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 examined the relationship between ACEs and age of initiation of substance use using 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 engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation. Results: A total of 107 participants completed the study. 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 ( hazard ratio (HR) = 1.14, 95% CI=1.02–1.28, p = 0.02, and HR=1.19, 95% CI = 1.04–1.37, p = 0.01, 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 for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.

Original languageEnglish (US)
Pages (from-to)218-231
Number of pages14
JournalInternational journal of psychiatry in medicine
Issue number2
StatePublished - Mar 2024


  • 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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