People with adverse childhood experiences are at increased risk of developing substance-related problems. Social support, however, may help to protect against this risk. Researchers in this study investigated how social support influences the relationship between adverse childhood experiences and substance-related problems in young adults.
l
Adverse childhood experiences are defined as “potentially traumatic events that occur in childhood (0-17 years).” Examples include events such as experiencing violence, abuse, or neglect, growing up in a household with someone who has a substance use or mental health disorder, or not having enough to eat. These events are quite common, with just over half of adults in the U.S. reporting that they have experienced at least one of them and 21.5% reporting that they have experienced 3 or more.
Experiencing such events can interrupt children’s healthy development and ability to regulate their emotions, leading to difficulties in adulthood, including but not limited to alcohol and other drug use (i.e., substance use). For example, individuals in early adulthood who reported experiencing multiple adverse events during childhood had an increased risk of experiencing alcohol-related problems compared to individuals who have not experienced any adverse events. Likewise, adverse childhood experiences have been associated with daily cannabis use and cannabis-related problems.
Social support, however, may protect against this risk. In other words, when people have high levels of social support, it may act as a buffer against the risks of adverse childhood experiences. Researchers in this study aimed to investigate how social support influences the relationship between adverse childhood experiences and substance-related problems. Studies like this can help inform prevention and intervention efforts designed to reduce substance use.
This cross-sectional study surveyed young adults recruited from Prolific, an online platform connecting researchers to prospective study participants, to examine whether current perceptions of social support moderates (i.e., influences) the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. They also examined which type of social support moderated the associations, if they were present.
Individuals who lived in the United States were invited to participate in an online survey that asked about adverse childhood experiences, social support, and substance-related problems. Participants were eligible to participate if they were at least 18 years old, were able to speak or read English, and reported use of alcohol and cannabis (parameters regarding frequency or recency of substance use were not reported).
Adverse childhood experiences were assessed with the original Adverse Childhood Experiences Questionnaire, which includes 10 items asking participants to indicate whether they have experienced each event while they were growing up (e.g., “While you were growing up, during your first 18 years of life… Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you?”; “Did a household member go to prison?”). Each “yes” response equaled 1 point, with a maximum score of 10 points.
Social support was assessed with the Multidimensional Scale of Perceived Social Support, which includes 12 items asking participants to rate the extent to which they agree with each statement about their perception of support from 3 sources: family, friends, or a significant other (e.g., “I can talk about my problems with my friends”; “There is a special person whom I can share my joys and sorrows”). Notably, significant other did not have to be a romantic partner and instead could be any “special person.” Participants could respond using a 7-point scale, where 1 indicated “strongly disagree” and 7 indicated “strongly agree.” The responses were averaged to calculate an overall score, with higher scores reflecting higher social support.
The researchers were interested in the outcomes of alcohol- and cannabis-related problems. Alcohol-related problems were assessed with the Brief Young Adult Alcohol Consequences Questionnaire, which measures whether participants experienced problems from alcohol use during the past 30 days. Participants could reply yes or no for each potential problem. Cannabis-related problems were assessed by the Marijuana Problems Scale, which measures problems experienced from cannabis use during the last year. Participants could respond using a 3-point scale, with 0 being no problems, 1 being a minor problem, and 2 being a serious problem.
Examples of questions on study measures
Adverse childhood experiences
Social support
Alcohol-related problems
In total, the study included 401 participants. Of these, 59.1% were women and were on average approximately 23 years old. Approximately half identified as White (48.4%) and were currently employed (48.6%).
Adverse childhood experiences more strongly associated with alcohol-related problems when there was low social support.
More adverse childhood experiences were associated with less overall social support and support from family. Individuals reporting more adverse childhood experiences also tended to have more alcohol-related problems with a medium-sized relationship – 7% of the variability in alcohol problems was accounted for by adverse experiences and vice versa.
There was a moderating effect of social support on the association between adverse childhood experiences and alcohol-related problems. Adverse childhood experiences were most strongly associated with alcohol-related problems when participants reported low levels of overall perceived social support. This association is dampened at average levels of support – though still present. For those with high levels of support, there is no association between adverse childhood experiences and alcohol-related problems.
Adverse childhood experiences were not associated with cannabis-related problems, however. Also, social support did not moderate the association between adverse childhood experiences and cannabis-related problems.
Note: ACEs = Adverse childhood experiences.
Association between adverse childhood experiences and alcohol-related problems moderated by certain types of social support.
When different types of support making up the overall social support score were examined, both perceived social support from family and social support from friends moderated the association between adverse childhood experiences and alcohol-related problems. The patterns – with a stronger association at low support and no association at high support – were similar to the pattern for overall social support. Perceived social support from a significant other, however, did not moderate the association between adverse childhood experiences and alcohol-related problems.
Researchers in this study investigated whether current perceptions of social support influence the strength of the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. Results showed that social support influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, adverse childhood experiences were more strongly associated with alcohol-related problems when there was low social support, but not associated with alcohol-related problems for those with higher levels of support. Importantly, this study measured variables at one point in time (i.e., a cross-sectional study). While participants reported on adverse experiences from their childhood (0-17 years), both alcohol-related problems and social support were measures of current experiences. Because social support was assessed in a way that did not position it before alcohol-related problems, conclusions cannot be made about whether social support indeed helped protect against the risk of adverse childhood experiences on alcohol-related problems. That said, it is theoretically possible that social support did buffer against the risks of adverse childhood experiences in this young adult sample.
This suggests that young adults who have experienced adverse events during childhood, but perceive that they can turn to a family member or friend for support, may be partially protected from developing alcohol-related problems. These findings are consistent with prior research –also cross-sectional – demonstrating that, among adolescents who reported adverse childhood experiences, feeling like there was “an adult in the family who can be trusted” and feeling “close to other students at school” can act as protective factors against using substances in the last 30 days. Presumably, having such individuals in one’s social network can help affected youth cope better with the stress of these experiences, perhaps even enabling them to talk directly with such individuals about their histories and reduce the negative emotional burden (“a problem shared is a problem halved”). Strategies that help youth obtain social support may therefore be an important component of prevention and intervention programs to protect against the risk of adverse events on later alcohol problems.
The finding that there were no associations found between adverse childhood experiences and cannabis-related problems is surprising, given previous research that did demonstrate such associations. However, this inconsistency may be due to prior research focusing on child maltreatment specifically (i.e., abuse and neglect), rather than adverse experiences broadly. It may be that certain types of adverse experiences lead to problems with specific substances, for which additional research would be needed to understand.
One possible explanation for why support from family and friends was found to influence the association between adverse childhood experiences and alcohol-related problems, but not from a significant other, may be due to how “significant other” was defined. The significant other type of social support was not limited to a romantic partnership, but was defined as support from any “special person,” which could include family and friends. Indeed, when participants were asked who they were thinking about when answering these questions, 41% indicated they were thinking of a romantic partner, while 26% indicated a friend and 14% indicated a family member. This suggests that some of the effect for the significant other type of social support may have been absorbed by the other types. It is also possible that significant others, in this sample of young adults with an average age of 23, had romantic partnerships that were not sufficiently long-term and stable to promote the level of social support needed to protect against risks of adverse events. Accordingly, future research that specifically examines how influential romantic partners are for this relationship, and the nature of the relationship, would be needed to make such an interpretation.
Social support positively influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, there was no relationship between adverse childhood experiences and alcohol-related problems for participants with higher levels of social support. While this may have implications for alcohol use prevention and intervention in youth, these variables were assessed at one point in time, and participants reported on current social support and alcohol-related problems. Thus, whether social support indeed helped buffer the risks of adverse childhood consequences on alcohol-related problems cannot be determined directly from this study, although findings are consistent with theoretical and empirical work on the helpful and healing effects of social support.
McCollum, D. C., Teeters, J. B., Moskal, K. R., & Woodward, M. J. (2023). Does social support moderate the association between adverse childhood experiences and substance-related problems? Substance Use & Misuse, 1-9. doi: 10.1080/10826084.2023.2269570
l
Adverse childhood experiences are defined as “potentially traumatic events that occur in childhood (0-17 years).” Examples include events such as experiencing violence, abuse, or neglect, growing up in a household with someone who has a substance use or mental health disorder, or not having enough to eat. These events are quite common, with just over half of adults in the U.S. reporting that they have experienced at least one of them and 21.5% reporting that they have experienced 3 or more.
Experiencing such events can interrupt children’s healthy development and ability to regulate their emotions, leading to difficulties in adulthood, including but not limited to alcohol and other drug use (i.e., substance use). For example, individuals in early adulthood who reported experiencing multiple adverse events during childhood had an increased risk of experiencing alcohol-related problems compared to individuals who have not experienced any adverse events. Likewise, adverse childhood experiences have been associated with daily cannabis use and cannabis-related problems.
Social support, however, may protect against this risk. In other words, when people have high levels of social support, it may act as a buffer against the risks of adverse childhood experiences. Researchers in this study aimed to investigate how social support influences the relationship between adverse childhood experiences and substance-related problems. Studies like this can help inform prevention and intervention efforts designed to reduce substance use.
This cross-sectional study surveyed young adults recruited from Prolific, an online platform connecting researchers to prospective study participants, to examine whether current perceptions of social support moderates (i.e., influences) the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. They also examined which type of social support moderated the associations, if they were present.
Individuals who lived in the United States were invited to participate in an online survey that asked about adverse childhood experiences, social support, and substance-related problems. Participants were eligible to participate if they were at least 18 years old, were able to speak or read English, and reported use of alcohol and cannabis (parameters regarding frequency or recency of substance use were not reported).
Adverse childhood experiences were assessed with the original Adverse Childhood Experiences Questionnaire, which includes 10 items asking participants to indicate whether they have experienced each event while they were growing up (e.g., “While you were growing up, during your first 18 years of life… Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you?”; “Did a household member go to prison?”). Each “yes” response equaled 1 point, with a maximum score of 10 points.
Social support was assessed with the Multidimensional Scale of Perceived Social Support, which includes 12 items asking participants to rate the extent to which they agree with each statement about their perception of support from 3 sources: family, friends, or a significant other (e.g., “I can talk about my problems with my friends”; “There is a special person whom I can share my joys and sorrows”). Notably, significant other did not have to be a romantic partner and instead could be any “special person.” Participants could respond using a 7-point scale, where 1 indicated “strongly disagree” and 7 indicated “strongly agree.” The responses were averaged to calculate an overall score, with higher scores reflecting higher social support.
The researchers were interested in the outcomes of alcohol- and cannabis-related problems. Alcohol-related problems were assessed with the Brief Young Adult Alcohol Consequences Questionnaire, which measures whether participants experienced problems from alcohol use during the past 30 days. Participants could reply yes or no for each potential problem. Cannabis-related problems were assessed by the Marijuana Problems Scale, which measures problems experienced from cannabis use during the last year. Participants could respond using a 3-point scale, with 0 being no problems, 1 being a minor problem, and 2 being a serious problem.
Examples of questions on study measures
Adverse childhood experiences
Social support
Alcohol-related problems
In total, the study included 401 participants. Of these, 59.1% were women and were on average approximately 23 years old. Approximately half identified as White (48.4%) and were currently employed (48.6%).
Adverse childhood experiences more strongly associated with alcohol-related problems when there was low social support.
More adverse childhood experiences were associated with less overall social support and support from family. Individuals reporting more adverse childhood experiences also tended to have more alcohol-related problems with a medium-sized relationship – 7% of the variability in alcohol problems was accounted for by adverse experiences and vice versa.
There was a moderating effect of social support on the association between adverse childhood experiences and alcohol-related problems. Adverse childhood experiences were most strongly associated with alcohol-related problems when participants reported low levels of overall perceived social support. This association is dampened at average levels of support – though still present. For those with high levels of support, there is no association between adverse childhood experiences and alcohol-related problems.
Adverse childhood experiences were not associated with cannabis-related problems, however. Also, social support did not moderate the association between adverse childhood experiences and cannabis-related problems.
Note: ACEs = Adverse childhood experiences.
Association between adverse childhood experiences and alcohol-related problems moderated by certain types of social support.
When different types of support making up the overall social support score were examined, both perceived social support from family and social support from friends moderated the association between adverse childhood experiences and alcohol-related problems. The patterns – with a stronger association at low support and no association at high support – were similar to the pattern for overall social support. Perceived social support from a significant other, however, did not moderate the association between adverse childhood experiences and alcohol-related problems.
Researchers in this study investigated whether current perceptions of social support influence the strength of the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. Results showed that social support influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, adverse childhood experiences were more strongly associated with alcohol-related problems when there was low social support, but not associated with alcohol-related problems for those with higher levels of support. Importantly, this study measured variables at one point in time (i.e., a cross-sectional study). While participants reported on adverse experiences from their childhood (0-17 years), both alcohol-related problems and social support were measures of current experiences. Because social support was assessed in a way that did not position it before alcohol-related problems, conclusions cannot be made about whether social support indeed helped protect against the risk of adverse childhood experiences on alcohol-related problems. That said, it is theoretically possible that social support did buffer against the risks of adverse childhood experiences in this young adult sample.
This suggests that young adults who have experienced adverse events during childhood, but perceive that they can turn to a family member or friend for support, may be partially protected from developing alcohol-related problems. These findings are consistent with prior research –also cross-sectional – demonstrating that, among adolescents who reported adverse childhood experiences, feeling like there was “an adult in the family who can be trusted” and feeling “close to other students at school” can act as protective factors against using substances in the last 30 days. Presumably, having such individuals in one’s social network can help affected youth cope better with the stress of these experiences, perhaps even enabling them to talk directly with such individuals about their histories and reduce the negative emotional burden (“a problem shared is a problem halved”). Strategies that help youth obtain social support may therefore be an important component of prevention and intervention programs to protect against the risk of adverse events on later alcohol problems.
The finding that there were no associations found between adverse childhood experiences and cannabis-related problems is surprising, given previous research that did demonstrate such associations. However, this inconsistency may be due to prior research focusing on child maltreatment specifically (i.e., abuse and neglect), rather than adverse experiences broadly. It may be that certain types of adverse experiences lead to problems with specific substances, for which additional research would be needed to understand.
One possible explanation for why support from family and friends was found to influence the association between adverse childhood experiences and alcohol-related problems, but not from a significant other, may be due to how “significant other” was defined. The significant other type of social support was not limited to a romantic partnership, but was defined as support from any “special person,” which could include family and friends. Indeed, when participants were asked who they were thinking about when answering these questions, 41% indicated they were thinking of a romantic partner, while 26% indicated a friend and 14% indicated a family member. This suggests that some of the effect for the significant other type of social support may have been absorbed by the other types. It is also possible that significant others, in this sample of young adults with an average age of 23, had romantic partnerships that were not sufficiently long-term and stable to promote the level of social support needed to protect against risks of adverse events. Accordingly, future research that specifically examines how influential romantic partners are for this relationship, and the nature of the relationship, would be needed to make such an interpretation.
Social support positively influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, there was no relationship between adverse childhood experiences and alcohol-related problems for participants with higher levels of social support. While this may have implications for alcohol use prevention and intervention in youth, these variables were assessed at one point in time, and participants reported on current social support and alcohol-related problems. Thus, whether social support indeed helped buffer the risks of adverse childhood consequences on alcohol-related problems cannot be determined directly from this study, although findings are consistent with theoretical and empirical work on the helpful and healing effects of social support.
McCollum, D. C., Teeters, J. B., Moskal, K. R., & Woodward, M. J. (2023). Does social support moderate the association between adverse childhood experiences and substance-related problems? Substance Use & Misuse, 1-9. doi: 10.1080/10826084.2023.2269570
l
Adverse childhood experiences are defined as “potentially traumatic events that occur in childhood (0-17 years).” Examples include events such as experiencing violence, abuse, or neglect, growing up in a household with someone who has a substance use or mental health disorder, or not having enough to eat. These events are quite common, with just over half of adults in the U.S. reporting that they have experienced at least one of them and 21.5% reporting that they have experienced 3 or more.
Experiencing such events can interrupt children’s healthy development and ability to regulate their emotions, leading to difficulties in adulthood, including but not limited to alcohol and other drug use (i.e., substance use). For example, individuals in early adulthood who reported experiencing multiple adverse events during childhood had an increased risk of experiencing alcohol-related problems compared to individuals who have not experienced any adverse events. Likewise, adverse childhood experiences have been associated with daily cannabis use and cannabis-related problems.
Social support, however, may protect against this risk. In other words, when people have high levels of social support, it may act as a buffer against the risks of adverse childhood experiences. Researchers in this study aimed to investigate how social support influences the relationship between adverse childhood experiences and substance-related problems. Studies like this can help inform prevention and intervention efforts designed to reduce substance use.
This cross-sectional study surveyed young adults recruited from Prolific, an online platform connecting researchers to prospective study participants, to examine whether current perceptions of social support moderates (i.e., influences) the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. They also examined which type of social support moderated the associations, if they were present.
Individuals who lived in the United States were invited to participate in an online survey that asked about adverse childhood experiences, social support, and substance-related problems. Participants were eligible to participate if they were at least 18 years old, were able to speak or read English, and reported use of alcohol and cannabis (parameters regarding frequency or recency of substance use were not reported).
Adverse childhood experiences were assessed with the original Adverse Childhood Experiences Questionnaire, which includes 10 items asking participants to indicate whether they have experienced each event while they were growing up (e.g., “While you were growing up, during your first 18 years of life… Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you?”; “Did a household member go to prison?”). Each “yes” response equaled 1 point, with a maximum score of 10 points.
Social support was assessed with the Multidimensional Scale of Perceived Social Support, which includes 12 items asking participants to rate the extent to which they agree with each statement about their perception of support from 3 sources: family, friends, or a significant other (e.g., “I can talk about my problems with my friends”; “There is a special person whom I can share my joys and sorrows”). Notably, significant other did not have to be a romantic partner and instead could be any “special person.” Participants could respond using a 7-point scale, where 1 indicated “strongly disagree” and 7 indicated “strongly agree.” The responses were averaged to calculate an overall score, with higher scores reflecting higher social support.
The researchers were interested in the outcomes of alcohol- and cannabis-related problems. Alcohol-related problems were assessed with the Brief Young Adult Alcohol Consequences Questionnaire, which measures whether participants experienced problems from alcohol use during the past 30 days. Participants could reply yes or no for each potential problem. Cannabis-related problems were assessed by the Marijuana Problems Scale, which measures problems experienced from cannabis use during the last year. Participants could respond using a 3-point scale, with 0 being no problems, 1 being a minor problem, and 2 being a serious problem.
Examples of questions on study measures
Adverse childhood experiences
Social support
Alcohol-related problems
In total, the study included 401 participants. Of these, 59.1% were women and were on average approximately 23 years old. Approximately half identified as White (48.4%) and were currently employed (48.6%).
Adverse childhood experiences more strongly associated with alcohol-related problems when there was low social support.
More adverse childhood experiences were associated with less overall social support and support from family. Individuals reporting more adverse childhood experiences also tended to have more alcohol-related problems with a medium-sized relationship – 7% of the variability in alcohol problems was accounted for by adverse experiences and vice versa.
There was a moderating effect of social support on the association between adverse childhood experiences and alcohol-related problems. Adverse childhood experiences were most strongly associated with alcohol-related problems when participants reported low levels of overall perceived social support. This association is dampened at average levels of support – though still present. For those with high levels of support, there is no association between adverse childhood experiences and alcohol-related problems.
Adverse childhood experiences were not associated with cannabis-related problems, however. Also, social support did not moderate the association between adverse childhood experiences and cannabis-related problems.
Note: ACEs = Adverse childhood experiences.
Association between adverse childhood experiences and alcohol-related problems moderated by certain types of social support.
When different types of support making up the overall social support score were examined, both perceived social support from family and social support from friends moderated the association between adverse childhood experiences and alcohol-related problems. The patterns – with a stronger association at low support and no association at high support – were similar to the pattern for overall social support. Perceived social support from a significant other, however, did not moderate the association between adverse childhood experiences and alcohol-related problems.
Researchers in this study investigated whether current perceptions of social support influence the strength of the associations between adverse childhood experiences and current alcohol- or cannabis-related problems. Results showed that social support influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, adverse childhood experiences were more strongly associated with alcohol-related problems when there was low social support, but not associated with alcohol-related problems for those with higher levels of support. Importantly, this study measured variables at one point in time (i.e., a cross-sectional study). While participants reported on adverse experiences from their childhood (0-17 years), both alcohol-related problems and social support were measures of current experiences. Because social support was assessed in a way that did not position it before alcohol-related problems, conclusions cannot be made about whether social support indeed helped protect against the risk of adverse childhood experiences on alcohol-related problems. That said, it is theoretically possible that social support did buffer against the risks of adverse childhood experiences in this young adult sample.
This suggests that young adults who have experienced adverse events during childhood, but perceive that they can turn to a family member or friend for support, may be partially protected from developing alcohol-related problems. These findings are consistent with prior research –also cross-sectional – demonstrating that, among adolescents who reported adverse childhood experiences, feeling like there was “an adult in the family who can be trusted” and feeling “close to other students at school” can act as protective factors against using substances in the last 30 days. Presumably, having such individuals in one’s social network can help affected youth cope better with the stress of these experiences, perhaps even enabling them to talk directly with such individuals about their histories and reduce the negative emotional burden (“a problem shared is a problem halved”). Strategies that help youth obtain social support may therefore be an important component of prevention and intervention programs to protect against the risk of adverse events on later alcohol problems.
The finding that there were no associations found between adverse childhood experiences and cannabis-related problems is surprising, given previous research that did demonstrate such associations. However, this inconsistency may be due to prior research focusing on child maltreatment specifically (i.e., abuse and neglect), rather than adverse experiences broadly. It may be that certain types of adverse experiences lead to problems with specific substances, for which additional research would be needed to understand.
One possible explanation for why support from family and friends was found to influence the association between adverse childhood experiences and alcohol-related problems, but not from a significant other, may be due to how “significant other” was defined. The significant other type of social support was not limited to a romantic partnership, but was defined as support from any “special person,” which could include family and friends. Indeed, when participants were asked who they were thinking about when answering these questions, 41% indicated they were thinking of a romantic partner, while 26% indicated a friend and 14% indicated a family member. This suggests that some of the effect for the significant other type of social support may have been absorbed by the other types. It is also possible that significant others, in this sample of young adults with an average age of 23, had romantic partnerships that were not sufficiently long-term and stable to promote the level of social support needed to protect against risks of adverse events. Accordingly, future research that specifically examines how influential romantic partners are for this relationship, and the nature of the relationship, would be needed to make such an interpretation.
Social support positively influenced the relationship between adverse childhood experiences and alcohol-related problems, but not cannabis-related problems. Specifically, there was no relationship between adverse childhood experiences and alcohol-related problems for participants with higher levels of social support. While this may have implications for alcohol use prevention and intervention in youth, these variables were assessed at one point in time, and participants reported on current social support and alcohol-related problems. Thus, whether social support indeed helped buffer the risks of adverse childhood consequences on alcohol-related problems cannot be determined directly from this study, although findings are consistent with theoretical and empirical work on the helpful and healing effects of social support.
McCollum, D. C., Teeters, J. B., Moskal, K. R., & Woodward, M. J. (2023). Does social support moderate the association between adverse childhood experiences and substance-related problems? Substance Use & Misuse, 1-9. doi: 10.1080/10826084.2023.2269570
SIGN UP FOR THE BULLETIN
