Adverse childhood experiences (ACEs) are linked to various lifelong negative outcomes. However, there is little counseling literature on the effects of ACEs on adult mental health. Utilizing the 2021 Behavioral Risk Factor Surveillance System dataset, we examined individual ACEs and cumulative ACEs scores to quantify the relationship between ACEs and behavioral and mental health outcomes. Findings showed that 60.9% of the participants experienced at least one ACE, with nearly 1 in 6 participants reporting four or more ACEs. Childhood emotional abuse was the most prevalent form of ACE reported. Multiple logistic regression analyses adjusting for sociodemographic covariates showed that reporting any of the ACEs was significantly associated with heavy alcohol use, marijuana use, and poor mental health. Furthermore, a graded dose-response relationship was found between cumulative ACEs scores and outcome variables. The findings highlight the importance of consciously screening and considering ACEs to better assist clients with presenting behavioral and mental health issues.

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