Drug treatment outcomes: investigating the long-term effects of sexual and physical abuse histories

Individuals in drug treatment, particularly women, generally report high levels of past sexual and physical abuse. Although histories of sexual and physical abuse are associated with greater prevalence and severity of depression, anxiety, phobias, and interpersonal difficulties for individuals seeking substance-related treatment, several recent studies failed to show that prior sexual or physical abuse compromised short-term drug treatment outcomes. This study examined the possible effects of sexual and physical abuse on a wide array of behavioral domains over a two-year posttreatment period. The findings indicate few differences between those with and without past histories of such abuse in terms of drug use, drug treatment and 12-Step program participation, criminality, income sources, intimate relationships, family functioning, and psychiatric symptoms. There are specific exceptions, but they apply only to men. Overall, the findings indicate that the impact of sexual and physical abuse histories on relatively long-term treatment outcomes is minimal. Addressing the sexual and physical abuse histories of those seeking treatment for drug abuse may be justified on humanistic grounds, but it will not significantly improve the long-term effectiveness of drug treatment, nor will it substantially enhance the lives of those with histories of abuse.     

The Castaneda Series

Abstract

Women who enter drug abuse treatment programs are likely to report histories of sexual abuse that may impact psychosocial functioning, retention, and outcomes. This study investigates differences at admission between women with and without sexual abuse histories who entered an outpatient methadone treatment program in Texas. In a sample of 137 women, 39% reported prior sexual abuse. Findings show that women with sexual abuse histories were more likely also to have experienced physical and emotional abuse, to report poorer family-of-origin relationships, and to report more drug-related problems. These clients also reported more depression, anxiety, thoughts of suicide, trouble concentrating, and trouble controlling violent behavior. Results are discussed in terms of the need for adequate assessment of abuse history at intake and the need for targeted outcome studies to better define the impact of past abuse on treatment participation and outcome.     

History of reported sexual or physical abuse among long-term heroin users and their response to substitution treatment

Opioid-dependent individuals with a history of abuse have exhibited worse mental and physical health compared to those without such a history; however, the evidence regarding the influence of abuse histories on addiction treatment outcomes are conflicting.In the present study, we identified history of physical or sexual abuse at treatment initiation in relation to drug use and health among long-term opioid-dependent individuals and we determined the relationship of abuse histories with treatment outcomes following substitution treatment.We analyzed data from a randomized controlled trial that compared the effectiveness of opioid-agonists in the treatment of chronic opioid dependence. The North American Opiate Medication Initiative (NAOMI) was conducted in Vancouver and Montreal (Canada) and provided oral methadone, injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months.A total of 112 (44.6%) participants reported a history of physical or sexual abuse at baseline. Participants with an abuse history reported a significantly higher number of chronic medical problems, suicide attempts, and previous drug treatments and had poorer psychiatric, family and social relations, and quality of life status compared to those without abuse histories. No differences in current and past substance use were found between those with and without abuse histories. Following 12 months of treatment, the participants with abuse histories improved to a similar degree as those without a history of abuse in all of the European Addiction Severity Index sub-scales, with the exception of medical status.The findings suggest that individuals with abuse histories were able to achieve similar outcomes as those without abuse histories following treatment despite having poorer scores in physical and mental health, social status and quality of life at treatment initiation. These findings suggest that the substitution treatments as provided in this study can benefit the most vulnerable and access needs to be expanded to reach this population.     

Prior substance abuse and related treatment history reported by recent victims of sexual assault

To inform intervention approaches, the current study examined prevalence and comorbidity of recent use and history of abuse of alcohol, marijuana, and other illicit drugs as well as history of substance treatment among a sample of female victims of sexual assault seeking post-assault medical care. Demographic variables and prior history of assault were also examined to further identify factors relevant to treatment or prevention approaches. Participants were 255 women and adolescent girls seeking post sexual assault medical services who completed an initial follow-up assessment on average within 3 months post-assault. The majority (72.9%) reported recent substance use prior to assault, approximately 40% reported prior substance abuse history, and 12.2% reported prior substance treatment history. Prior history of assault was associated with recent drug use and history of drug abuse as well as substance treatment. Among those with prior histories of substance abuse and assault, assault preceded substance abuse onset in the majority of cases. Almost all those with prior treatment history reported recent drug or alcohol use. A portion of sexual assault survivors seen for acute medical services may benefit from facilitated referral for substance abuse treatment in addition to counseling at the time of screening. Assessment and intervention approaches should target alcohol, marijuana, and other illicit drug use and abuse. Substance use and associated impairment may serve as a rape tactic by perpetrators of assault. Substance use at the time of assault does not imply blame on the part of assault victims. Previous findings indicate that rape poses high risk of PTSD particularly among women with prior history of assault. Screening and intervention related to substance abuse should be done with recognition of the increased vulnerability it may pose with regard to assault and the high risk of PTSD within this population.     

The Prevalence of Sexual Abuse and Its Impact on the Onset of Drug Use Among Adolescents in Therapeutic Community Drug Treatment

ABSTRACT

Assessing the prevalence of sexual abuse among adolescents is problematic because they are generally reluctant to disclose abusive experiences. Often the abuse is ongoing and may involve family members with whom the adolescent lives or with whom there may be strong emotional attachments. Statistics based on self-reports of childhood victimization suggest that issues of childhood abuse are critical factors in the initiation of drug use. The current study describes the prevalence of sexual abuse among a sample of 938 adolescents admitted to residential therapeutic communities for the treatment of substance abuse and related disorders. The data indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than boys (64% vs. 24%). A history of sexual abuse correlates with several social, behavioral, and psychological characteristics of clients at entry to treatment, including greater drug use, more severe psychopathology, family drug use and more deviant peer associations. Cox regression analyses show that a history of sexual abuse is related to earlier onset of alcohol and illicit drug use. One explanation of the findings is the self-medication hypothesis (Cavailo & Schiff, 1989) which states that drug use functions to ameliorate feelings of depression, and poor self-esteem which often accompany childhood abuse.     

The Impact of Abuse Trauma on Alcohol and Drug Use: a Study of High-Risk Incarcerated Girls

ABSTRACT

This study examines the impact of abuse trauma (physical and sexual) on alcohol and drug use of high-risk girls (12 to 18 years of age) who were surveyed within the first two weeks of their incarceration. One-way ANOVA analyses and Tukey post hoc tests indicate physical abuse with a weapon was associated with higher marijuana use and number of drugs used. Sexual abuse, especially within the past year, increased marijuana use, alcohol use, number of drugs used, and alcohol and other drug (AOD) problems. Policy implications reflect the need for treatment protocols within substance abuse programs to address abuse trauma, particularly forced sex which has occurred within the past year.     

Strength in the midst of pain: Abuse as a predictor of sexual relationship power among substance-abusing Black women

ABSTRACT

The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA). The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale. The findings suggest that designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices.     

The Prevalence of Childhood Trauma Among Those Seeking Buprenorphine Treatment

ABSTRACT

In this study, the authors examined the prevalence of five types of childhood trauma among a sample of adult patients who were addicted to opioids and seeking treatment with buprenorphine. Using a survey methodology, the authors examined a consecutive sample of 113 participants and found that 20.4% reported having experienced sexual abuse, 39.8% reported having experienced physical abuse, 60.2% reported having experienced emotional abuse, 23.0% reported having experienced physical neglect, and 65.5% reported having witnessed violence. Only 19.5% of the sample denied having experienced any of the five forms of childhood trauma. Most respondents (60.2%) reported having experienced one, two, or three different forms of childhood trauma. A minority reported having experienced four (13.3%) or all five (7.1%) forms of childhood trauma. These data indicate that among individuals with opioid dependence who are seeking treatment with buprenorphine, the prevalence rates of various types of childhood trauma are quite high.     

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.     

Sexual abuse history and treatment outcomes among women undergoing methadone treatment

Women entering drug abuse treatment programs who report a history of sexual abuse are also likely to report poorer psychosocial functioning, more drug-related problems, and more family-of-origin problems. This study investigates outcome differences at follow-up between women with and those without sexual abuse histories who were treated at an outpatient methadone treatment program. Follow-up interviews were conducted with 98 women, 40% of whom reported prior sexual abuse. Those with a history of sexual abuse who reported problems at intake with psychosocial functioning and family support continued to report such problems at follow-up as compared with the women without a history of sexual abuse. However, no difference was found at follow-up between women with and those without sexual abuse histories in terms of drug use, employment, criminality, or HIV-risky behaviors. The findings suggest that sexual abuse history alone cannot predict treatment outcomes for women in methadone treatment. The implications of these findings are discussed in terms of treatment process and services.     

Addiction,Abuse, and Family Relationships

Abstract

Young, poor African American women are at high risk for victimization and stigmatization through multiple avenues, including childhood sexual abuse, drug use, and incarceration. This study describes the childhood experiences of five imprisoned African American women who have extensive histories of drug addiction and criminal behavior. Through the use of personal interviews and qualitative analysis, the women's childhood experiences are explored with attention to the themes of alcohol and drug use, sexual abuse, and mother-daughter relationships. Relational theory provides a conceptual framework for the analysis. Practice and policy considerations are discussed, with an emphasis on benefiting women with histories of abuse and addiction.     

Correlates of Sexual Self-Esteem in a Sample of Substance-Abusing Women

Abstract

An exploratory study was conducted to investigate the construct of sexual self-esteem of women in substance abuse (SA) treatment. Demographical and abuse data were collected from 99 women in SA treatment centers in New York State in 2006 to explore relationships between demographic, addiction, abuse, and treatment variables and sexual self-esteem. Correlation of scores from the SSEI-W and its subscales and abuse variables were conducted to examine relationships between variables. T-tests showed significant differences between the mean scores of the physical abuse and physical/sexual abuse variables, relationship variables and sexual orientation. Regression analyses examined the effects of abuse, sexual orientation, relationship variables and treatment characteristics. Abuse and sexual orientation remained significant in all of the models and their affect is not influenced by controlling for the other variables. The results are discussed with regard to treatment implications. This study provides evidence of the reliability of this measure in a female substance-abusing population and contributes to the knowledge of sexual self-esteem as it relates to an adult female population of women in SA treatment. Limitations and future directions are discussed, along with proposed clinical use and assessment.     

Sexual and physical abuse: Do they compromise drug treatment outcomes?

Histories of sexual and physical abuse are frequently reported by individuals participating in substance abuse treatment, these experiences may be associated with psychopathology and poor drug treatment outcomes. This paper presents the findings from a longitudinal study of 330 subjects participating in 26 outpatient treatment programs. Sexual abuse among women was associated with higher levels of depression, anxiety, suicidal ideation, suicide attempts, and PTSD, while physical abuse was associated with fewer psychological disturbances. For men, sexual abuse was associated only with anxiety. Physical abuse was associated with depression, anxiety, suicidal ideation, and PTSD. However, no significant association was found between sexual and physical abuse, and lower levels of treatment participation or drug use at follow-up. These findings indicate that there is a complex connection between abuse, psychopathology, treatment participation, and relapse. Clinical and research implications of these findings are discussed.     

Current approaches for the discovery of drugs that deter substance and drug abuse

Introduction: Much has been presented and debated on the topic of drug abuse and its multidimensional nature, including the role of society and its customs and laws, economical factors, and the magnitude and nature of the burden. Given the complex nature of the receptors and pathways implicated in regulation of the cognitive and behavioral processes associated with addiction, a large number of molecular targets have been interrogated during recent years to discover starting points for development of small-molecule interventions.

Areas covered: This review describes recent developments in the field of early drug discovery for drug abuse interventions with an emphasis on the advances published during the 2012 – 2014 period.

Expert opinion: Technologically, the processes/platforms utilized in drug abuse drug discovery are nearly identical to those used in the other disease areas. A key complicating factor in drug abuse research is the enormous biological complexity surrounding the brain processes involved and the associated difficulty in finding ‘good’ targets and achieving exquisite selectivity of treatment agents. While tremendous progress has been made during recent years to use the power of high-throughput technologies to discover proof-of-principle molecules for many new targets, next-generation models will be especially important in this field. Examples include: seeking advantageous drug–drug combinations, the use of automated whole-animal behavioral screening systems, advancing our understanding of the role of epigenetics in drug addiction and the employment of organoid-level 3D test platforms (also referred to as tissue-chip or organs-on-chip).     

Guidelines for Investigating Alcohol Problems and Developing Appropriate Responses

Abstract

This analysis is based on a follow-up study of 48 White male young adults who had been former youth multiple drug abuse patients in day-care treatment. For the most part, these respondents came from middle-class homes. As youthful offenders, many had been sent into treatment as an alternative to incarceration. Approximately six years after terminating their day-care treatments, interview data were collected when most were in their middle twenties. Consistent with previous research, those consuming more drugs were found to be more likely to have resisted treatment, to have trouble with the law, to have poorer work histories and diminished educational attainments, and they showed evidence of poorer psychological health. Surprisingly, the data also indicated that high-volume drug users were more likely to be living in their parental homes, compared to those whose drug use patterns were more moderate. It is suggested that the pattern of taking up residence with one's parents while drug dependent may be encouraged by parental enabling. The implications of these findings for guiding efforts in substance abuse treatment are discussed.     

Sexual abuse among women entering methadone treatment

Women who enter drug abuse treatment programs are likely to report histories of sexual abuse that may impact psychosocial functioning, retention, and outcomes. This study investigates differences at admission between women with and without sexual abuse histories who entered an outpatient methadone treatment program in Texas. In a sample of 137 women, 39% reported prior sexual abuse. Findings show that women with sexual abuse histories were more likely also to have experienced physical and emotional abuse, to report poorer family-of-origin relationships, and to report more drug-related problems. These clients also reported more depression, anxiety, thoughts of suicide, trouble concentrating, and trouble controlling violent behavior. Results are discussed in terms of the need for adequate assessment of abuse history at intake and the need for targeted outcome studies to better define the impact of past abuse on treatment participation and outcome.     

Psychological Distress in Abused,Chemically Dependent Adolescents

ABSTRACT

Prior research has identified physical and sexual abuse as prevalent in both adult and adolescent substance use disorder populations. The purpose of this study was to assess whether differences exist in the levels of psychological distress in abused, chemically dependent adolescents when compared to their non-abused counterparts, and to a second comparison group of non-abused, non-chemically dependent adolescents, for the purposes of determining if this might provide a means of differentiating abused adolescents earlier in treatment. Results of the SCL-90-R indicated that abused adolescents demonstrated more severe levels of psychological distress, as well as earlier onset of alcohol and drug use. There were also significant distress profiles that distinguished the abused group from their non-abused counterparts. These findings are discussed with regard to early identification and treatment implications.     

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.     

Patterns of prescription opioid abuse and comorbidity in an aging treatment population

Very little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems. Women had more pain than men and much worse psychiatric issues in all age groups. Our results indicate that a “one-size-fits-all” approach to prevention, intervention, and treatment of opioid abuse that ignores the shifting needs of opioid-abusing men and women as they age is destined to fail.