Adverse childhood experiences and early initiation of substance use: A survival analysis

Amy L. Meadows, Justin C. Strickland, S. Maela Hyder, Rita C. Basconi, Margaret E. Stull, Frances P. Wagner, Mai N. Nguyen, Abner O. Rayapati, Craig R. Rush

Research output: Contribution to journalArticlepeer-review


Objective: Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examines the relationship between ACEs and age of initiation of substance use using a survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation. Method: Participants were recruited from the University of Kentucky’s Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English-speaking, and actively partaking in substance use. Participants were not in or seeking treatment for substance use. A paper screening protocol was completed. ACE scores were calculated and age of initiation was noted. A Cox proportional hazard model was used to predict substance use initiation by ACE score. Results: A total of 107 responses were analyzed. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset, demonstrating a hazard ratio (HR) of 1.14 and 1.19, P-value of.02 and.01, and 95% confidence intervals of (1.02, 1.28) and (1.04, 1.37) respectively. Conclusions: A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening, and intervention in childhood may be unique approaches to decrease the risk of substance use/SUD.

Original languageEnglish
JournalInternational Journal of Psychiatry in Medicine
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute on Drug Abuse (NIDA) [R01DA047391], [R01DA043938], [R01DA048617], [R01DA036550], [R01DA045023], [R01DA047368], [T32 DA07209], [R13DA042568], [K23DA054309]; and the National Institute on Alcohol and Alcoholism (NIAAA) [R01AA026255], [R21AA026129]. The funding body had no role in the design, analysis, or interpretation of the study.

Publisher Copyright:
© The Author(s) 2023.


  • adverse childhood experiences
  • initiation of substance use
  • mental illness
  • opioid use disorder
  • psychiatry
  • psychology
  • substance use
  • substance use disorder

ASJC Scopus subject areas

  • Psychiatry and Mental health


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