The role of cumulative adverse childhood experiences in the interrelationships among addictive behaviors: A network analysis study

Background: Adverse childhood experiences have been identified as important risk factors for addictive behaviors, particularly when cumulatively occurring. The present cross-sectional study aimed to investigate the differences and interrelationships of addictive behaviors (both substance and behavior-related, such as gaming and overeating) according to adverse childhood experiences. Method: A total of 802 participants recruited from the Italian general population completed the brief Screener for Substance and Behavioral Addiction and Childhood Traumatic Events Scale. Based on reported adverse childhood experiences, participants were divided into three groups: no adverse experience, single adverse experience, and multiple adverse experiences. The interrelationships among addictive behaviors in the groups were assessed using a network analysis approach. Results: The multiple adverse experiences group reported significantly higher levels of addictive behaviors related to tobacco, overeating, and sex. Network analysis showed that in the multiple adverse experiences group, addictive behaviors were more interrelated, displaying a greater number of associations among each other than in the no adverse experience and single adverse experience groups. Particularly, in the multiple adverse experiences group, substance-related addictive behaviors (alcohol, tobacco, cannabis, cocaine) showed strong interrelationships, suggesting a pattern of polysubstance use. Moreover, in the multiple adverse experiences group, overeating showed associations with the other types of addictive behaviors. Lastly, in each group, compulsive sex was associated with most of the other types of addictive behaviors, and, specifically, in the multiple adverse experiences group, it showed connections with shopping and overworking, while in the no adverse experience group, with cannabis, videogaming, and overeating. Conclusions: The main findings of the study showed that individuals with cumulative adverse childhood experiences not only reported higher severity of single addictive behaviors, but also greater interrelationships among each other, highlighting in these individuals a potential pattern of mutual reinforcement and links between several addictive behaviors.