Adverse Childhood Experiences and Substance Use: The Mediating Role of Executive Function Deficits

INTRODUCTION: While adverse childhood experiences (ACEs) are robust risk factors for adolescent substance use, the prospective neurocognitive pathways linking both cumulative and specific adversities to substance use remain understudied. This study tested a vulnerability model by examining whether executive function (EF) deficits mediate the link between cumulative and specific ACEs and substance use, and whether this pathway differs for deprivation- versus threat-based adversities. METHODS: at baseline = 9.9 years; 52.3% male; 56.5% White, 13.8% Hispanic, 13.1% Black). We tested mediation models with temporally ordered assessments of ACEs (ages 9-11), parent-reported EF deficits (12-13), and subsequent substance use (13-14). RESULTS: The indirect effect of cumulative ACEs on substance use through EF deficits was significant, accounting for 10% of the total effect. Deprivation-based ACEs (material hardship and emotional neglect) were fully mediated by EF. Several threat-based adversities (e.g., household violence, bullying) also showed full mediation. In contrast, sexual abuse demonstrated a significant direct effect but no significant indirect effect through EF. CONCLUSIONS: EF deficits represent a significant pathway from cumulative ACEs to adolescent substance use, supporting a vulnerability model. This pathway appears robust for deprivation-based and many chaotic threat-based adversities, but sexual abuse is an exception that likely operates through non-EF, trauma-specific mechanisms. Prevention efforts should be multifaceted, incorporating EF-focused interventions for at-risk youth while prioritizing trauma-focused care for survivors of sexual abuse.