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Teen Addiction & Adverse Childhood Events (ACEs)

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It’s no question that what happens to you as a child can impact the rest of your life. The way your childhood—especially the bad things that happen during it—affects your mental health and the likelihood you’ll abuse substances is complicated, but it’s something people in the mental health industry are trying to understand.

Adverse childhood events (ACEs) is the term researchers and mental health professionals use to describe very stressful or traumatic situations that occur during a person’s formative years.1 Research has shown that ACEs can have a significant impact on the development of substance abuse and alcohol disorders in adolescents.Teenage girl struggling with addiction

Specifically, the more ACEs a teen is exposed to, the more likely it is that they will begin drug use at an earlier age and develop an addiction. One study found that a higher number of ACEs was associated with an increased likelihood of substance use before the age of 14. Additionally, people who experienced 5 or more ACEs were 7 to 10 times more likely to abuse illicit drugs.2

In this article, you will learn:

  • More about ACEs.
  • How they’re linked to teen substance abuse.
  • What treatment is available.

Types of ACEs and How They Affect Teens

Adverse childhood events can be defined as any traumatic, disturbing, or stressful event that causes a disruption in normal childhood development.The events may be either short-term or ongoing, but in either case they must create in the child a sense of powerlessness and the belief that their physical or psychological safety is compromised.4

Although there are numerous types of ACES, some of the more common examples include:3,4,5 

  • Physical, emotional, or sexual abuse.
  • Physical or emotional neglect.
  • Growing up with family members who abuse drugs or alcohol.
  • Criminal behavior in family members.
  • Mental illness in family members.
  • Strife between parents, such as domestic abuse.
  • Parental absence.
  • Traumatic loss of a loved one.
  • Sudden or frequent relocations.
  • School violence.
  • Community violence.
  • Bullying.
  • Serious accidents.
  • Growing up in poverty.
  • Exposure to or participation in pornography.
  • Life-threatening childhood illness or injury.
  • Peer rejection/lack of friends.
  • Parental separation or divorce.
  • Incarceration of a family member.

Troubled teenage boyACEs clearly have a negative impact on a child’s social, psychological, cognitive, and behavioral functions. Although some degree of stress is normal in everyday life, ACEs result in a “strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship.”5 This means that a child suffering from an ACE believes that they must be constantly on guard or feels as though the world is an unsafe place. They may feel that they cannot rely on their parents or adult caretakers for support and protection; they feel heightened levels of stress and insecurity and feel anxious even in the absence of the ACE.

Some of the emotional, psychological, and mental impacts that ACEs can have on teens include:4,6,7

  • An increased risk of developing learning and behavioral problems.
  • An increased risk of somatic disorders (a mental health condition associated with numerous physical symptoms).
  • A higher chance of developing an anxiety or obsessive-compulsive disorder.
  • A higher chance of depression.
  • A greater likelihood of suicidality.
  • A lowered sense of well-being.
  • Feeling dissatisfied with life.
  • Teen pregnancy.
  • Lower life expectancy.

Information On Postpartum Depression

How It Links to Substance Abuse in Adolescents

Research strongly supports the link between ACEs and teen substance abuse, which is not limited to illicit drugs but includes alcohol abuse and smoking. An important study found that substance abuse “increases proportionally in a strong, graded, dose-response manner that closely parallels the intensity of adverse life experiences during childhood.”8 This means that the more ACEs a teen experiences, the more likely the teen will smoke, abuse drugs, or drink alcohol. The study postulates that a significant portion of addiction development comes from within ourselves and the way we treat each other rather than from the influence of drug dealers or exposure to harmful substances themselves.8

When children are exposed to stressful life experiences, their cognitive and neurological development can be negatively affected, which can impact their ability to effectively cope with unpleasant or difficult emotions. It can also lead to the development of unhealthy and maladaptive coping mechanisms, such as substance abuse.7 In other words, teens who have experienced ACEs may start drinking, smoking, or using drugs as a way to escape from or deal with their day-to-day life stress.

A study of 260 adolescents found that 46.5% had experienced 1 ACE, while 25% experienced 2 or more ACEs. Exposure to a dysfunctional household correlated with a higher prevalence of substance use disorders, while multiple ACEs were associated with earlier and more severe substance use.9

Teen girl addicted to injectable drugsFurthermore, ACEs are associated with an increased likelihood of injection drug use, including heroin and methamphetamine, as well as increased prescription drug abuse.7,8 In one study, researchers found that specific ACEs—including sexual abuse, physical abuse, having a mentally ill household member, substance abuse in the home, and parental discord or divorce—were more strongly associated with alcohol use prior to the age of 14 than other types of ACEs. The theory is, these teens started drinking earlier as a way to cope with stress, rather than for pleasure or for social purposes.10

Another clinical review found that people with 4 or more ACEs have an increased risk of smoking (2.2 times), alcoholism (7.4 times), substance abuse (4.2 times), and intravenous illicit substance abuse (11.3 times), as compared to those without exposure to an ACE. These behaviors form what is known as a “trauma organized lifestyle” and are linked with a life-long predisposition to mental and physical health problems.4

Options for Treatment and Recovery

Since ACEs are traumatic experiences that can severely impact a teen’s ability to cope and function in everyday life, those suffering from addictions need to be treated in a sensitive and caring manner to help them feel safe and supported during their recovery.

Trauma-informed care (TIC) is a treatment framework designed to shift “the way organizations view and approach trauma.” Its main premise is that the traumatic experiences a person has endured (ACEs, for example) are closely tied to dysfunctional and maladaptive behaviors (such as substance abuse).4

TIC has been adopted by a number of treatment agencies as a way to provide support and care to children and teens who have experienced trauma. Organizations that adopt a TIC approach are able to identify the signs and symptoms of trauma in their clients, acknowledge the impact of trauma, and incorporate “fully integrated knowledge about trauma into policies, procedures, and practices.”4 This is important to avoid re-traumatization (which can occur in traditional treatment settings where people are not aware of the impact of trauma) and to provide effective care to teens who have experienced ACEs.4Teen attending a therapy session

When treating ACEs, clinicians are trained to see each teen as an individual and to look at the unique impact of their specific trauma. Teens who have experienced ACEs require validation and recognition of how traumatic events have affected them; need to learn common coping strategies; and must have access to effective treatments.4 A wide range of therapies are used to treat substance abuse in teens who have experienced trauma, including:

  • Dialectical behavioral therapy (DBT): Mainly recognized as an effective treatment for adolescents suffering from substance abuse and co-occurring psychiatric disorders, DBT views substance abuse as a response to mood dysregulation, which is when you experience extreme irritability, anger, and outbursts.11 DBT is based on individual psychotherapy and group skills training classes to help you develop better coping mechanisms and improved self-regulation.
  • Cognitive behavioral therapy (CBT): This is usually a short-term form of treatment (5–16 weeks) that is effective at treating adolescent substance abuse and other problematic behaviors.12 CBT employs a variety of techniques to help teens increase their motivation to change; identify negative or dysfunctional thought and behavior patterns; enhance coping skills and problem-solving capabilities; and identify alternative, enjoyable activities that do not involve substance abuse.
  • Family therapy: This form of treatment may not be appropriate for teens who have suffered specific types of trauma involving family members.13 However, for teens with a safe family structure, family therapy can help support their recovery and address underlying issues that may have contributed to substance use. Such issues might include conflict within the family, communication difficulties, problems with school attendance, or other mental health or learning disorders.14
  • Medication: Under the direction and discretion of a psychiatrist, medication can be helpful for treating teens with substance abuse disorders and trauma, especially if they have co-occurring issues, such as depression. However, since many types of medication commonly used to treat adult substance abuse have not been evaluated for use in adolescents, they must be implemented cautiously and with consideration for developmental needs.12
  • Mindfulness-based techniques: Techniques that focus on mindfulness (such as meditation or breath awareness) may be a useful supplement to other forms of treatment. Mindfulness may help teens develop the capacity to tolerate negative emotions, manage cravings, and respond to stress in healthier ways that do not involve substance use.15

Treatment for adolescent addiction can take place in a variety of settings, including:

  • Detox: This is often the first step in the recovery process, but detox alone is no substitute for comprehensive substance abuse treatment. Medical detox may be indicated for those with certain substance dependencies. This form of detox can help your teen stay as safe and comfortable as possible while they gradually withdraw from the substance. Detox can occur in inpatient or outpatient settings, such as hospitals or specialty clinics.
  • Outpatient programs: Your teen lives at home and travels to a treatment facility on a regular basis and participates in a wide range of therapies, such as individual and group counseling, family therapy (if indicated), and 12-step groups like Alcoholics or Narcotics Anonymous. They also receive regular drug testing.
  • Inpatient or residential programs: Your teen lives at a residential facility for a specific period of time (generally between 30 and 90 days) and engages in similar therapies to those offered at outpatient programs, but with a more intense level of care and support. Inpatient programs offer 24/7 care and access to medical staff who can attend to any medical or psychiatric needs that may arise.
  • Individual therapy: In some cases, people choose to receive substance abuse treatment from a private counselor. However, this is best suited for those who do not have severe addictions or who do not require a high level of support. People often transition to individual therapy as a form of aftercare once they have completed treatment at an inpatient or outpatient recovery center.
  • Support groups: Different 12-step groups, like Alcoholics Anonymous, or non-12-step groups, like SMART Recovery, are beneficial for helping people stay on the road to recovery. All 12-step groups are based on the concepts of acknowledging that your life has become unmanageable, submitting to a higher power, and working through the 12 steps of recovery with a sponsor. Non-12-step groups adopt a more secular approach and are based on the idea of personal responsibility and accountability. A few groups offer programs specifically geared toward teens. For example, SMART Recovery offers teen programs as well as online meetings. A specific form of treatment for teens known as 12-step facilitation therapy is also designed to help adolescents actively engage in 12-step recovery groups.16

The important thing with any of these therapies is that you get into them sooner than later. Early intervention leads to better long-term results, and this is especially important for teens who have experienced ACEs and struggle with substance abuse.


  1. Substance Abuse and Mental Health Services Administration. (2017). Adverse Childhood Experiences.
  2. Chakravarthy, B., Shah, S., & Lotfipour, S. (2013). Adolescent Drug Abuse—Awareness & Prevention. The Indian Journal of Medical Research137(6), 1021–1023.
  3. Dube, S.R., Felitti, V.J., Dong, M., Chapman, D.P., Giles, W.H., & Anda, R.F. (2003). Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study. Pediatrics, 111(3), 564–572.
  4. Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A. et al. (2016). Adverse Childhood Experiences and Trauma Informed Care: The Future of Health Care. Pediatric Research, 79, 227–233.
  5. American Academy of Pediatrics. (2014). Adverse Childhood Experiences and the Lifelong Consequences of Trauma.
  6. Centers for Disease Control and Prevention. (2016). About Adverse Childhood Experiences.
  7. Substance Abuse and Mental Health Services Administration. (n.d.). SAMHSA’s Center for the Application of Prevention Technologies: The Role of Adverse Childhood Experiences in Substance Abuse and Related Behavioral Health Problems.
  8. Felitti, V. (2003). The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study. Praxis der Kinderpsychologie und Kinderpsychiatrie, 52, 547–559.
  9. Gomez, B., Peh, C., Cheok, C., & Guo, S. (2017). Adverse Childhood Experiences and Illicit Drug Use in Adolescents: Findings from a National Addictions Treatment Population in Singapore. Journal of Substance Abuse, 1–6.
  10. Rothman, E.F., Edwards, E.M., Heeren, T., & Hingson, R.W. (2008). Adverse Childhood Experiences Predict Earlier Age of Drinking Onset: Results from a Representative US Sample of Current or Former Drinkers. Pediatrics, 122(2).
  11. Hulvershorn, L.A., Quinn, P.D., & Scott, E.L. (2015). Treatment of Adolescent Substance Use Disorders and Co-Occurring Internalizing Disorders: A Critical Review and Proposed Model. Current Drug Abuse Reviews, 8(1), 41–49.
  12. Riggs, P.D. (2003). Treating Adolescents for Substance Abuse and Comorbid Psychiatric Disorders. Science & Practice Perspectives, 2(1), 18–29.
  13. Center for Substance Abuse Treatment. (1999). Brief Interventions and Brief Therapies for Substance Abuse: Treatment Improvement Protocol (TIP) Series, No. 34. Chapter 8—Brief Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration.
  14. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Family-Based Approaches.
  15. Cohen, M., Wupperman, P., & Tau, G. (2013). Mindfulness in the Treatment of Adolescents with Problem Substance Use. Adolescent Psychiatry, 3(2), 172–183.
  16. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Behavioral Approaches.