J., Padilla-Sarmiento, S. L., Carrillo-Sierra, S.-M., Villamizar-Carrillo, A. P., Fernández-Montalvo, J., Rozo-Pérez, O., Cepeda-Pineda, D., & Rivera-Porras, D. (2026). Early adverse experiences and the likelihood of substance use disorders and non-fatal overdose in clinical and community settings: A systematic review and meta-analysis. Behavioral Sciences, 16(4), 589. https://doi.org/10.3390/bs16040589 DOI: https://doi.org/10.3390/bs16040589
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Journal of Clinical Epidemiology, 134, 178–189. https://doi.org/10.1016/j.jclinepi.2021.03.001 DOI: https://doi.org/10.31222/osf.io/v7gm2
Rakovski, C., Lalli, M., Gu, J., Hobson, M., Wollenhaupt-Aguiar, B., Minuzzi, L., Kapczinski, F., de Azevedo Cardoso, T., & Frey, B. N. (2024). Childhood maltreatment as a predictor of substance use/misuse among youth: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 166, 105873. https://doi.org/10.1016/j.neubiorev.2024.105873 DOI: https://doi.org/10.1016/j.neubiorev.2024.105873
Regmi, S., Kedia, S. K., Ahuja, N. A., Lee, G., Entwistle, C., & Dillon, P. J. (2024). Association between adverse childhood experiences and opioid use-related behaviors: A systematic review. Trauma, Violence, & Abuse, 25(3), 2046–2064. https://doi.org/10.1177/15248380231205821 DOI: https://doi.org/10.1177/15248380231205821
Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., Koffel, J. B., & PRISMA-S Group. (2021). PRISMA-S: An extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic Reviews, 10(1), 39. https://doi.org/10.1186/s13643-020-01542-z DOI: https://doi.org/10.1186/s13643-020-01542-z
Scott, J. G., Malacova, E., Mathews, B., Haslam, D. M., Pacella, R., Higgins, D. J., Meinck, F., Dunne, M. P., Finkelhor, D., Erskine, H. E., Lawrence, D. M., & Thomas, H. J. (2023). The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study. The Medical Journal of Australia, 218(S6), S26–S33. https://doi.org/10.5694/mja2.51870 DOI: https://doi.org/10.5694/mja2.51870
Shin, S. H., McDonald, S. E., & Conley, D. (2018). Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis. Addictive Behaviors, 78, 187–192. https://doi.org/10.1016/j.addbeh.2017.11.020 DOI: https://doi.org/10.1016/j.addbeh.2017.11.020
Stein, M. D., Conti, M. T., Kenney, S., Anderson, B. J., Flori, J. N., Risi, M. M., & Bailey, G. L. (2017). Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug and Alcohol Dependence, 179, 325–329. https://doi.org/10.1016/j.drugalcdep.2017.07.007 DOI: https://doi.org/10.1016/j.drugalcdep.2017.07.007
Stocchero, B. A., Rothmann, L. M., Portolan, E. T., Lopes, T. G., Ferraz-Rodrigues, C., Garcia, M. G., Narvaez, J. C. M., Grassi-Oliveira, R., & Viola, T. W. (2024). The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis. Child Abuse & Neglect, 158, 107085. https://doi.org/10.1016/j.chiabu.2024.107085 DOI: https://doi.org/10.1016/j.chiabu.2024.107085
Tang, S., Jones, C. M., Wisdom, A., Lin, H.-C., Bacon, S., & Houry, D. (2021). Adverse childhood experiences and stimulant use disorders among adults in the United States. Psychiatry Research, 299, 113870. https://doi.org/10.1016/j.psychres.2021.113870 DOI: https://doi.org/10.1016/j.psychres.2021.113870
Umut, G., Evren, C., & Unal, G. T. (2017). Could childhood trauma types predict the relapse in alcohol use disorder? Asian Journal of Psychiatry, 25, 253. https://doi.org/10.1016/j.ajp.2016.12.009 DOI: https://doi.org/10.1016/j.ajp.2016.12.009
Vieira, J. L., Snaychuk, L. A., Milicevic, J., Hodgins, D. C., Shead, N. W., Keough, M. T., & Kim, H. S. (2024). Adverse childhood experiences and problematic cannabis use: The role of emotion dysregulation and affective impulsivity. Cannabis, 6(4), 111–126. https://doi.org/10.26828/cannabis/2023/000190 DOI: https://doi.org/10.26828/cannabis/2023/000190
Zhu, J., Racine, N., Devereux, C., Hodgins, D. C., & Madigan, S. (2025). Associations between adverse childhood experiences and substance use: A meta-analysis. Child Abuse & Neglect, 168(Pt 1), 106431. https://doi.org/10.1016/j.chiabu.2023.106431 DOI: https://doi.org/10.1016/j.chiabu.2023.106431
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Miguel Armando Camino Coronel, Johanna Estefania Núñez Silva, Carlos Enrique Muñoz Cofre, Isaac Esteban Navas Trujillo, Kevyn Steev Castillo Barrera (Autor/a)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
