The relationship between adverse childhood experiences and substance use among Deaf American Sign Language users

Adverse childhood experiences (ACEs) are strongly associated with increased risk for substance use across the life course, yet limited research has examined this relationship among deaf individuals using culturally and linguistically appropriate instruments. Deaf individuals who use American Sign Language (ASL) as their preferred language experience higher rates of ACEs than the general population and face unique barriers to substance use prevention and treatment services.

This study examined the association between ACEs and alcohol and drug use among deaf adults who use ASL as their preferred language.

A cross-sectional online survey was administered to 290 deaf adults aged 18 years and older using ASL-translated instruments, including the Adverse Childhood Experiences-ASL (ACE-ASL), United States Alcohol Use Disorders Identification Test-ASL (USAUDIT-ASL), and Drug Abuse Screening Test-ASL (DAST-ASL). Multivariable linear regression models assessed associations between cumulative ACE scores and alcohol and drug use outcomes, adjusting for age, sex, race, ethnicity, income, and language preference.

Higher ACE-ASL scores were significantly associated with greater alcohol use risk (USAUDIT-ASL: B = 1.00, p < .001) and drug use risk (DAST-ASL: B = 0.46, p < .001). Differences were associated with substance use outcomes among males, being younger, and different racial/ethnic groups.

Findings align with broader ACEs literature while extending evidence to a historically underrepresented population using linguistically accessible measures. Results underscore the need for trauma-informed, culturally and linguistically responsive prevention, counseling, and substance use treatment programs for deaf individuals, as well as early interventions to reduce ACE-related health disparities.