Latent Classes of Adverse Childhood Experiences (ACEs) and Adult Substance-use Problems and Psychosocial Outcomes: Complex and Heterogeneous Associations.

UNLABELLED: Adverse childhood experiences (ACEs), expressed as summary scores, are associated with adverse adult outcomes. We aimed to detect more nuanced associations via latent class analysis (LCA) of ACEs. We tested associations between class membership and adult anxiety, depression, loneliness, stress, and substance-use patterns/disorders. Our nationwide data set, part of our larger study of substance use with or without addiction, included 2615 mTurk workers with any past-6-month alcohol use (71.6% n = 986) or any past-6-month nonmedical use of opioids or stimulants (28.4%, n = 391). Using a 10-item ACE questionnaire, we identified high, moderate, and two differentiable low-ACE classes (exposed to either parental substance use or divorce). In regression models, the high-ACE class had more past-year substance use (ORs 2.01-3.38, R 2 = 0.12), problematic use (ORs 1.89-2.66, R 2 = 0.10), SUD treatment (ORs 2.10-5.45, R 2 = 0.15), and psychological symptoms (betas 1.32-8.74, R 2 = 0.11-0.19). Despite aggregate associations, the low R 2 values underscore within-class heterogeneity in outcomes. ACE patterns are informative about adult outcomes in the aggregate, but do not support case-by-case inferences. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11469-025-01527-w.