Early Exposure to a Parent's Alcohol Use Disorder as an Adverse Childhood Experience: Neurobiological and Clinical Consequences in Adulthood.

Adverse childhood experiences (ACEs) are a significant determinant of health across the life course and exhibit a dose-dependent relationship with the risk of mental and physical disorders in adulthood. One common yet under-recognized ACE is growing up in a family with an alcohol problem. The objective of this study was to review current data on the neurobiological mechanisms and clinical consequences of early exposure to parental alcohol use disorder, considered an ACE, along with implications for medical practice. A review was conducted of the literature on ACEs, with a particular focus on exposure to parental alcohol use disorder, the co-occurrence of other developmental adversities, and health outcomes in adulthood. Data on ACE screening and the trauma-informed care approach were also included. Parental alcohol use disorder often co-occurs with violence, neglect, and mental health disorders among caregivers, increasing overall stress exposure. Chronic developmental stress is associated with hypothalamic-pituitary-adrenal axis dysregulation and persistent inflammation, as well as an increased risk of depression, anxiety disorders, posttraumatic stress disorder, and substance use disorders. Somatic consequences are also described, including a higher risk of type 2 diabetes and cardiovascular disease, as well as a poorer response to treatment in individuals with ACE exposure. The term adult children of alcoholics is descriptive in nature and does not constitute a diagnostic entity. Early exposure to a parent's alcohol use disorder as an ACE is associated with multidimensional health consequences in adulthood. Further research is needed on the efficacy and safety of ACE screening and the implementation of trauma-informed care.