The Impact of Adverse Childhood Experiences on Substance Use Severity: The Protective Role of Coping and Resilience

            Background: Research indicates a robust correlation between adverse childhood experiences (ACE) and substance use disorders (SUD) (Dube, et al., 2003; Elwyn & Smith, 2013; Felitti, et al., 2007; Levenson, 2015). Maltreatment in childhood or adolescents is linked to increased risk for developing SUD in adulthood (Elwyn & Smith, 2013). To ensure the healthy development and wellbeing of children and youth, it is important that research explore factors that protect against the deleterious impact of ACE. The importance of emotional intelligence, self-efficacy, coping, and resilience for wellbeing has been explored and confirmed through numerous studies; however, the potential importance of these curative factors in reducing substance use severity (SUS) in the face of childhood trauma among clinical populations is still understudied. Understanding the potential role of specific protective factors may provide clear and effective targets for intervention among this clinical population, as well as directions for preventative interventions among children and youth exposed to ACE. As such, the primary aim of this study was to investigate the extent to which key risk and protective factors may be of significance on the ACE to SUS continuum.

Methods: The sample consisted of 241 adults diagnosed with SUD. Data were collected from residential treatment programs for co-occurring SUD. The majority of the sample was non-Hispanic white (71.8%), heterosexual (83.8%), and male (58.5). Participants’ age ranged from 18-68 (mean = 33), age of drug-use onset ranged from 4-42 (mean =14.5). First drugs used were alcohol (67.5%) and marijuana (24.7%). Primary drugs of choice reported were alcohol (44.5%), heroin (33.9%), and prescribed opioids (20%). Over 80% of participants reported needing emotional help, had psychiatric admissions (32%), or attempted suicide (28%). Study measures included: Adverse Childhood Experiences scale (Felitti, et al., 1998), Self-Report Emotional Intelligence Test (Schutte, et al., 1998), Proactive Coping Scale (Greenglass, et al., 1999), Brief Resilience Scale (Smith, et al., 2008), General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995), and Mental Health Screening Form III (Carroll & McGinley, 2001). Three scales were developed to measure the dependent variable SUS: meeting DSM-V diagnosis criteria, negative substance-use outcomes, and substance-use persistence despite adversity.

            Results: As anticipated, hierarchical regression analysis revealed significant positive correlations between ACE (p < .05), age-of-onset (p < .05), and mental-health-pathology (p < .01), on SUS. While neither emotional intelligence nor self-efficacy maintained significance, resilience (p < .01) and coping (p < .05), were significantly negatively related to two of the three measures of SUS.

            Conclusions: Despite the robust impact of ACE on SUS, coping and resilience appear to play an important buffering role, mitigating the impact of traumatic childhood experiences.  Social work education and practice aimed at treating at-risk populations must integrate trauma informed practices focused on creating opportunities to develop and enhance coping skills and resilience into prevention and early intervention programs for youth, as well as, into treatment programs for clinical samples of adults already diagnosed with SUD. Future research should further explore factors that may buffer the negative impact of ACE on later SUS and the development of SUD.