Physical and sexual abuse,depression and alcohol use disorders in adolescents: onsets and outcomes

Adolescents with alcohol use disorders (AUDs) often have major depressive disorder (MDD). While physical abuse and sexual abuse (PS Abuse) have been observed to be common in adolescents with AUDs, the influence of PS Abuse on comorbid MDD and AUD has not been determined. The effect of pre-existing PS Abuse on the young adulthood outcomes of adolescents with AUDs has also not been adequately explored. This study examined the relationships among PS Abuse, MDD, and AUD in adolescence, as well as related young adult outcomes. Adolescents (mean age: 16.4 years; range: 14-18 years) were recruited from clinical and community sources and classified into four groups: (1) AUD+PS Abuse (n=154), (2) AUD only (n=255), (3) PS Abuse only (n=74), and (4) Controls (n=268). Subjects were longitudinally assessed through young adulthood (age 19 years or older). Measures included interview assessments of DSM-IV AUD and MDD, classified as "primary" or "secondary", and questionnaire measures of alcohol consumption and depression. Primary MDD preceded AUD whereas secondary MDD had a later onset than AUD. PS Abuse accelerated the onsets of primary MDD, secondary MDD and AUD. While affected adolescents had typically improved in both alcohol consumption and depression at the young adult assessment, the majority of those with adolescent AUD had AUDs in young adulthood, and MDD remained common in those with a history of PS Abuse. These results indicate that MDD among adolescents with AUD may be partly attributable to PS Abuse.     

Childhood sexual abuse,PTSD, and the functional roles of alcohol use among women drinkers

The present study investigated whether a history of childhood sexual abuse (CSA) or current post traumatic stress disorder (PTSD) was associated with alcohol-related expectancies and recalled effects of drinking reported by women in substance user treatment. The results indicate that CSA status was not associated with the alcohol-related expectancies or effects of drinking reported by women in substance user treatment. However, those currently manifesting PTSD were more likely than their peers without PTSD to report greater alcohol-related expectancies of tension reduction and having experienced greater positive enhancement from drinking. Theoretical and clinical implications of these findings are considered.     

Lifetime physical and sexual abuse and substance use treatment outcomes in men

Although lifetime physical and sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months postintake. Men with a history of physical or sexual abuse had more severe drug problems at intake, but by 6 months, there were no group differences in drug use. However, relative to men without an abuse history, men with a sexual abuse history had more severe psychiatric problems at all three time points and were more likely to report significant suicidality at intake and 6 months. Findings suggest that men with a history of sexual abuse benefit from SUD treatment, but additional intervention may be warranted to remedy persisting psychiatric distress.     

PTSD symptom presentation among people with alcohol and drug use disorders: Comparisons by substance of abuse

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) commonly co-occur, and there is some evidence to suggest that PTSD symptom clusters are differentially related to various substances of abuse. However, few studies to date have compared PTSD symptom patterns across people with different types of SUDs, and fewer still have accounted for the presence of comorbidity across types of SUDs in understanding symptom patterns. Thus, in the current study, we use a treatment-seeking sample of people with elevated symptoms of PTSD and problem alcohol use to explore differential associations between past-year SUDs with active use and PTSD symptoms, while accounting for the presence of multiple SUDs. When comparing alcohol and drug use disorders, avoidance symptoms were elevated in those with alcohol use disorder, and hyperarousal symptoms were elevated in those who had a drug use disorder. In the subsample with alcohol use disorder, hyperarousal symptoms were elevated in people with co-occurring cocaine use disorders and numbing symptoms were elevated in people with co-occurring sedative/hypnotic/anxiolytic use disorder. These findings provide evidence for different symptom cluster patterns between PTSD and various types of SUDs and highlight the importance of examining the functional relationship between specific substances of abuse when understanding the interplay between PTSD and SUDs.     

Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders

Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in patients seeking treatment for substance use disorder. The prevalence rate of suicidal ideation and/or suicide attempts was explored among lifetime physically and/or sexually abused patients receiving treatment for drug addiction. The differential characteristics between these patients and those without suicidal behaviours were studied.

Method: Three hundred and seventy-five patients were assessed. Socio-demographic characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and psychopathological symptoms were explored.

Results: Eighty-two patients (21.9%) presented with a history of lifetime abuse and were included in the study (37 men and 45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2% in the last month), and 30.5% with suicide attempts (1.2% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R).

Conclusion: This study highlights the relationship between previous traumatic experiences and suicidal behaviours. According to these results, systematic screening of suicidal risk in patients seeking treatment in addiction centres with histories of abuse is recommended.     

Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women

ObjectiveThe aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women.MethodsData were drawn from a same-sex female twin study of substance use (n = 3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure).ResultsAfter adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR) = 1.43, 95% confidence intervals (CI): 1.26–1.62) and with smoking initiation ≤ 16 in African Americans (HR = 1.70, CI: 1.26–2.29). CSA was associated with regular smoking onset ≤ 15 in European Americans (HR = 1.63, CI: 1.21–2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR = 3.30, CI: 1.23–8.89 to HR = 1.16, CI: 0.71–1.92 for regular smoking ≤ 15).ConclusionsCSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.     

Symptom endorsement of alcohol and other substance abuse and dependence criteria among American-Indian adolescents in residential substance abuse treatment

OBJECTIVE: This study addresses the prevalence of DSM-IV substance abuse and dependence and the endorsement of specific symptoms of these disorders among American Indian adolescents admitted to a residential substance abuse treatment program. METHOD: We interviewed 89 American Indian adolescents using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). RESULTS: The most frequent diagnoses included marijuana dependence (51.7%), followed by alcohol abuse and dependence (33.7% each) and marijuana abuse (32.6%). Among the three substances with the highest prevalence of any use disorder (alcohol, marijuana and stimulants), the most frequently endorsed abuse criterion was Impaired Role Obligations. The two most frequently endorsed dependence criteria were Use Despite Substance-Related Psychological/Physical Problems and Unsuccessful Attempts to Quit/Cut down on substance use. CONCLUSIONS: These American Indian adolescents presented to a residential substance abuse treatment program with serious, highly complex substance use disorders that represent substantial challenges to effective treatment.     

Childhood physical abuse,non-suicidal self-harm and attempted suicide amongst regular injecting drug users

Background

Childhood physical abuse (CPA), non-suicidal self-harm and attempted suicide are all highly prevalent amongst injecting drug users (IDU). This paper reported on the association of CPA with self-harm and attempted suicide.

Methods

Cross-sectional study, with 300 IDU administered a structured interview examining the prevalence of CPA, non-suicidal self-harm and suicide attempts.

Results

CPA was reported by 74.3%, and severe CPA by 40.3%. A history of non-suicidal self-harm was reported by 23.7%, and 25.7% had attempted suicide. Non-suicidal self-harm preceded the suicide attempt in 83.3% of cases where both had occurred. Independent correlates of non-suicidal self-harm were: female gender (OR 3.62), avoided home due to conflict (OR 2.28) and more extensive polydrug use (OR 1.32). Independent correlates of attempted suicide were: severe CPA (OR 3.18), frequent CPA (OR 2.54), avoided home due to conflict (OR 3.95), female gender (OR 2.99), a positive screen for Conduct Disorder (OR 3.53), and more extensive polydrug use (OR 1.52).

Conclusions

Those presenting to treatment agencies are highly likely to have a history of CPA, that may still influence their behaviours. Screening for histories of CPA and non-suicidal self-harm appears warranted when determining suicide risk for this population. At the population level, reductions in the rate of CPA, could possibly reduce the rate of subsequent suicidality.     

Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: screening for drug and alcohol risk

OBJECTIVE: Native-American adolescents are reported to be at high risk for drug and alcohol use and related negative consequences. A brief screening instrument that is culturally and developmentally appropriate can aid clinicians who work with Native youth in determining whether more extensive assessment of substance use is necessary. The CRAFFT has been shown to be a valid and reliable screen among general adolescent outpatient clinic samples. METHOD: Data were collected as part of the Journeys of the Circle project, a collaborative effort between the Seattle Indian Health Board (SIHB) and the University of Washington's Addictive Behaviors Research Center. Psychometric properties of the CRAFFT were examined in 70 American-Indian and Alaska-Native youths ages 13 to 19 recruited from public schools and SIHBs outpatient clinics. RESULTS: The CRAFFT demonstrated good internal consistency (alpha = 0.81). A score of 2 or higher on the CRAFFT was found to be optimal for capturing youths with high alcohol-related problems (sensitivity, 0.95; specificity, 0.86), frequent alcohol use (sensitivity, 1.00; specificity, 0.72) and frequent marijuana use (sensitivity, 1.00; specificity, 0.75). A cut-point of 3 was appropriate for identifying adolescents with frequent other drug use (sensitivity, 0.86; specificity, 0.76). CONCLUSIONS: The CRAFFT may be a valid instrument for identifying Native youths at risk for alcohol and other drug problems. This brief screen can be effective in helping providers determine the need for further assessment and treatment or prevention services for Native-American adolescents.     

Childhood sexual abuse and substance abuse treatment utilization among substance-dependent incarcerated women

Incarcerated women have high rates of substance abuse problems and trauma. A variety of variables may influence whether these women seek help or are referred for substance abuse problems. This study reports an exploratory project on service utilization among incarcerated substance-dependent women (N = 40) in southeastern Idaho. Using self-report and interview tools, most participants reported some substance abuse treatment history, although extent and types of treatment varied. Most of the women also reported some type of childhood abuse. Age, income, and consequences of alcohol and other drug use related positively to substance abuse treatment. However, severity of childhood sexual abuse and current trauma symptoms were negatively correlated with substance abuse treatment episodes. These women may use substances to cope with childhood trauma or may not perceive the substance abuse system as responsive to their co-occurring trauma symptoms.     

Childhood sexual abuse and the course of alcohol dependence development: findings from a female twin sample

Childhood sexual abuse (CSA) has been associated with increased risk for alcohol dependence (AD), but the extent to which CSA history may impact transitions in the course of AD development remains unclear. The current study examined the role of CSA in initiation of alcohol use and rate of progression from first drink to AD using a sample of 3536 female twins (mean age=21.6 years). Psychiatric diagnoses and alcohol use histories were obtained via telephone interviews using an adaptation of the SSAGA. The contribution of CSA to alcohol outcomes independent of familial influences was estimated by using co-twin AD status to adjust for familial liability to AD. CSA was associated with higher rates of both lifetime alcohol use and AD, but CSA-associated risk for consumption of first alcoholic drink was evident only at ages 12 and 13. Rate of transition from first alcohol use to AD did not differ by CSA status. Findings indicate that CSA and elevated risk for AD may be linked via early age at first drink and that progression from first drink to AD follows a similar course among women with and without histories of CSA.     

Anxiety sensitivity and drug or alcohol use in individuals with anxiety and substance use disorders

Anxiety sensitivity (AS) has been linked to both pathological anxiety and substance use problems. We evaluated relations between AS and substance use situations among individuals with substance use disorders (SUDs) and concurrent DSM-IV anxiety disorders. We predicted that AS would be most strongly associated with substance use in situations involving negative emotions and interpersonal conflict in substance abusers with anxiety disorders. This group was compared to substance abusers with concurrent mood disorders and substance abusers without other disorders (N=88). AS was positively related to negative emotion situations substance use for substance abusers with anxiety disorders and for substance abusers without other disorders. Contrary to predictions, significant differences between these groups were not found. The relationship between AS and negative emotion situations substance use remained after controlling trait anxiety in a combined group (anxiety disorders and substance abuse only groups). AS did not predict substance use for participants with concurrent mood disorders. Identification of factors that place anxious patients at risk for substance use problems will have implications for treatment and for the prevention of this form of maladaptive coping.     

The relationship between sexual and physical abuse and substance abuse consequences

This study examines the relationship between a history of physical and sexual abuse (PhySexAbuse) and drug and alcohol related consequences. We performed a cross-sectional analysis of data from 359 male and 111 female subjects recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences (InDUC), measured negative life consequences of substance use. Eighty-one percent of women and 69% of men report past PhySexAbuse, starting at a median age of 13 and 11, respectively. In bivariate and multivariable analyses, PhySexAbuse was significantly associated with more substance abuse consequences (p < 0.001). For men, age < or =17 years at first PhySexAbuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse (p = 0.048). For women, the association of PhySexAbuse with substance use consequences was similar across all ages (p = 0.59). Future research should develop interventions to lessen the substance abuse consequences of physical and sexual abuse.     

Coping and alcohol use and abuse disorder

One hundred and forty-one (141) heroin users were interviewed at the time of their most recent overdose of which 34% returned for in-depth interviews within seven days. Subjects were predominantly male (77%), aged between 18 and 29 (53%), highly dependent, and unlikely to be (8%) or to have ever been (68%) in MMT. Poly-drug use was prevalent (54%) at the time of overdose despite most subjects' awareness of the association between poly-drug use and overdose. Subjects consumed other drugs with heroin in order to increase the pleasurable effects of drug use rather than to medicate symptoms of withdrawal or depression. The overdose did not appear to change subjects' low level of concern about overdosing - only a minority (11 %) said they would seek treatment following overdose. Experience of overdose therefore does not appear to be a motivating factor for entry into treatment. A variety of harm reduction initiatives needs to be supported in order to reduce the frequency and hazards of overdose.     

Priorities for policy research on treatments for alcohol and drug use disorders

The Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP) supported 368 awards for nearly $60 million to complete policy research related to alcohol, tobacco, and illicit drug use and abuse. As part of its closure in 2009, SAPRP commissioned four papers that articulated policy research priorities for tobacco cessation and control, alcohol prevention, drug prevention, and addiction treatment. The papers were released at a Congressional Briefing on October 2, 2009 and are available on the SAPRP Web site (http://www.saprp.org/Research_Agenda.cfm). An abridged version of the treatment policy paper summarizes what we know, what we need to know, and research recommendations. The paper examines five categories of policy concerns that are likely to affect addiction treatment services over the next 5 years: (a) organization and delivery of care, (b) quality of care, (c) evidence-based practices, (d) access to care, and (e) financing, costs, and value of care.