Adverse childhood experiences, internalizing/externalizing symptoms, and associated prescription opioid misuse: A mediation analysis

Adverse childhood experiences (ACEs) are associated with mental health and substance use problems, but lesser known is how they interconnect. The objective of this study was to examine how internalizing and externalizing symptoms mediate the association of ACEs with prescription opioid misuse in order to understand how ACEs interconnect with mental health and substance use problems. Adults aged 18 or older from the National Epidemiological Survey on Alcohol and Related Conditions Wave 3 (NESARC-III) conducted in 2012–2013 were included (N = 36,309). The prescription opioid misuse outcomes examined include prescription opioid misuse status, early-onset status of prescription opioid misuse, frequency of past-year prescription opioid misuse, and opioid use disorder. A natural effect model and regression analyses were used to conduct the mediation analyses. We found that respondents with higher ACE scores had greater odds of reporting past-year and lifetime prescription opioid misuse and DSM-V-diagnosed opioid use disorder as well as early onset of prescription opioid misuse (AORs range from 1.06 to 1.12). These associations are partially mediated by internalizing and externalizing symptoms. The findings suggest that internalizing and externalizing symptoms may be potential pathways through which ACEs are associated with prescription opioid misuse. Our results underscore the importance of preventing ACEs and reducing risk for internalizing and externalizing symptoms after exposure, which may reduce later prescription opioid misuse. •History of ACEs is associated with prescription opioid misuse in adulthood.•Internalizing/externalizing symptoms partially mediate the association.•ACEs prevention is an important part of the response to the opioid overdose crisis.•Preventing internalizing/externalizing symptoms may mitigate the impact of ACEs.