# Substance Use Behaviors as Markers of Emotional Dysregulation and Childhood Adversity Among Adult Emergency Department Patients

## TL;DR

This study finds that substance use in emergency department patients is linked to childhood trauma and poor emotion regulation, suggesting it could be a marker for emotional dysregulation.

## Contribution

The study is one of the first to examine the relationship between substance use, ACEs, and emotion regulation in emergency department patients.

## Key findings

- TAPS scores were positively correlated with ACEs and emotional dysregulation scores.
- Substance users had higher ACE scores compared to non-users.
- Substance use in the ED is associated with poorer adaptive emotion regulation strategies.

## Abstract

Introduction

Substance use is frequently encountered in emergency department (ED) visits and may reflect underlying emotional or developmental challenges. Adverse childhood experiences (ACEs) are linked to both emotional dysregulation and later substance use, but this relationship is rarely examined in acute care settings. We investigated whether recent substance use, as measured by the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) screening tool, is associated with ACEs, emotional dysregulation, and use of cognitive reappraisal (an adaptive emotion regulation strategy) among adult ED patients.

Methodology

In this cross-sectional study, 58 adult ED patients completed the ACE Inventory, the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ)-Cognitive reappraisal subscale, and the TAPS screening. Descriptive statistics characterized the sample. Pearson correlations and linear regression analyses (adjusting for age and gender) examined associations between TAPS scores and ACE, DERS, and ERQ scores.

Results

TAPS scores were positively correlated with ACEs (r = 0.23, P < 0.05) and DERS scores (r = 0.30, P < 0.01), and negatively correlated with ERQ-Cognitive reappraisal scores (r = -0.22, P < 0.05). In regression models, higher TAPS scores significantly predicted greater ACE burden, higher DERS scores, and lower ERQ-Cognitive reappraisal scores (all P < 0.05, with covariate adjustment). Participants reporting alcohol or marijuana use had significantly higher mean ACE scores than non-users.

Conclusion

Recent substance use identified during ED visits was associated with greater childhood trauma exposure and poorer emotion regulation. Substance use in the ED may serve as a marker of underlying emotional dysregulation and adversity. These findings support the incorporation of trauma-informed screening and referral practices into ED care as part of integrated care models to better address these underrecognized psychosocial factors.