Association linking adverse childhood experiences with unhealthy intimate relationships among women who used illegal drugs in community

Objectives: This study investigated the association between adverse childhood experiences (ACEs) and unhealthy intimate relationships among community-dwelling women of reproductive age (16-45 years) who use illegal drugs in Taiwan. Methods: Based on a cross-sectional study design, data were collected using computer-assisted self-interviewing questionnaires (n=219) from September 2021 to May 2023. A 10-item checklist was used to assess the three domains of ACEs (i.e., household dysfunctions, neglect, and abuse). Unhealthy intimate relationships include early sexual initiation, sexualized drug use (SDU)/chemsex, and intimate violence victimization (IPV). Logistic regression analysis was used to evaluate the association estimates. Results: 75.3% had experienced at least one ACEs and 38.8% had four or more ACEs. Exposure to 4+ACEs may increase the odds of early sexual initiation by 101%, and the corresponding risks for SDU/ chemsex and IPV were 126% and 368%, respectively. Having a substance-using family member in the household was associated with early sexual initiation (adjusted odds ratio [aOR]=2.45). Witnessing domestic violence (aOR=3.08) and sexual abuse (aOR=3.55) were strongly associated with SDU/chemsex, while parental divorce/separation (aOR=2.21), emotional neglect (aOR=2.63), and emotional abuse (aOR=2.13) were strongly associated with increased IPV. Conclusions: These findings indicate that childhood adversity is common in women who use drugs. The observed increased risk of unhealthy intimate relationships associated with ACEs may highlight the need to address ACEs in addiction intervention or treatment to reduce unfavorable outcomes.