Association between adverse childhood experiences and over-the-counter drug abuse in Japan: A nationwide population-based cross-sectional study.

Abstract

Aim: We aimed to examine the association between adverse childhood experiences (ACEs) and habitual over-the-counter (OTC) drug abuse in a nationwide Japanese population and determine whether this association varies with other substance use behaviors.

Methods: We analyzed nationwide cross-sectional data and used multivariable logistic regression to estimate adjusted odds ratios (aORs) for the association between ACEs and OTC drug abuse. We also examined whether this association varied by other addictive behaviors, including habitual use of combustible cigarettes, electronic cigarettes (e-cigarettes), heated tobacco products (HTPs), alcohol, or illicit drugs.

Results: We analyzed 25,424 adults from the 2025 Japan Society and New Tobacco Internet Survey (Feb 23 to Mar 31, 2025). Habitual OTC drug abuse prevalence was 6.8% (95% confidence interval [CI]: 6.2-7.4). Individuals with high ACE exposure had significantly higher odds of OTC drug abuse than those with lower ACE exposure (aOR = 3.18, 95% CI: 2.47-4.10, p < 0.001). The association was particularly strong among users of e-cigarettes (aOR = 27.14, 95% CI: 13.12-56.14) and HTPs (aOR = 6.88, 95% CI: 4.21-11.24). However, no significant interaction was observed among participants reporting illicit drug use (p = 0.14).

Conclusion: ACEs were independently associated with habitual OTC drug abuse in this study. Similar associations were observed among individuals with other addictive behaviors, with higher odds indicating potential overlap in vulnerability pathways. These findings underscore the lasting impact of childhood adversity and the need for trauma-informed strategies to prevent emerging substance abuse.