Exploring the Relationship Between Adverse Childhood Experiences and Internalized Substance Use Stigma: A Mediation Analysis Among Incarcerated Women.

While adverse childhood experiences (ACEs) and mental health (MH) may significantly influence internalized substance use stigma (ISUS), these relationships remain underexplored. This study addresses this gap by: (1) examining bivariate relationships between ACEs, MH, and ISUS, and (2) investigating the mediating role of MH-specifically anxiety, depression, and post-traumatic stress disorder (PTSD)-in this relationship. As part of the ongoing NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial, 900 women with a history of opioid use disorder were randomly selected from nine Kentucky jails, consented, and interviewed on their substance use histories and related stigma, ACEs, and MH. Linear regression with mediation was used to analyze data. Women were an average age of 37 years and were predominantly non-Hispanic white (92.4%). ACEs and all MH variables were significantly associated with ISUS (p<.001). Mediation models indicated that anxiety and depression partially mediated the relationship between ACEs and ISUS, each explaining about a third (anxiety=38%, depression=32%) of the total effect of this relationship. Additionally, PTSD fully mediated this relationship, highlighting that PTSD is a significant explanatory factor and accounts for about 69% of the relationship. Results suggest that ACEs among women who have been incarcerated are linked to MH issues, which may contribute to ISUS. Addressing MH may help mitigate ISUS, underscoring the need for integrated, trauma-informed treatment interventions targeting ACEs, MH, and ISUS to improve recovery outcomes.