Patterns of Expanded Adverse Childhood Experiences (ACEs) and Adult Cannabis Use

Introduction. Adverse childhood experiences (ACEs) have been expanded to include additional ACEs, such as discrimination and bullying. However, few studies have examined associations between the expanded ACEs and cannabis use. Also, we know little about patterns of these expanded ACEs and whether different clusters confer additional risk for substance use. Understanding associations between ACEs and cannabis use is critical due to increasingly more liberalized cannabis regulations. This study addresses these gaps by using latent class analysis (LCA) with expanded ACE items and explores their associations with cannabis use.

Methods. We used quota sampling to survey 712 adults via Qualtrics, an online platform. Participants were cisgender females (57.7%) and males (40.7%), or transgender or non-binary (1.6%). Fifty five percent were White, 15% African American/Black, 16% Hispanic/Latinx, 9% Asian/Asian American, and 5% Other. Participants were surveyed on nine of ten original ACEs (i.e., sexual abuse not asked), five extended ACEs, cannabis use, and a cannabis use disorder screener, the CUDIT-R-SF. LCA were conducted in Mplus software. Logistic regression analyses were conducted to examine relationships between identified classes and cannabis outcomes.

Results. Lifetime (30%), past month (19%) and medicinal cannabis use (16%) were common. Approximately 16% of participants screened for having probable cannabis use disorders (CUD, ≥2 on CUDIT-R-SF). Analyses indicated that a four-class model fit the data best (BIC=9107.198, LMR p<0.05), including participants: 1) with low levels of ACEs, but who experienced bullying (Low Adversity, 33%), 2) who reported community violence, racial/ethnic discrimination, and bullying (Interpersonal Harm, 24%), 3) who experienced childhood abuse in addition to community violence, racial/ethnic discrimination, and bullying (Interpersonal Abuse and Harm, 25%), or 4) who experienced high levels of all ACEs (High Adversity, 18%).

Those experiencing High Adversity had significantly greater odds of past month (OR = 5.87) and medicinal marijuana use (OR = 7.35). They also reported significantly higher CUDIT-R-SF scores (M = 4.97). Participants in the Interpersonal Harm (OR = 3.12) and Interpersonal Abuse and Harm (OR = 5.95) classes also reported greater odds of marijuana use than those in the Low Adversity class.

Discussion.

Although limited by being cross-sectional and fully online, novel patterns of ACEs were identified using the expanded measure. Particularly important in today’s sociopolitical climate was the identification of two classes with high racial discrimination and community violence with or without elevated physical abuse. These classes were associated with elevated risks for cannabis use, raising the possibility that violence prevention and anti-discrimination efforts may curb cannabis use. Because participants in the High Adversity class had elevated risks for CUD, trauma-focused CUD treatments are essential. Additionally, given the much greater odds of medical cannabis use among the High Adversity class, future research must establish the efficacy of cannabis for treating PTSD and conditions that may be present among people with elevated ACEs. Most studies on the effects of cannabis on PTSD symptoms are observational. The effects of antiviolence and antidiscrimination efforts on cannabis use should be studied further, and we advocate trauma-focused care to those with CUD who experienced multiple ACEs.