Adults with substance use disorders are more likely to have suffered trauma as children, according to study findings published in the Journal of Interpersonal Violence. Trauma could include emotional, physical and sexual abuse, neglect, mental illness, divorce and separation, substance misuse, and other issues.

“There is a difference in risk profiles between families involved in child welfare due primarily to substance misuse and those where substance misuse was not the main issue,” said Elinam Dellor, PhD, MPH, lead author of the study and senior researcher at The Ohio State University College of Social Work. “When you add substance use to an already vulnerable sample of adults that may help explain why these adults report higher levels of trauma exposure.”

The study reviewed data from 2 Ohio-based child welfare interventions that target families that have had issues with both mistreatment of children and substance misuse. The treatment programs are Ohio START and EPIC. The study included 402 adults, 271 children up to 5 years of age, and 177 children aged 6 to 18 years who participated in the 2 intervention programs.

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The scores assessing childhood trauma exposure among adults with substance misuse issues were 24% higher than previous estimates for other adults in the child welfare system, and 108% higher than the general population, reported the researchers.

Children in these families also have suffered more trauma. The study found that trauma scores of children aged 6 to 18 years in families with substance misuse issues were 27% higher than scores for children involved in the juvenile justice system.

To be included in the study, adults completed the Adverse Childhood Experiences questionnaire, which asks if participants experienced any of 10 traumatic experiences before they were 18 years old such as abuse, neglect, and household dysfunction. The parents and caregivers in this study had an average score of 4.2. According to the researchers, adults with scores greater than 4.0 are at greater risk for a variety of physical and mental health problems later in life including heart disease and suicide.

“In the US, only about 16% of people have a score over 4 on this test, so you can see that adults with substance misuse issues in the child welfare system have a high burden of trauma,” Dr Dellor said.

The children in the study were screened using the CTAC Trauma Screening Checklist. In children up to 5 years old, 90% experienced 2 or more traumatic experiences, while more than half (56%) experienced 5 or more. Older children in the study had an average score of 5.6 on the trauma screening test, 27% higher than scores for children in the juvenile justice system.

“Children who live with parents who are abusing substances tend to come in with trauma issues beyond just the initial abuse or neglect issues that brought them into the system,” Dr Dellor said. “They often have already been exposed to multiple traumatic events.”

The 2 intervention programs that provided the samples for this study were in mostly rural southern Ohio, which means most participants are white, she said. The Ohio START program has expanded into more metropolitan areas of the state and future research will examine racial differences in trauma.

Screen All Adults and Children in the Welfare System for Trauma

An important implication of this study, noted Dr Dellor, is the need to screen all adults and children who enter the child welfare system for trauma. “We’ve learned in the past 20 years or so how harmful trauma exposure is, across physical, mental, and behavioral health,” Dr Dellor said. “With so many parents scoring high for trauma, their risks for all kinds of conditions skyrocket. It is important to talk about it, to address it within the child welfare system, but also give families the tools to cope when they leave.”

The work was supported by the Administration for Children and Families, part of the U.S. Department of Health and Human Services.


Dellor ED, Yoon S, Bunger AC, Himmeger M, Freishtler B. Benchmarking trauma in child welfare: a brief report. J Interpers Violence. 2021;8862605211038324  doi:10.1177/08862605211038324