Childhood Adversity and Drug Addiction: A Comparative Analysis of Adversity Models and the Mediating Role of Alexithymia

Background: Drug addiction is a chronic relapsing disorder that imposes serious health and societal burdens. Adverse childhood experiences (ACEs) have been widely recognized as a significant risk factor, yet few studies have deciphered the key components of early adversity exposure that lead to addiction outcomes. Objective: This study aimed to compare the predictive utility of the type of adversity (adversity classification model) and the dose-response effect of exposure (the cumulative risk model) for drug addiction, and to examine the mediating role of alexithymia in the relationship between childhood adversity and drug addiction symptoms. Participants and Setting: Participants were 461 male drug addiction offenders recruited from a detoxification center in a southwestern province of China. Methods: Participants completed self-report measures assessing childhood adversity, alexithymia, and drug addiction symptoms. Multivariate regression analyses were conducted under both the adversity classification and cumulative risk models. Model fit was compared using likelihood ratio tests. A path mediation model was constructed to assess the mediating role of alexithymia. Results: Compared to the cumulative risk model, the adversity classification model better predicts drug addiction. Specifically, emotional neglect and parental incarceration were significantly related to drug addiction. Regarding the role of alexithymia, difficulties in emotion recognition and description partially mediated the effects of emotional neglect on unconscious drug cravings and automatic behaviors. In contrast, parental incarceration showed a direct association with automatic behaviors, but this effect was not mediated by alexithymia. Conclusions: Types of childhood adversity explain the psychological mechanisms of drug addiction more effectively than the cumulative adversity exposure. In particular, emotional neglect contributes to addiction through difficulties in emotion processing, highlighting the importance of early emotional development in prevention and intervention efforts.