Cumulative Stressors and Adolescent Substance Use: A Review of 21st-Century Literature

Abstract

The aim of this review is to assess empirical studies from the last 2 decades that have examined the association between cumulative stressors and adolescent substance use. Cumulative stressors were measured in these studies with adverse childhood experiences or adolescent stressful life events inventories. The 109 articles meeting the eligibility criteria that emerged from the review demonstrated a consistent, yet modest, association between cumulative stressors and adolescent substance use. Of note, several studies found that the associations were moderated or mediated by genetic factors related to cortisol regulation, intrapersonal factors such as low self-control, or interpersonal factors such as peer substance use. The review’s findings thus suggest that efforts to reduce the effects of cumulative stressors on substance use could gainfully identify and target these risk moderators and mediators.

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

“…The link between ACEs and substance misuse was moderated by depressive symptoms, religiosity, future orientation, family cohesion and quality of relationships. Hoffman and Jones 2020 24 PA, SA, EA, N, DV, household SU, household MI, household incarceration, PS SUD, misuse, dependence. General population of adolescents or adolescents from secondary schools.…”

“…Specifically, Hoffmann and Jones reviewed the literature on cumulative adversities and adolescent substance use, and found evidence of a positive association for initiation, frequency of use, disorder, and dependence. 24 Moreover, among young adults, Rogers et al found that greater ACEs predicted increased quantity and frequency of alcohol consumption, harmful alcohol use, and alcohol use disorder. 31 This was also confirmed for other drugs, with studies finding a positive association between ACEs and tobacco and e-cigarette use, cannabis dependence, other illicit drugs and non-medical prescription opioid use.…”

“… 28 Another included review found that several studies concluded stronger associations between cumulative adversity and substance use in adolescent females, compared to males. 24 Yet among young adults in a recent review, three of the five studies examining sex as a moderator of the ACE-substance misuse relationship found significant moderation, specifically, that the relationships between ACEs and alcohol use problems, illicit drug use, and e-cigarette use, were found to be stronger for males, compared to females. 31 Moreover, in a meta-analysis of the association between childhood maltreatment and SUD among bipolar disorder patients, meta-regression revealed the proportion of female participants in the sample did not change the effect size.…”

“…In addition, many of these associations are based on cross-sectional data, which cannot provide evidence on the hypothesized direction of association between ACEs and substance misuse, and which often finds a stronger association between ACEs and substance misuse compared to longitudinal studies. 24 Importantly, ACEs often co-occur in environments where the presence of other confounding factors can limit the ability to infer causality in the absence of rigorous study design. For example, parental alcohol use disorder can confer risk for offspring alcohol use problems through both genetic and environmental pathways, but living with a parent suffering an alcohol use disorder may also increase the risk of accumulating ACEs through reduced capacity of the parent to provide physical and emotional needs, as well as supervision.…”

Family Structure, Unstructured Socializing, and Heavy Substance Use among Adolescents

“…Finally, scholars have posited that the stress produced by family reconfiguration may lead some youth to substance use as a way of coping with the pressures they feel at home. The euphoria produced by psychoactive substances can furnish a way for young people to alleviate feelings of distress, anxiety, and negative affect due to adverse family experiences and other untoward events [ 38 , 39 , 40 ].…”