PEDIATRICS Vol. 111 No. 3 March 2003, pp. 564-572
Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study
* National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Department of Preventive Medicine, Southern California Permanente Medical Group (Kaiser Permanente), San Diego, California
--> Objective. Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed.
Methods. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: 
14 years, 15 to 18 years, or as an adult (
19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use.
Results. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with 5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use.
Conclusions. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.
Key Words: childhood abuse • domestic violence • drug use • substance abuse • parenteral drug use
Abbreviations: ACE, adverse childhood experience • CTS, Conflict Tactics Scale • CTQ, Childhood Trauma Questionnaire • SD, standard deviation • OR, odds ratio • CI, confidence interval • ARF, attributable risk fraction
Received for publication Mar 20, 2002; Accepted Jul 22, 2002.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  P. C. Hebert and N. MacDonald Soins de sante pour les enfants en famille d'accueil: Reparer le systeme, sauver un enfant Can. Med. Assoc. J., October 13, 2009; 181(8): E123 - E124. [Full Text] [PDF]
|
|
|
|
|
|
P. C. Hebert and N. MacDonald Health care for foster kids: Fix the system, save a child Can. Med. Assoc. J., October 13, 2009; 181(8): 453 - 453. [Full Text] [PDF]
|
|
|
|
 |
|
 Committee on Psychosocial Aspects of Child and Fam The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care Pediatrics, July 1, 2009; 124(1): 410 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. HARVEY Teen Behaviors Reflective of Parental Smoking Am J Psychiatry, March 1, 2009; 166(3): 373 - 373. [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Dube, D. Fairweather, W. S. Pearson, V. J. Felitti, R. F. Anda, and J. B. Croft Cumulative Childhood Stress and Autoimmune Diseases in Adults Psychosom Med, February 1, 2009; 71(2): 243 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Boynton-Jarrett, L. M. Ryan, L. F. Berkman, and R. J. Wright Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States Pediatrics, November 1, 2008; 122(5): 961 - 970. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Lu, K. T. Mueser, S. D. Rosenberg, and M. K. Jankowski Correlates of Adverse Childhood Experiences Among Adults With Severe Mood Disorders Psychiatr Serv, September 1, 2008; 59(9): 1018 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. G. Flaherty, R. D. Sege, J. Griffith, L. L. Price, R. Wasserman, E. Slora, N. Dhepyasuwan, D. Harris, D. Norton, M. L. Angelilli, et al. From Suspicion of Physical Child Abuse to Reporting: Primary Care Clinician Decision-Making Pediatrics, September 1, 2008; 122(3): 611 - 619. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. O. Afifi, M. W. Enns, B. J. Cox, G. J.G. Asmundson, M. B. Stein, and J. Sareen Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated With Adverse Childhood Experiences Am J Public Health, May 1, 2008; 98(5): 946 - 952. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Iversen, N. T. Fear, E. Simonoff, L. Hull, O. Horn, N. Greenberg, M. Hotopf, R. Rona, and S. Wessely Influence of childhood adversity on health among male UK military personnel The British Journal of Psychiatry, December 1, 2007; 191(6): 506 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Messina, C. Grella, W. Burdon, and M. Prendergast Childhood Adverse Events and Current Traumatic Distress: A Comparison of Men and Women Drug-Dependent Prisoners Criminal Justice and Behavior, November 1, 2007; 34(11): 1385 - 1401. [Abstract] [PDF]
|
|
|
|
|
|
N. D. Kellogg and and the Committee on Child Abuse and Neglect Evaluation of Suspected Child Physical Abuse Pediatrics, June 1, 2007; 119(6): 1232 - 1241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Flaherty, R. Thompson, A. J. Litrownik, A. Theodore, D. J. English, M. M. Black, T. Wike, L. Whimper, D. K. Runyan, and H. Dubowitz Effect of Early Childhood Adversity on Child Health Arch Pediatr Adolesc Med, December 1, 2006; 160(12): 1232 - 1238. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Moffett, J. Harley, D. Francis, S. P. Sanghani, W. I. Davis, and M. J. Kuhar Maternal Separation and Handling Affects Cocaine Self-Administration in Both the Treated Pups as Adults and the Dams J. Pharmacol. Exp. Ther., June 1, 2006; 317(3): 1210 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Bair-Merritt, M. Blackstone, and C. Feudtner Physical Health Outcomes of Childhood Exposure to Intimate Partner Violence: A Systematic Review Pediatrics, February 1, 2006; 117(2): e278 - e290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. W. Lineberry and J. M. Bostwick Methamphetamine Abuse: A Perfect Storm of Complications Mayo Clin. Proc., January 1, 2006; 81(1): 77 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Dong, R. F. Anda, V. J. Felitti, D. F. Williamson, S. R. Dube, D. W. Brown, and W. H. Giles Childhood Residential Mobility and Multiple Health Risks During Adolescence and Adulthood: The Hidden Role of Adverse Childhood Experiences Arch Pediatr Adolesc Med, December 1, 2005; 159(12): 1104 - 1110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Noether, N. Finkelstein, N. R. VanDeMark, A. Savage, B. G. Reed, and D. J. Moses Design Strengths and Issues of SAMHSA's Women, Co-occurring Disorders, and Violence Study Psychiatr Serv, October 1, 2005; 56(10): 1233 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Galea, A. Nandi, and D. Vlahov The Social Epidemiology of Substance Use Epidemiol. Rev., July 1, 2004; 26(1): 36 - 52. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Dong, S. R. Dube, V. J. Felitti, W. H. Giles, and R. F. Anda Adverse Childhood Experiences, Obesity, and Liver Disease--Reply Arch Intern Med, February 23, 2004; 164(4): 460 - 461. [Full Text] [PDF]
|
|
