Adverse Childhood Experiences and Problems with Substance Use: Results from a Large-Scale Survey of Social Workers

Background/Purpose

Problem
Kaiser Permanente and the Centers for Disease Control and Prevention developed the Adverse Childhood Experiences (ACE) scale to measure maltreatment and its association with health outcomes during adulthood.  Utilizing the ACE inventory, numerous studies have demonstrated that childhood abuse, neglect, and household dysfunction are strong predictors of health risk behaviors, including substance misuse.  While limited, research suggests that social workers are disproportionately affected by both childhood trauma and problems with alcohol and/or illicit drugs.  However, this hypothesis has not been tested in a large sample of social workers. 

Objectives
This presentation shares findings from a recent online survey of licensed social workers (n=6,251).  This study investigated social workers’ ACEs and problems with substance use (PWSU), among other issues.     

Research questions
1.  What is the prevalence of ACEs among social workers?  How do these estimates compare to ACEs in the general population?

2.  What is the scope and nature of social workers’ PWSU?

3.  In this sample, what is the association between ACEs and PWSU?       

Methods

Design  
The cross-sectional study used convenience sampling.  Social workers’ email addresses were acquired from licensing boards of 13 states that provide this information, representing all four regions of the U.S.  Email addresses of 70,000 social workers were obtained; 35,000 were randomly selected to participate. Depending upon analytic approach, the estimated response rate is 17%-30%. 

Data collection
An initial invitation and two reminders were emailed to all individuals.  A web-link embedded in the email granted access to a Qualtrics-supported site detailing IRB-approved informed consent and hosting the survey.   

Measures
The ACE scale consists of 10 items with yes/no response options. Two questions commonly used by the CDC assess alcohol and drug problems. Follow-up questions with open-ended response options generated additional information about ACEs, PWSU, and their impact on respondents’ work. 

Analysis
Descriptive analyses detailed the prevalence of ACEs and PWSU.  Hypothesized associations between ACEs and PSWU were tested using binary logistic regression.  Main-effect analyses were performed by regressing the outcome variables on each item of the ACE.  Tests of moderation examined differences by gender, race/ethnicity, fields of practice, and other factors.

Results
Seventy percent of social workers reported 1 or more ACEs (general population: 64%), 50% had 2 or higher (general population: 38%), and 23% had 4 or more ACEs (general population: 13%).  Among social workers, growing up with a family member with a major mental illness was the most commonly occurring ACE; in the general population, the most prevalent ACE was familial substance abuse.      

Similar to national averages, problems with alcohol (9%) and/or other drugs (6%) impacted a small portion of the sample.

Statistical analyses indicated there were significant, graded associations between ACEs and PWSU.  As exposure to ACEs increased, so did the likelihood of PWSU. 

Conclusions/Implications
Compared to the general population, social workers may be disproportionately affected by childhood maltreatment.  These experiences are strongly associated with substance misuse, impacting wellness and the workplace.  Coupled with findings from ongoing investigation, these results have tremendous implications for social work practice, education, and workforce development.