Unpacking adverse childhood experiences: Examining the role of ACEs domains in mental health and alcohol consumption in college students.

BACKGROUND: Adverse Childhood Experiences (ACEs) are linked to increased risk for mental health and substance use problems. College students, facing academic and social stressors, may be particularly vulnerable to ACEs exposure. Understanding these associations is essential for strategies that consider lived experiences. OBJECTIVE: To examine how cumulative ACEs exposure and specific domains (abuse, neglect, household dysfunction) relate to alcohol use, and whether depressive symptoms moderate these associations. PARTICIPANTS AND SETTING: 1866 full-time U.S. college students aged 18-24 reporting past-year alcohol use and at least one ACE. METHODS: ACEs were assessed using the 2021 Behavioral Risk Factor Surveillance ACEs module. Alcohol use and depressive symptoms were measured with the Alcohol Use Disorders Identification Test (AUDIT) and Patient Health Questionnaire-9 (PHQ-9). Regression models examined cumulative and domain-specific ACEs effects on alcohol use and tested ACEs-depression interactions. RESULTS: Participants reported an average AUDIT score of 10.90 (hazardous drinking), PHQ-9 score of 12.35 (mild-moderate depression), and an average of 4.1 ACEs. Higher ACEs scores were associated with increased alcohol use (B = 0.26, p < .001). At the domain level, abuse (B = 0.36, p < .01) and neglect (B = 0.62, p < .05) were significantly associated with alcohol use, whereas household dysfunction was not. Depressive symptoms were positively associated with alcohol use and significantly moderated the relationship between abuse and alcohol use (B = 0.02, p < .05), but no other domain. CONCLUSION: ACEs are associated with hazardous alcohol use among college students, with domain-specific differences in risk. Integrating trauma-informed, mental health-focused approaches into campus prevention strategies may improve outcomes among students with a history of ACEs.