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Article Abstract
Objective: Much research has found that adverse childhood experiences predict later adult problems in physical and mental health, justice-system involvement, trauma, and substance use. There is less research on the role of positive childhood experiences and none in the context of opioid use disorder. This study was designed to test a new instrument measuring both positive and adverse childhood experiences. The Positive and Adverse Childhood Experiences Survey (PACES) instrument was designed with a pattern of questioning that balances nervous system responses to keep patients in what Leitch (2015) described as the "resilient zone."
Method: We analyzed intake data from 728 clients seen at rural Colorado clinics for opioid use disorder treatment. Participants completed measures of PACES, depression (Patient Health Questionnaire), pain (Patient-Reported Outcomes Measurement System), drug use, health care utilization, and justice-system involvement (Addiction Severity Index, sixth edition). We examined the PACES instrument psychometrics and correlations with other measures.
Results: PACES items loaded cleanly onto two subscales measuring positive versus adverse childhood events, with moderate reliability (α = .81-.84) and a small inverse correlation ( = -.14). Adverse events showed expected relationships with depression, drug use, pain, health care use, and justice-system involvement. Positive events had inverse relationships with mental health and alcohol use, but not with other variables.
Conclusions: This study is the first to demonstrate the protective effects of positive childhood experiences in clients with opioid use disorder. PACES is a reliable, valid tool for assessing positive and adverse childhood experiences, which have independent effects on adult outcomes. Clinicians should assess both positive and adverse childhood experiences as part of trauma-informed care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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