Impact of adverse childhood experiences on substance abuse and emotional distress among female juvenile offenders

Background: Female juvenile offenders in the United States experience high rates of Adverse Childhood Experiences (ACEs) such as abuse, neglect and household dysfunction. However, little is known about the influence of ACEs on substance abuse and mental health outcomes in this vulnerable population. Methods: 305 female adolescents who received sanctions to probation (with or without detainment) completed audio computer assisted interviews. Validated measures were used to assess substance abuse (CRAFFT), psychological distress (BSI-18), and eight adverse childhood events (physical abuse, sexual abuse, physical neglect, father's incarceration, mother's incarceration, single parent custody, removal from home, running away from home). ACE scores were calculated by summing the total number of ACE categories (range 0-8). Logistic regression was used to assess the independent relationship between ACEs and substance abuse as well as emotional distress. Results: Almost half (49%) of participants reported 4 or more ACEs. After controlling for age, race, and detention, there remained a strong dose response relationship between the number of ACEs reported and substance abuse [1-2 ACEs (AOR=5.78; 95% CI 1.81, 18.52), 2-3 ACEs (AOR=6.87; 95% CI 2.19, 21.57) and 4-5 ACEs (AOR=20.23; 5.70, 71.85)]. ACEs were also associated with emotional distress [1-2 ACEs (AOR=3.56; 95% CI 0.64, 19.70), 2-3 ACEs (AOR=7.48; 95% CI 1.38, 40.54) and 4-5 ACEs (AOR=8.76; 95% CI 1.58, 48.57)]. Conclusions: Our results suggest that preventing or addressing ACEs among female juvenile offenders could have a profound impact on substance abuse and emotional distress. Family centered interventions that focus ACEs are urgently needed for this population.