Is Child Maltreatment Associated with Substance Use? New Evidence Emerges


Female emergency department patients with adverse childhood experiences were more likely to have substance use issues.


According to a new study1 from the Prevention Research Center of the Pacific Institute for Research and Evaluation, child maltreatment is associated with increased risk of substance use among urban female emergency department (ED) patients.

Using a survey of 1037 married/partnered ED patients at a public safety-net hospital, researchers gathered data about at-risk drinking, cannabis, and illicit drug use. At least 1 adverse childhood experience was reported by 53% of men and 60% of women.

Carol Cunradi, the lead author, had this to say to the press: “Health disparities are pervasive among underserved populations, such as those seeking care at urban EDs. So it is important to understand how adverse childhood experiences are linked with substance use among urban ER patients. The prevalence of exposure to childhood maltreatment in this urban ED sample underscores the importance of ED staff providing trauma-informed care to patients, including the delivery of brief interventions and referral to treatment.”2

Child maltreatment, or adverse childhood experiences (ACEs), was quantified as exposure to a person with a mental illness in the home; a parent or caregiver with alcohol use disorder; sexual abuse; physical abuse; psychological abuse; and violence directed towards the mother. Participants were assessed on their exposure to the experiences with a brief version of the ACE scale, with 1 question per experience.

Men’s adverse childhood experiences were not associated with increased likelihood of substance use outcomes. Women’s, however, were associated. For example, women with more than 1 adverse experience were more likely to use cannabis or illicit drugs, and women whose mothers were victims of domestic abuse had a greater risk of unhealthy drinking.

Evidence of ACE-related health disparities in urban, low-income populations suggest the need for the development of effective primary prevention, and should be a priority in local, state, and federal entities. In the meantime, EDs may help with secondary prevention and assistance of care in disadvantaged patients.


1. Cunradi CB, Caetano R, Alter HJ, Ponicki WR. Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study. Am J Drug Alcohol Abuse. 2020:1-10.

2. Pacific Institute for Research and Evaluation. Adverse childhood experiences and at-risk drinking, cannabis, and illicit drug use. News release. Medical Xpress. November 23, 2020.

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