Systematic review of Adverse Childhood Experiences (ACEs) and their association with later life substance use in prisoner populations in high-income countries


  • Jack Hodgkinson


Adverse Childhood Experiences (ACES), Prisoners, Offenders, Trauma, Alcohol Use Disorder (AUD), Substance Misuse Disorder (SUD)


Background: Studies are ever more recognising the relationships Adverse Childhood Experiences (ACEs)  and  adult  health  risk  behaviours,  physical  and  mental  health,  and  social determinants of health. ACEs and their association to Alcohol Use Disorder (AUD) and Substance Misuse Disorder (SUD) in later life has been recognised internationally as a key public health concern. While children and adults with experiences of ACEs are more prone than the general population to interact with the criminal justice system, as victims, witnesses and/or perpetrators of crime. This considered, within the UK, more than a third of individuals serving a custodial are imprisoned for drug-related crimes, and around 15% of prisoners are testing positive to random drug tests (Black, 2020). A review of reoffending found that one-quarter of individuals released returned to prison within 3 years for violations that included testing positive for drug use (Chandler et al., 2009). A theoretically significant related factor is ACEs.  Often trauma  paves  the  way  for  SUD  (Khantzian,  1985)  and  SUD has also been related to rates of re-offending.  However,  relatively  few  studies  have  explored the  prevalence  of  ACEs  in  prisoners with AUD and SUD. Existing studies of this topic have primarily been conducted with non-incarcerated  populations.  Given  that  ACEs  have  been associated  to  violent offending  and  SUD  to  general  offending,  understanding  the  effects  of  ACEs  within forensic settings is exceptionally important this understanding may make way for more inclusive assessment of prisoner need and treatment planning. This study intended to obtain insight of the prevalence and associations of ACEs in this population.

Methods: A systematic review was conducted to search for studies covering the topic of ACEs in  prisoners  with  AUD  and  SUD.  A  search  strategy  was  developed,  and  several databases  were  searched  using  specific  search  terms  and  inclusion  criteria.  The review  was  guided  by  the  PRISMA-P  (Preferred  Reporting  Items  for  Systematic Reviews and Meta-Analyses Protocols) guidelines.

Results: A  total  of  437  studies  were  identified  through  the  search  strategy  and  12  where included into the study. While only 5 of the studies assessed AUD, all of these studies found a positive relationship between ACEs and AUD. Meanwhile, all studies assessed SUD and 9 of the studies found a positive correlation between ACEs and SUD in prisoners.

Conclusion:  ACEs serve as an immense predictor of later life health and social conditions of daily life. Prisoners are a vulnerable population for both experiencing and developing AUD and SUD. There is a gap in literature about this issue and more primary research is needed to inform public health about the actual burden of ACEs in prisoner populations and the most effective ways to treat AUD and SUD within these groups.