Chapter 8: Adverse Childhood Experiences (ACEs) and Age of First “Gateway” Substance Use

In this chapter, we assess how adverse childhood experiences (ACEs) impact the age of first use of gateway substances (tobacco, alcohol, and marijuana), which are substances typically used by adolescents before transitioning into more addictive illicit substances. ACEs, specifically child maltreatment and household dysfunction, have been consistently shown to have detrimental psychological, social, and health effects. We use the 2023 Youth Risk Behavior Survey (YRBS) to assess this relationship. We conducted multivariate Cox Regression analyses on responses from over 10,000 adolescents to examine associations between specific ACEs and age of first substance use (SU). We found that females reported more ACEs than males, but that the effects of ACEs on the age of onset into gateway drugs do not vary by gender. Sexual abuse, the least frequently reported ACE, and living with a household member with a drug disorder are two ACEs with the most profound impact on the age of first use of all three gateway substances, regardless of gender. Implications for targeted prevention programs and recommendations for future studies are discussed.