Research on Adverse Childhood Experiences (ACEs) and Preventing Substance Use

Have you ever wondered how challenges during childhood can affect a child’s ability to make healthy choices about alcohol, tobacco, or other substances?

A study published in Psychology, Health & Medicine looked at the relationship between adverse childhood experiences (ACEs) and middle school students’ understanding and attitudes related to substance use.

It found that students who experienced more ACEs tended to know less about substance use. This may help explain why ACEs are linked to an increased risk of substance use later in life.

The study also examined the role of a life-skills intervention, called the Positive Interpersonal and Life Skills Training (PILOT) program. Results showed that participation in PILOT significantly increased students’ knowledge about substances, particularly for students who had experienced higher levels of adversity.

Understanding the Research

This study was carried out in two middle schools in Keelung County, Taiwan. One school continued teaching the regular national curriculum, while the other added the Positive Interpersonal and Life Skills Training (PILOT) to its classes.

The PILOT program was designed specifically for Taiwanese students and focused on practical, real-life skills. It included 8 classroom modules that taught the following:

• Communication skills
• Coping with stress and anger
• Decision-making
• Assertiveness
• Handling peer pressure
• Resolving conflicts

Teachers received training before teaching the lessons and delivered the program as part of regular classes across two school semesters in 2023. The activities were interactive and hands-on.

To measure the program’s impact, students completed surveys. These surveys asked students about their childhood experiences, what they know about substance use, how they feel about drugs and alcohol, and everyday skills like self-control and saying no to peer pressure.

These were the key findings:

• Students with more adverse childhood experiences (ACEs) had lower knowledge about substance use and its risks.
• The PILOT program improved students’ knowledge. Those who took part in the PILOT life skills program showed higher substance use-related knowledge than those who did not.
• The greatest benefit was seen in students with higher ACE exposure. It enhanced their knowledge of substance use by helping reduce gaps caused by adversity early in life.
• Academic performance also played a role. Students who generally did better in school were more likely to have stronger knowledge about substance use.
• A student’s starting point mattered. How they felt about substances before the program strongly predicted how they felt afterward.

Practical Strategies for Parents and Caregivers

This research shows that school programs like PILOT are important and that ACEs need to be considered. It's also important that caring adults at home and at school provide support to help children make healthy choices.

So, what can we do to help?

Make space for your child’s feelings

Make space for feelings, especially big or uncomfortable ones. A common misconception, and something many parents can relate to, is the urge to fix these feelings right away.

The truth is, children don’t always need immediate solutions. What they need most is to feel validated. Children who feel that their emotions are acknowledged without judgment are more likely to make healthier decisions.

Simply listen and reflect back what they share. These simple gestures can go a long way toward supporting them.

Help them practice skills for everyday situations

Many instances of substance use can be prevented by teaching kids assertiveness skills. One skill I teach my clients is how to say “no” confidently and without hesitation.

Stress management is just as important, since children are more likely to give in to peer pressure when they feel overwhelmed.

At home, parents can support this by role-playing real-life situations. I also recommend practicing how to ask for help, so children know it’s okay to reach out.

Give them a stable and caring environment

A predictable, supportive home helps children feel safe — and feeling safe makes it easier for them to make positive choices.

In everyday life, this looks like consistent routines they can count on, such as regular mealtimes and connecting with them at the end of the day.

Identify challenges early

Changes in mood, sleep, behavior, or school performance can sometimes be signs that a child is carrying more stress than they can handle on their own.

If something doesn’t feel right, you can check in with your child more often. Ask open-ended questions like, “How have things been feeling for you lately?” or “Is there anything that’s been worrying you at school or at home?” These check-ins let your child know you’re willing to listen.

Stay connected with your child’s teachers or school counselor, and reach out to a mental health professional if concerns continue.

The authors suggest that while the program helped, more research is needed to see if the benefits will last over time and work across different cultures.

Download our Stress Management Worksheets and Coping Skills Worksheets to give your child tools for handling stress, managing big emotions, and building confidence in everyday situations.