Childhood Trauma Predicts Performance-Enhancing Substance Use

The presence of ACE, or Adverse Childhood Experience scores, plays a heavy role in an individual’s wellbeing later in life, and there is plenty of data to support how ACE scores impact and increase the likelihood of harmful outcomes such as chronic disease, smoking, and substance abuse.

Most recently, a study published in the journal Substance Use and Misuse discovered that childhood trauma may increase the likelihood of performance-enhancing substance use in young adults.

What the Study Found

For the purposes of this study, the ACEs included childhood sexual abuse, physical abuse, two neglect indicators, and cumulative ACEs. The specific substances sutdied were both legal (such as creatine monohydrate) and illegal (such as non-prescription anabolic-androgenic steroids) substances. 

Researchers analyzed data from a sample of over 14,000 U.S. young adults within Waves I and III of the National Longitudinal Study of Adolescent to Adult Health, from 1994–1995 and 2001–2002, respectively. 

Sexual abuse for cismen and ciswomen was found to be the ACE factor most likely to inform an individual’s usage of performance-enhancing substances later in life. There are many potential reasons for this, including the hypervigilance that often occurs after a trauma.

Childhood trauma expert Beth Tyson, MA, says, “While performance-enhancing drugs are more likely to be used by males, all individuals with high ACE scores are going to be at a significantly increased risk for developing a substance use disorder.” 

“ACEs put folks at a higher risk of prescription drug use, earlier initiation of drinking and tobacco use and a higher risk of lifetime drug abuse and addiction. Specifically for folks who never receive proper mental health treatment to address their trauma, issues with substance use and even addiction crop up earlier with high ACEs,” says Tyson.

The study found that for the cismen participants, surviving physical abuse was the number two ACE factor that contributed to the likelihood of PES use. This too could be a result of hypervigilanceor perhaps the assumed assurance that their physical strength would no longer be tested.

Neidich notes that "Individuals who experience trauma may turn to performance-enhancing drugs as a response to a hypervigilant tendency, a symptom often seen in individuals with PTSD wherein they are constantly aware of their surroundings and cognizant of possible dangers. These individuals may pursue efforts to create a larger appearing body as a way to protect themselves or create a sense of security that quells their anxiety.” 

What Is an ACE Score?

These childhood experiences are placed into a categorical pyramid with factors that include:

• Psychological, physical, or sexual abuse; 
• Violence against mother
• Living with household members who were substance users
• Navigating mental illness or suicidality
• Incarceration. 

ACE scores have been shown as predictors of complications later in life. Neidich explains that high Adverse Childhood Events (ACE) scores in adulthood are one of the greatest predictors of mental health conditions.

"Mood disorders, anxiety disorders, PTSD and substance abuse are seen as the biggest issues among individuals who were exposed to or experienced traumatic events in the home as children," says Neidich

“Suicide attempts and sleep disturbances are also more common among individuals with higher ACE scores. Even in those without diagnosable mental health or substance abuse issues, many folks with high ACE scores will struggle with relationships, general direction in life and have poor self esteem.” she says.

In addition to the aforementioned chronic diseases and relationship challenges, there is also an increased chance of individuals with high ACEs participating in risky behavior.

The Necessity of Trauma-Informed Care

Researchers urged experts and clinicians to consider ACE scores when dealing with those who may have used performance-enhancing substances and to take precautions with those with high ACE scores that have not yet participated in any substance use.

Neidich says, “Trauma-informed care cannot be implemented if practitioners are not properly screening their patients for early childhood traumatic events. I recommend that the ACES questionnaire be given to all new patients as a comprehensive manner of understanding an individual from a developmental perspective.”

ACE scores are a large part of treating an individual holistically, as all of their experiences result in who someone is present-day. “Practitioners should be vigilant in asking patients about community violence and should be administering the Urban ACES measure rather than the regular ACES measure in order to properly screen for traumatic events." says Neidich.

She says, "Finally, med schools and mental health training programs alike should be implementing efforts to further educate their students about the impact of ACEs on health and mental health as a means to encourage trauma-informed practice.”

This approach to caring for individuals, both adults and children, is important when it comes to understanding how someone operates in varied relationships. Because of this, a trauma-informed approach can be useful for everyone navigating relationships with those who have experienced trauma, not just the experts and clinicians.

Tyson says, “Relationships are the foundation for healing childhood trauma, but often the behaviors a child displays after trauma pushes caring adults away."

"We need to help adults understand the reason behind the behaviors and help them interact with trauma survivors with empathy and care instead of punishment/rejection. Parents also need to be aware of the trauma responses so that they can have their child accurately diagnosed.”  she says.