Substance Use and Retrospective Adverse Childhood Experiences: An Ambulatory Assessment of Cortisol Awakening Response

Abstract

Although support for the relationship between early life stress and substance use in adulthood is well documented, there is a paucity of research examining the relationship between adverse childhood experiences (ACEs), substance use, and cortisol awakening response (CAR) in college-aged adults. Thus, the current studies were designed to address this gap in the literature. The specific aims of this project included determining the relationship between ACE exposure and risky substance use, whether perceived stress mediates the relationship between ACEs and substance use, whether the diurnal cortisol rhythm varies by substance use status and sex, and whether CAR varies by ACE exposure. In Study One, 265 college students completed measures of ACEs, substance use, perceived stress, and mental health. In Study Two, 55 participants self-administered salivary cortisol samples within their place of residence and completed inventories for ACEs, substance use, and mental health. For Study One, perceived stress levels were higher among those with high risk of hazardous drinking, high e-cigarette use, and daily THC/marijuana use. Results also revealed a significant positive relationship between ACEs and drinking consequences and e-cigarette use as well as a mediating role of perceived stress in the relationship between ACEs and drinking consequences. In Study Two, results revealed a medium effect of cortisol collection time point by sex and by risky substance use status. Further, results indicated that those with high ACEs exhibited blunted cortisol levels immediately upon waking compared to those with low ACE exposure. This study contributes to the growing literature base by using a well-established cortisol collection method that has been previously unexplored in the context of ACEs and substance use. The use of self-collected cortisol samples to identify students at risk for hazardous substance use and other health-compromising behaviors has important implications for tailored prevention efforts for those with a history of ACEs.