Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency

Abstract

Objective: Adolescents with adverse childhood experiences (ACEs) and suicidality may engage in high levels of substance use to alleviate distress. Most studies of associations among ACEs, suicidality, and substance use rely on retrospective reports by adults. Comparatively less is known about concurrent relationships between ACEs, suicide risk, and substance use in adolescents, which is important for prevention. This study tested if the associations between ACEs and drinking and between ACEs and cannabis use would be even stronger among youth with suicidal ideation or attempt, relative to youth without suicidal ideation or attempt.

Method: High schoolers (N = 1,625; 50.8% male; 47.1% female; 2% nonbinary) from western New York completed the Youth Risk Behavior Survey. Ordinal regressions tested main effects and interactions of the number of ACEs and suicidal ideation/behavior (i.e., none, ideation/plan, attempt) on categories of past-month drinking and cannabis days of use, controlling for age, gender, and race/ethnicity.

Results: Significant ACEs by suicide interactions on adolescent drinking indicate that the association between ACEs and drinking was stronger for adolescents with suicide attempt adjusted odds ratio (AOR = 2.63) compared to youth with no ideation or attempt (AOR = 1.56) and suicidal ideation/planning only (AOR = 1.58). Main effects of ACEs (AORs = 1.95-2.08) and suicide attempt (vs. no suicidal ideation/attempt [AOR = 2.11] and suicidal ideation/plan [AOR = 2.11]) were associated with greater cannabis use; interactions were not significant.

Conclusions: Associations between ACEs and drinking were particularly strong for adolescents with suicide attempt. Conversely, ACEs and suicide attempt were independently associated with cannabis use. Mitigating against ACEs may reduce both adolescent alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Figure 1.

Stronger association between adverse childhood events and greater alcohol frequency among youth with suicide attempts, relative to youth with suicidal ideation and no suicidal ideation or attempt Notes. ACEs = Adverse childhood experiences. This figure depicts the significant ACEs by suicide attempt interaction; differences between adolescents with no suicide ideation/plans/attempts and adolescents with suicide ideation/plans are not significant. The y-axis is predicted probabilities of alcohol use frequency at 0 (no days of alcohol use), 1 (1–2 days of use), 3 (6–9 days of use), and 6 (all 30 days of use) by ACEs separately for youth with no suicidal ideation, planning, or attempts (dotted line), suicidal ideation/planning (dashed line), and suicide attempt (solid black line). The graph to the left shows that for youth with suicide attempt, greater number of ACEs were associated with significantly lower probability of endorsing 0 days of alcohol use (i.e., being a non-drinker in the past month). The association between ACEs and probability of 0 days of alcohol use is attenuated for youth with no suicidality, relative to those with suicidal ideation and attempt. The graph on the right shows that for youth with suicide attempt, ACEs are associated with greater probability of reporting all 30 days of alcohol use; for youth with no suicidality and ideation/planning only, there was an attenuated association between ACEs and probability of endorsing all 30 days of alcohol use.