Association of adverse childhood experiences (ACEs) and substance use disorders (SUDs) in a multi-site safety net healthcare setting

BACKGROUND: Adverse childhood experiences (ACEs) and substance use disorders (SUDs) are highly prevalent public health challenges that have been shown to be strongly correlated. Although previous research has suggested a dose-response relationship between ACEs and SUDs, less is known about this phenomenon and the prevalence of ACEs in lower income, racially/ethnically diverse populations. This study sought to examine these relationships in a population treated at a multi-site safety net provider. METHODS: The ACEs survey was delivered as a standard assessment to all behavioral health patients seen at a large Federally Qualified Health Center (FQHC) in Connecticut. 4378 patients completed the questionnaire. Both total score and individual ACE questions were correlated with diagnostic history, according to chi-square and multiple-group structural equation modeling tests. RESULTS: 84.8% of patients reported at least one ACE and 49.1% had an ACE score ≥ 4. Experiencing 1 or more ACEs predicted having any SUD, after controlling for race/ethnicity and gender. Parent substance use, physical abuse, and sexual abuse in particular were the strongest predictors of developing any SUD. Men and non-white individuals were more likely to develop an SUD with lower ACE scores than women and white individuals. CONCLUSIONS: While ACEs predict an increased likelihood of developing any SUD, the nature of this relationship differs by both gender and race/ethnicity. In this FQHC patient population there is no obvious dose-response relationship between ACEs and SUDs. Additional research is required to help understand why the relationship between ACEs and SUDs observed here differs from other populations.