Latent Classes of Adverse Childhood Experiences (ACEs) and Adult Substance-use Problems and Psychosocial Outcomes: Complex and Heterogeneous Associations.

Featured Paper of the Month – February 2026

Published in International Journal of Mental Health and Addiction by Emily Herberholz, Rachel Wolchok an David Epstein, et al. of the NIDA IRP Real-world Assessment, Prediction, and Treatment Section.

Study Authors — Top row: Emily Herberholz and Rachel Wolchok (co-first-authors), Jeff Rogers. Bottom row: Sophia Selenou‑Yemgang, Bianca Beckwith, Kirsten Smith, and David Epstein.

Summary

This paper began as a summer-student project, using data from a nationwide survey conducted by our group (RAPT) on US adults who currently used any of several drugs (specifically alcohol, opioids, or psychostimulants), whether or not they had symptoms of a substance use disorder (SUD, which includes alcohol use disorder). The survey included a standard measure of adverse childhood events (ACEs), such as abuse, neglect, and other stressors; it also included assessment of SUD symptoms. In this paper, we first showed that we could categorize people by specific patterns/types of ACE exposure, providing a more informative summary than the older approach of just tallying up each person’s total number of types of ACEs. Then we showed that even though ACE exposure can predict later SUD symptoms to a statistically significant degree in people who use alcohol or other drugs, the predictions are too imprecise for case-by-case decisionmaking. (We also found that people exposed to parental SUD may actually avoid substance use in adulthood, a process called aversive transmission.) We cited evidence that routine use of ACE scores as SUD-risk indicators might harm people by becoming a source of stigma, a self-fulfilling prophecy, or a barrier to some forms of medication access. We proposed, instead, the use of ACEs data at the level of whole medical practices or communities, perhaps with an ACEs measure developed by the World Health Organization that assesses large-scale social disruptions as well as familial ones. Upticks in ACE prevalence could be used to scale up resources for communities that need them, without the harms that can accompany inherently uncertain individual predictions and classifications.

Publication Information

@article{cite-keyg,

title = {Latent Classes of Adverse Childhood Experiences (ACEs) and Adult Substance-use Problems and Psychosocial Outcomes: Complex and Heterogeneous Associations},

author = {Emily S. Herberholz and Rachel E. Wolchok and Jeffrey M. Rogers and Sophia Selenou-Yemgang and Bianca D. Beckwith and Kirsten E. Smith and David H. Epstein},

url = {https://doi.org/10.1007/s11469-025-01527-w},

doi = {10.1007/s11469-025-01527-w},

isbn = {1557-1882},

journal = {International Journal of Mental Health and Addiction},

abstract = {Adverse childhood experiences (ACEs), expressed as summary scores, are associated with adverse adult outcomes. We aimed to detect more nuanced associations via latent class analysis (LCA) of ACEs. We tested associations between class membership and adult anxiety, depression, loneliness, stress, and substance-use patterns/disorders. Our nationwide data set, part of our larger study of substance use with or without addiction, included 2615 mTurk workers with any past-6-month alcohol use (71.6% n = 986) or any past-6-month nonmedical use of opioids or stimulants (28.4%},

keywords = {},

pubstate = {published},

tppubtype = {article}

}