Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review

Abstract

Background and aims Childhood adversity is a strong, and concerningly prevalent, risk factor for the later development of substance misuse. Yet despite substantial accumulating evidence for causal mechanisms, there has been little attempt to synthesize the strength of the evidence. Importantly, these mechanisms may be amenable to intervention, providing targets for substance use prevention among those exposed to childhood adversity. The present review aimed to systematically identify mediating and moderating mechanisms operating between childhood adversity and substance use. Methods A systematic review was conducted. Electronic databases (PubMed, MEDLINE, PsycINFO, Web of Science and CINAHL) were searched from 1998 to 2020 for modifiable mediators and moderators of the relationship between childhood adversity and substance use in people aged 10–24. Data was qualitatively synthesised, using a socio-ecological perspective to group mediators/moderators into individual, interpersonal, community, and public policy/cultural levels of behaviour. Results After screening against eligibility criteria, 50 studies were included in the current review. The mediators at the individual level of behaviour showing the largest and most consistent effect sizes included externalising behaviour, anger, coping motives for substance use, and post-traumatic stress symptoms. Among individual-level moderators, religiosity, future orientation and depressive symptoms all attenuated the relationship between childhood adversity and substance use. At the interpersonal level, peer relationships and mother-child relationships mediated the effect of adversity on substance use. Moderators included family cohesion and relationship quality. Community factors were less commonly studied, though school mobility and educational achievement mediated 14% and 28% of the total effect of childhood adversity on substance use respectively. No mediators or moderators were identified for public policy/culture. Conclusions A substantial proportion of the relationship between childhood adversity and substance use in youth is mediated through individual, interpersonal and community factors. Coupled with the knowledge that existing, evidence-based programs effectively address many of the identified mediators and moderators, this review advances knowledge on optimal targets to prevent substance misuse among those exposed to childhood adversity.

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

“…One systematic review examined social factors as mediating or moderating the relationship between ACEs and substance misuse. 23 ACE exposure was found to be associated with increased substance misuse through lower educational opportunity and achievement and involvement with the justice system. 23 Moreover, living in a neighborhood characterized by greater trust and social cohesion reduced the association between ACEs and alcohol misuse.…”

“… Mean age: 34–42 579 ACEs were positively associated with problem substance use and earlier age of initiation. Grummitt et al 2021a 23 PA, SA, EA, EN, PN, DV, household SU, household MI, household incarceration, PS Substance misuse, SUD, SU dependence, age of SU initiation Youth with SU outcome measured ≤ age 24 Longitudinal studies only 59,798 Found the relationship between ACEs and substance misuse was mediated by anger, coping motives, posttraumatic stress symptoms, externalizing behavior, peer relationships, mother-child relationship, school mobility, and educational achievement. The link between ACEs and substance misuse was moderated by depressive symptoms, religiosity, future orientation, family cohesion and quality of relationships.…”

“… 23 Moreover, living in a neighborhood characterized by greater trust and social cohesion reduced the association between ACEs and alcohol misuse. 23 …”

Social and Behavioral Pathways between Adverse Childhood Experiences and Poor Adult Physical Health: Mediation by Early Adulthood Experiences in a Low-Income Population

“…This study builds on previous literature by focusing more specifically on mediation of physical health outcomes. However, substance use is often a coping mechanism for trauma [ 63 ] and frequently begins in childhood or adolescence [ 20 ]; this may complicate the timing of trauma-informed interventions to prevent this pathway, which are most successful before substance use becomes chronic [ 63 ].…”

“I Grew Up Amidst Alcohol and Drugs:” a Qualitative Study on the Lived Experiences of Parental Substance Use Among Adults Who Developed Substance Use Disorders Themselves

“…Growing evidence shows an association between early life stress and adversity and heightened risk for developing SUDs in adolescence (16)(17)(18)(19)(20)(21)(22)(23)(24), which is a critical window for initiation, experimentation, and establishment of more regular patterns of substance use (25)(26)(27)(28)(29)(30)(31)(32). A substantial proportion of the relationship between childhood adversity and substance use in adolescence is mediated through individual, interpersonal and community factors (33,34). Evidence suggests that associations between cumulative stressors and adolescent substance use are moderated or mediated by genetic factors (e.g., related to cortisol regulation) (21,35,36), intrapersonal factors (e.g., executive cognitive function, self-esteem, impulsive behavior, inhibitory control, temperament) (37)(38)(39)(40)(41), or interpersonal factors (e.g., household and peer influences) (42)(43)(44)(45)(46)(47)(48)(49)(50)(51).…”