Childhood adversity, substance use, and mental health problems: The protective influence of resilience and assets

Youth exposed to childhood adversity are at increased risk for substance use and mental health problems. There is increasing evidence that resilience and youth assets can offer protection; however, few studies have examined whether such protective factors can modify the influence of childhood adversity on substance use and mental health problems. The main aims pursued in my dissertation were to: 1) determine whether resilience and assets offer protection against substance use and mental health problems in the face of adversity (direct protective effect), 2) determine whether resilience or assets can buffer the relationship between adversity and substance use and mental health problems (interactive protective effect). To achieve these aims, data from three separate studies were analyzed. In the first cohort study of 1,111 youth, I assessed the direct and interacting influence of assets within individual, family, and community domains on the relationship between negative life events and binge drinking using generalized estimating equation (GEE) models. In the second study, I used data from large, representative samples of approximately 5,000 middle school and 5,000 high school youth in Nevada to evaluate the direct and interacting influence of family communication and school connectedness on the relationship between adverse childhood experiences (ACEs) and suicidal behaviors using GEE models. In the third study, I used data from a sample of juvenile justice involved youth to assess the direct and interacting influence of internal resilience and four assets on the relationship between (ACEs) and co-occurrence of substance abuse and psychological distress using multinomial logistic regression. Interaction was assessed on the multiplicative and additive scales; relative excess risk due to interaction (RERI) was used to evaluate additive interaction. In all three studies, there was evidence that resilience and assets offered direct protection against substance use and mental health problems in the presence of adversity (aim 1). In the second and third study, there was also evidence of buffering by resilience and/or assets on the multiplicative scale (aim 2). Despite the protective influence of resilience and assets, childhood adversity (particularly ACEs) continued to be a strong predictor of substance use, mental health problems, and co-occurrence.The findings highlight the need for the development, implementation, and evaluation of strength-based interventions designed to build resilience and assets among youth. Given the negative influence of adversity on substance use and mental health problems, trauma-informed interventions are also warranted, especially for juvenile justice involved youth