Among 715 Dutch adolescents tracked from age 16 to 22, childhood trauma was associated with earlier initiation and faster escalation of cannabis use, but differences in stress physiology did not explain the connection.
Adolescent mental health professionals, prevention researchers, and those interested in trauma and substance use pathways.
What the researchers found
Traumatic experiences before age 16 increased the risk of cannabis use trajectories characterized by early initiation and escalation, as well as consistently low-level use and later-escalation patterns, compared to no use. However, acute neuroendocrine stress reactivity (heart rate, HRV, cortisol) did not mediate this relationship.
Why it matters
The link between childhood trauma and substance use is well established, but why it happens remains unclear. This study tested a leading theory (that trauma alters stress physiology, which drives substance use) and found it did not hold up, pushing researchers to look for other mechanisms.
The numbers in context
N=715 from TRAILS cohort. Trauma assessed up to age 16. Cannabis trajectories tracked from ~16 to ~22. Trauma was associated with early-initiation/escalation, low-level use, and later-escalation trajectories. No mediation by heart rate, HF-HRV, PEP, or cortisol reactivity.
How the study worked
Longitudinal data from the TRAILS cohort study (N=715). Traumatic experiences assessed up to age 16. Stress reactivity measured via standardized stress test at age 16. Cannabis use trajectories modeled from age 16 to 22. Cox proportional hazards and growth mixture models used.
What this study cannot tell us
Single cohort from the Netherlands may not generalize to other populations. Stress reactivity measured at one time point. Self-reported trauma and substance use are subject to recall and reporting biases. Cannabis trajectories may not capture all relevant patterns of use.
How to read the evidence
Prospective longitudinal cohort with objective stress measures and validated trajectory modeling, though single-cohort design and self-reported outcomes limit generalizability.
When this study was published
Published 2025, using TRAILS cohort data (Netherlands).
The bigger picture
If stress physiology does not explain why traumatized youth start using cannabis earlier and escalate faster, other pathways must be involved. Candidates include psychological factors (coping strategies, emotion regulation), social factors (peer networks, family environment), and epigenetic changes from early adversity.
Questions still open
- What mechanisms beyond stress physiology explain the trauma-to-cannabis-use pathway
- Whether interventions targeting emotion regulation rather than stress physiology would be more effective for trauma-exposed youth
Common questions
Why did the researchers think stress physiology would explain the link?
Does childhood trauma always lead to substance use?
Read the original research
The associations between traumatic experiences and trajectories of substance use in adolescence and young adulthood - the role of acute neuroendocrine and subjective stress reactivity.
Psychoneuroendocrinology, 182, 107642
Citation
Schmengler, Heiko; Hartman, Catharina A; Marceau, Kristine; Giletta, Matteo; Peeters, Margot. (2025). The associations between traumatic experiences and trajectories of substance use in adolescence and young adulthood - the role of acute neuroendocrine and subjective stress reactivity.. Psychoneuroendocrinology, 182, 107642. https://doi.org/10.1016/j.psyneuen.2025.107642
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