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.
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: <or=14 years, 15 to
18 years, or as an adult (>or=19 years); lifetime use for each of 4 birth cohorts
dating back to 1900; drug use problems; drug addiction; and parenteral drug use.
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 >or=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.
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.