Psychological Pathways from Adverse Childhood Experiences to Cigarette, Marijuana, and Excessive Alcohol Use in Early Middle Adulthood: A Longitudinal Examination

Previous studies have demonstrated that adverse childhood experiences (ACEs) are associated with subsequent substance use, yet the pathways through which they are connected remain understudied. This study investigated how ACEs and substance use behaviors in early middle adulthood are connected through a sequential psychological pathway from internalizing problems to externalizing problems. Participants (N = 2308) from the National Longitudinal Study of Adolescent to Adult Health Waves I–V (1994–2018) were included. Generalized structural equation modeling was conducted to investigate the sequential mediation relationships. ACEs were positively associated with past 30-day cigarette use, marijuana use, and co-use of cigarette and marijuana (Wave V) (ORs = 1.50, 1.13, 1.01 respectively; all ps < 0.01). Internalizing problems (Wave III) and externalizing problems (Wave IV) sequentially mediated the aforementioned associations (all ps < 0.001). These findings underscore the importance of addressing internalizing problems and later externalizing problems to prevent substance use in early middle adulthood among individuals who were exposed to ACEs.