Early-life adversity and problem drinking in adulthood: Improving on the measurement of adverse childhood experiences

Excessive alcohol consumption poses significant public health concerns, contributing to adverse health, social, and economic outcomes. Prior research has established a strong link between Adverse Childhood Experiences (ACEs) and problem drinking in adulthood, yet limitations in measurement approaches and an incomplete understanding of moderating factors persist. This study refines the measurement of ACEs using a two-parameter Item Response Theory (IRT) model and multiple plausible values to capture item-level differences in adversity severity and propagate measurement uncertainty, and investigates the moderating role of perceived social support in the association between childhood adversity (CA) scores and problem drinking among U.S. adults. Drawing on cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS), survey-weighted quasibinomial logistic regression models show that higher CA scores are associated with greater likelihood of problem drinking, and that adults reporting both higher CA scores and low perceived social support have the highest predicted probabilities of problem drinking. These findings highlight how past adversity and current perceived support are jointly patterned with problem drinking and illustrate how psychometric approaches can strengthen ACE measurement in population health research.