Are adverse childhood experiences linked to early drug use?

We have known for some time that children who are exposed early on to ACEs  are more likely to suffer from a range of issues later. At the ESRC International Centre for Lifecourse Studies we have been doing research which has linked these events with an increased risk of conditions such as poor mental health.

Policymakers have been taking note, too. Recently, in response to the Leadsom review on how best to support children in their critical 1001 first days, the Government announced an investment of £300,000 million to transform “start for life” and family help services in half the council areas across England. The money will fund a network of family hubs, parent-infant mental health support, breastfeeding services and parenting programmes.

So what do we already know about ACEs? They’re defined as “experiences which require significant adaptation by the developing child in terms of psychological, social, and neurodevelopmental systems, and which are outside of the normal expected environment.” There isn’t a very clear list, but they can include violence, abuse and growing up in a family with mental health or substance use problems.

We have been able to show that these  early adversities increase the risk of all sorts of different mental health outcomes across the lifecourse, and that inflammatory markers in the blood are related to the risk of depression in early adulthood.

However, there is a real lack of UK research exploring the role of ACEs in teenage drug use, and until now even less was known about the complex interplay between these events and adolescents’ social, demographic and economic backgrounds.

Moreover, no study had explored links between ACEs and the timing of drug use in adolescence.

To address these gaps, we used rich longitudinal data from the nationally representative Millennium Cohort Study (MCS), which follows UK children born between September 2000 and January 2002. We had a sample group of 9500 individuals for whom full data was available up to age 17.

Traumatic events

Using a list of ACEs which included alcohol problems in the home, mental health issues, domestic violence, bullying and sexual abuse, we found that half this group had been exposed to at least one such issue, and one in 11 had been subjected to three or more.

Boys were more likely to live in a home where domestic violence had taken place, and were more likely to have been physically punished by the age of 7. Girls were more than three times more likely than boys to report sexual abuse by age 14, while boys were more likely to report being a victim of gun violence.

Overall, boys and girls experienced similar numbers of ACEs. And those from the poorest fifth of families were most at risk: almost a third of that group had experiences three or more ACEs by age 14 compared to fewer than one in 50 of those in the highest-income group. Those from Pakistani, Bangladeshi, Black African and Other heritage were more likely to suffer these events than white children, though these effects reduced when incomes were taken into consideration.

So we know social factors are playing a part, but it isn’t socio-economic conditions alone which lead to early drug use. Even those in the highest income groups were more at risk, we found, if they had experienced three or more ACEs by age 14.

We found that overall, young people from poorer backgrounds were more likely to have taken drugs at age 14. But this reversed by age 17, with those from wealthier backgrounds more likely to report drug use. Those with a mixed or Black Caribbean background were most likely to take drugs at age 17, and those from a Pakistani or Bangladeshi background were least likely to do so.

When we looked at ACES, we found girls who had experienced more than three were 9.6 times more likely to report drug use at age 14 than those who had experienced none, while boys were 3.4 times as likely.

Early drug use

So what do our findings tell us? We found drug use at 14 was relatively rare compared with at 17, and it’s possible that drugs are used at earlier ages as an escape from problems, while later they are a more common part of growing up and experimenting.

There’s a theory that boys are more likely to respond to ACEs with externalising behaviours such as stealing money, running away from abusive parents or engaging in violent behaviour, while girls may be more likely to resort to drugs.

But finding policy interventions which might short-circuit these effects by preventing the ACEs from happening in the first place could be fraught with difficulty. For instance, when the Early Intervention Foundation looked into ways of addressing sexual abuse, the programmes it assessed weren’t shown to be effective – sexual violence usually takes place in unsupervised spaces such as parties or parks, and is therefore hard to prevent.

Schools can help with Personal, Social, Health and Economic Education and by making pastoral support available, and the Children’s Commissioner has suggested schools should also model respectful and appropriate behaviour. But these are long-term initiatives, in which maybe young people will grow up to do things differently from their own parents.

The Government’s £300 for family hubs and other services certainly won’t do any harm. But it may be that more initiatives are needed: Our findings show exposure to sexual violence, bullying and violence within the household have knock-on consequences for wider aspects of young people’s lives, whatever their social, ethnic, or economic background. The need to reduce the incidence of these negative experiences is an urgent one.