Pathway of effects of adverse childhood experiences on the poly-drug use pattern among adults using drugs: A structural equation modeling

Front Public Health. 2023 Apr 5;11:1043222. doi: 10.3389/fpubh.2023.1043222. eCollection 2023.


Introduction: Adverse childhood experiences (ACEs) are associated with an increased risk of poly-substance use among drug-using adults. However, there is a paucity of literature on a direct or indirect relationship between ACEs and drug use patterns. We thus aimed to identify the pathway of effects of ACEs on drug use patterns in adults by the structural equation model (SEM).

Methods: A cross-sectional study was conducted by respondent-driving sampling and consecutive sampling among adult drug users in Southwest China in 2021. Descriptive, univariate, and SEM analyses were performed by R software 4.2.1.

Results: Of 406 participants recruited from a drug abuse clinic, the average age was 34 years. The majority of the participants were male patients (98.3%) from ethnic minorities (79.6%), who were unmarried (71.6%) and employed (81.2%). Nearly 95.5% experienced ACEs with 46.6% of them reporting four or more ACEs. The median value of self-perception of drug abuse score, friend drug use score, and drug use score was 8.0 (3.0, 11.0), 1.0 (0.0, 1.0), and 1.0 (1.0, 2.0) respectively. In the confirmatory analysis part of SEM, the construct of latent variables fitted well with the data. Poly-drug use was significantly and directly affected by three predictors including monthly incomes (β = 0.09), friend drug use (β = 0.50), and ACEs (β = 0.11). The indirect effect of ACEs passing through self-perception of drugs (β = 0.09) was not significant.

Discussion: ACEs have an independent and direct effect on the drug user for poly-drug use apart from the effect of drug-using friends and family income.

Keywords: addiction; adverse childhood experiences (ACEs); drug use; poly-drug uses; structural equation models (SEM).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adverse Childhood Experiences*
  • Child
  • Child Abuse*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Latent Class Analysis
  • Male
  • Substance-Related Disorders* / epidemiology

Grants and funding

The survey was supported by the National Natural Science Foundation of China (81760617 and 72274086), the Reserve Talents Program for Young and Middle-aged Academic and Technical Leaders of Yunnan Province (202205AC160064), and science and technology innovation team (No. K1322114). This research was also partially financially supported by the Prince of Songkla University and the Ministry of Higher Education, Science, Research and Innovation under the Reinventing University Project (Grant Number REV65XXX). The funding agencies were not involved in the design of the study, collection, analysis, and interpretation of data, and in writing the manuscript.