Objective To perform a critical review of studies examining the relation between adverse childhood experiences (ACEs) and substance use (SU) among university students. Methods Observational studies reporting SU of university students for whom ACEs were assessed were identified using PubMed, CINAHL, PsycINFO & ERIC and Web of Science from January 1998 to September of 2021. The study protocol was registered with PROSPERO: CRD42021277882. Results Of 450 articles screened, 16 met inclusion criteria, including 53,433 university students with and without ACEs exposure from 17 countries. University students reporting ACEs had an increased risk of alcohol, tobacco, marijuana, prescription-medication, and illicit drug consumption compared to students not reporting ACEs. Having four or more ACEs heightened likelihood of SU. A dose-response relationship between ACEs and SU was reported for each substance. The relationship between ACE type and SU is presented. Conclusions University students with higher levels of ACEs have increased probability of SU. The relationship between ACEs and substance type varies, with ACEs having the greatest association with tobacco and illicit drug use. Findings underline that university students may benefit from ACE screening to help identify those at higher risk of SU and engage them in preventive or therapeutic strategies.