Severity of childhood trauma is predictive of cocaine relapse outcomes in women but not men

We prospectively examined the gender-specific effects of childhood trauma on cocaine relapse outcomes in an inpatient sample of treatment engaged cocaine dependent adults. Cocaine dependent men (n=70) and women (n=54) participating in inpatient treatment for cocaine dependence were assessed on severity of childhood trauma and followed for 90 days after discharge from treatment. Greater severity of childhood emotional abuse was associated with an increased risk of relapse in women. Severity of emotional abuse, sexual abuse, and overall childhood trauma was associated with the number of days cocaine was used during follow-up in women, as was the association of severity of physical abuse and overall childhood trauma with the average amount of cocaine used per occasion. No associations between childhood trauma and cocaine relapse outcomes were found in men. These findings demonstrate that childhood trauma increases the likelihood of cocaine relapse and drug use escalation after initial relapse in women but not in men. Comprehensive assessments of childhood trauma and specialized treatments that address trauma-related pathophysiology could be of benefit in improving cocaine treatment outcomes in women.     

Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes

More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. To achieve this goal, baseline characteristics, no-show for treatment status, post-treatment clinical outcomes, and treatment history were studied for subjects with lifetime history of abuse (47.3%) versus without. Abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index (ASI), and general level of functioning. The two groups endorsed different drugs as primary, with the abused group less frequently endorsing heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment.     

Childhood trauma as a correlate of lifetime opiate use in psychiatric patients

Associations have been reported between childhood sexual and/or physical abuse and adult substance abuse in general. This study investigated the relationship between childhood abuse and opiate use in particular among 763 consecutively admitted psychiatric inpatients. Patients were interviewed about demographic information, alcohol and drug use, and history of interpersonal violence. Opiate users were 2.7 times more likely to have a history of childhood sexual and/or physical abuse than nonopiate users, after controlling for diagnostic and sociodemographic variables. Opiate use was higher among those reporting physical abuse alone (24.1%) or both physical and sexual abuse (27%) than among those reporting sexual abuse alone (8.8%). Implications of these findings are discussed.     

Trauma,Delinquency, and Substance Use: Co-Occurring Problems for Adolescent Girls in the Juvenile Justice System

Girls in the juvenile justice system are known to have high rates of co-occurring childhood abuse, trauma, and substance abuse. Girls with this constellation of problems are at high risk for serious adverse outcomes, including problems with drug dependence and abuse. The relationship among childhood sexual abuse, childhood physical abuse, other types of childhood trauma, and rates of substance use during adolescence were examined for girls in the juvenile justice system. As expected, childhood sexual abuse was significantly related to girls' substance use during adolescence. In contrast to prior research, no link was found between physical abuse, lifetime trauma, and substance use. Limitations and future directions are discussed.     

Childhood physical and sexual abuse and subsequent alcohol and drug use disorders in two American-Indian tribes

OBJECTIVE: The purpose of this study was to examine the relationship of childhood physical and sexual abuse to subsequent lifetime alcohol or drug use disorders among American Indians (AIs) by using cross-sectional and retrospective data collected from a structured epidemiological interview. METHOD: A sample of 3,084 AIs from two tribal populations-Southwest and Northern Plains--participated in a large-scale, community-based study. Participants were asked about traumatic events and family history and were administered standard diagnostic measures of substance use disorders. RESULTS: Prevalence of childhood physical abuse was approximately 7% for both tribes, and childhood sexual abuse was 4%-5%, much higher for females. The Northern Plains tribe had higher prevalences of substance use disorders. Childhood physical abuse had a significant main effect in bivariate models of substance dependence, but remained significant only in the multivariate models of substance dependence for the Northern Plains tribe. Correlates of disorder were psychiatric and medical comorbidity, parental alcohol problems and adult experience of physical attacks. CONCLUSIONS: Childhood physical abuse had a stronger effect than childhood sexual abuse on lifetime substance dependence. Childhood sexual abuse, on the other hand, was more associated with lifetime substance abuse. Females more commonly experienced childhood abuse but were less likely than males to develop substance use disorders. Although additional covariates reduced the main effect on disorder, results provide clinical guidance to constellations of risk factors and expand the population at risk to include males.     

The relationship between sexual abuse and drug use: a view of African-American college students in Texas

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were 4 times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.     

Childhood abuse and harmful substance use among criminal offenders

Childhood abuse is a serious problem that has been linked to harmful alcohol and drug use in non-offender samples. In a sample of 219 criminal offenders, we examined the associations between childhood physical and sexual abuse and three indices of harmful substance use. Results indicate that physical abuse was associated with symptoms of alcohol use disorder and sexual abuse was associated with symptoms of drug use disorder among offenders. Both forms of childhood abuse were associated with substance use consequences, even after taking into account substance type and frequency of use. No gender by childhood abuse interactions were found. Symptoms of depression and generalized anxiety partially mediated relationships between childhood abuse and substance use consequences. Findings underscore the importance of assessing childhood abuse and treating anxiety and depression among offenders who exhibit harmful substance use.     

The Relationship Between Sexual Abuse and Drug Use

Abstract

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were four times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.     

Physical Pain and History of Suicidal Behaviors in Alcohol-Dependent Patients Entering Treatment in Poland

Background: Individuals with alcohol use disorders have been shown to be at increased risk for suicidal behaviors and chronic pain. Objectives: The aim of this study was to conduct initial analyses of the association between current physical pain and the likelihood of suicidal behavior history in alcohol-dependent patients entering treatment in Poland. Methods: A sample of 366 (73.5% men and 26.5% women) participants were recruited from alcohol treatment centers in Warsaw, Poland. Information was obtained about a history of lifetime suicidal behavior, past 4-week pain level, demographics, social functioning, childhood abuse, depressive symptoms, severity of alcohol and sleep problems. Results: A total of 118 individuals (32.2%) reported at least one suicidal behavior during their lifetime. In unadjusted analyses, there was a significant association between a history of lifetime suicidal behavior and a moderate or greater experience of physical pain during the last four weeks. Other variables that were significantly associated with suicidal behaviors were: younger age, history of childhood abuse, depressive symptoms, sleep problems, consequences of drinking, and lower social support. In the multivariate logistic regression analysis, only experience of moderate or greater pain, age, and depressive symptoms remained significantly associated with a history of suicidal behavior. Conclusions: The experience of physical pain is significantly associated with a lifetime history of suicidal behavior in alcohol-dependent patients. Clinicians should be aware of these associations when conducting assessments and treating alcohol use disorders.     

Alcohol Use Problem Severity and Problem Behavior Engagement Among School-Based Youths in Minnesota

This study created an alcohol use problem severity taxonomy and examined its association to engagement in other problem behaviors. Minnesota youths were categorized based on their frequency of alcohol use and DSM-IV alcohol abuse and dependence criteria. Greater alcohol use problem severity was generally associated with higher prevalence of lifetime and regular marijuana use and higher odds of lifetime sexual intercourse and past-year arrest/law trouble. Knowing about variations in adolescent alcohol use and problems may be instrumental in gauging the degree to which youths may also be engaging in a range of other problem behaviors.     

Assessment of lifetime physical and sexual abuse in treated alcoholics. Validity of the Addiction Severity Index

We examined the validity of the Addiction Severity Index (ASI) regarding the identification of lifetime physical and sexual abuse histories using the Structured Trauma Interview (STI) as external criterion in alcohol-dependent patients (n=144). Compared to the STI, the ASI showed a lower incidence of lifetime physical abuse reports (51% vs. 24%) and lifetime sexual abuse reports (29% vs. 17%). Lower incidence of abuse reports was stronger in males compared to females, which could be largely explained by ASI perpetrator restrictions (i.e. exclusion of several extrafamilial perpetrators). Controlling for these restrictions, acceptable sensitivity for both sexual and physical abuse as well as good specificity was found. Data indicated no response bias on the ASI in terms of social desirability or abuse severity. Sensitivity of the ASI method can probably be improved by including an opening preface to the subsequent abuse questions, including questions inquiring about abuse histories that have neutral wording instead of using the word "abuse," and inclusion of all possible perpetrators.     

Posttraumatic stress disorder and short-term outcome in early methadone treatment

The aim of this study was to determine treatment adherence relative to frequency of violence and posttraumatic stress disorders (PTSD) among new methadone patients. Ninety-six opiate-abusing patients were evaluated for childhood physical and sexual abuse (CPSA), adulthood exposures to violence (ADVIOL), PTSD, and treatment adherence. Overall, 43% of the subjects dropped out of treatment within 3 months of intake. Occurrence of trauma or PTSD did not predict drop-out rates. A 2 (Gender) x 2 (PTSD) analysis of covariance (ANCOVA) with severity of other drug use on admission as a covariate, however, revealed a main effect for PTSD, F(4, 71) = 7. 69, p < or =.01, such that those patients with current PTSD revealed significantly more ongoing drug use at 3 months (M = 24.3, SD = 20. 9) than those without (M = 8.9, SD = 11.8). Examination of ongoing cocaine use using a 2 (Gender) x 2 (PTSD) ANCOVA also revealed a main effect for PTSD, F(4, 17) = 8.24, p < or = .005, such that those patients with current PTSD revealed significantly more ongoing cocaine use at 3 months postadmission (M = 51.6, SD = 37.6) than those without (M = 24.3, SD = 20.9). For both genders, CPSA and ADVIOL were associated with higher rates of PTSD, which in turn predicted poorer treatment adherence as measured by ongoing co-occurring drug abuse 3 months postadmission. Results underscore the need for routine assessment and targeted treatment of trauma in methadone patients.     

Differential Drug Use Patterns Among Sexually Abused Adolescent Girls in Treatment for Chemical Dependency

A sample of 444 girls admitted to adolescent chemical dependency treatment was divided into four groups based on sexual abuse experiences. Girls who reported intrafamilial abuse, extrafamilial abuse, or both, were compared with nonvictims in terms of alcohol and drug use histories. Prevalence and frequency of alcohol, marijuana, and cocaine did not differ significantly among the groups. However, all sexual abuse victims were significantly more likely to regularly use stimulants, sedatives, tranquilizers, and hallucinogens. Sexual abuse victims also reported earlier onset of alcohol and drug use, more self-medication, and more use to escape family problems.     

A history of drug use and childhood sexual abuse among incarcerated males in a county jail

This study explored the relationship between childhood sexual abuse and drug use among incarcerated males. A retrospective, self-reported survey was administered over an 8-week period (September and October 2001) to a random sample of 100 men who were incarcerated in a county jail. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors. Overall, 59% of this sample of male inmates reported some form of childhood sexual abuse, and all such instances occurred before or at the age of 13. Statistically significant relationships were found between drug use and childhood sexual abuse, with those who experienced childhood sexual abuse reporting drug use at percentages as much as 30% higher than those denying histories of childhood sexual abuse.     

Relationships between adult women's alcohol problems and their childhood experiences of parental violence and psychological aggression

OBJECTIVE: The objective of this study is to examine the associations between mother physical abuse, mother psychological aggression, father physical abuse and father psychological aggression and women's alcohol dependence while controlling for several demographic variables, childhood sexual abuse and mother and father alcohol problems. METHOD: Samples of women in treatment for substance use disorders (n = 225) and receiving services for domestic violence (n = 222) volunteered to be in the study. We used the Parent-Child Conflict Tactics Scales to assess retrospectively experiences of parental aggression during childhood and the Composite International Diagnostic Interview for a diagnosis of alcohol dependence based on International Classification of Diseases (ICD-10) criteria. RESULTS: Logistic regression applied to the data showed that being in the substance use disorder treatment sample, being unemployed and not being black were significantly related to a higher likelihood of lifetime diagnosis of alcohol dependence. Mother psychological aggression was found to be significantly associated with alcohol dependence. Father psychological aggression was found to be significantly related to alcohol dependence for nonwhite women but not for white women. Mother and father physical abuse were both found to be significantly related to alcohol dependence, but only for women who did not report childhood sexual abuse. CONCLUSIONS: Associations between experiences of childhood abuse and development of alcohol problems for women are complex. Experiences of mother and father abuse need to be examined separately with samples of women who are of different ethnicities and samples of women who are receiving services for different problems.     

Severity of substance abuse and psychiatric problems among perinatal drug-dependent women

The present study assessed 108 women enrolled in a residential treatment program for perinatal substance abusers in order to examine possible subtypes based on current alcohol, other drug and psychiatric problem severity. Most participants were African-American (81%), unmarried (91%), unemployed (97%), high school graduates (63%) with a mean age of 30 years. The primary substances of abuse were cocaine/crack (87%) and opiates (9%). The majority (79%) of subjects were also nicotine dependent. Drug severity did not distinguish between these groups; however, when cluster analysis was applied to ASI alcohol and psychiatric composite scores, three clusters emerged: (1) high alcohol, drug, and psychiatric problem severity (57%); (2) high drug and psychiatric problem severity (20%); and (3) high drug severity only (23%). Neither current nor childhood demographic characteristics differed among the three groups. However, significant differences were found among selected childhood risk factors, including perceived quality of relationships with family, age of onset of substance use, childhood abuse history, and family history of mental illness. These results emphasize the need for careful assessment and treatment planning that addresses the unique needs of these women.     

Examining Risk for Frequent Cocaine Use: Focus on an African American Treatment Population

Background: Cocaine use and its consequences are disproportionately higher and more severe among African Americans compared to other ethnic/racial groups. Objectives: The aims of this study were to examine a risk model specific for African American users and assess whether risk varies as a function of sex. Methods: 270 African American adults in a residential drug treatment facility completed measurements assessing first and past year crack/cocaine use frequency, childhood trauma, and stress reactivity. Multiple linear regression analysis was used to examine the unique effect of each predictor variable on past year crack/cocaine frequency. Sex was included as a moderator variable in the regression analysis. Results: All predictor variables were positively correlated with past year crack/cocaine use. However, sex differences were also observed: females reported higher rates of childhood emotional abuse, childhood sexual abuse, and stress reactivity—as well as past year crack use and cocaine use—than males. Regression analyses were performed with sex, first year use, and stress reactivity emerging as the only significant predictors for frequency of crack and cocaine use among all study participants. Moreover, sex differences were observed in the influence of first year crack use frequency on past year crack use frequency, such that the effect was stronger for males than for females. Conclusion/Importance: This study offers a clearer understanding of the risk factors for crack and cocaine abuse specific to African Americans, as well as sex specific pathways to risk, providing useful implications for future prevention and treatment efforts.     

Marijuana use motives mediate the association between experiences of childhood abuse and marijuana use outcomes among emerging adults

IntroductionExperiences of childhood sexual abuse (CSA) and childhood physical abuse (CPA) are associated with poor mental health outcomes including substance use in subsequent years. Marijuana use motives (i.e., coping with negative affect, enhancing positive affect, or improving social interactions) may influence problematic substance use among young adults. Specifically, motives may be associated with severity of marijuana use outcomes among individuals who have experienced CSA or CPA. This study investigated the indirect effect of marijuana use motives between experiences of CSA or CPA and marijuana use and problems among emerging adults.MethodParticipants were 397 young adults (50.1% male, 66.2% White) between ages 18–25 years, who reported 15.85 (SD = 11.66) days of marijuana use in the past month. Participants reported on history of childhood abuse, marijuana use days, problems, and motives for use.ResultsFindings suggest a significant indirect effect of coping motives in the association between CPA and marijuana use days and marijuana problems. Further, both coping motives and marijuana use days indicated a significant indirect effect between CPA and problems. Motives of socializing or enhancement did not have a significant indirect effect between CPA and marijuana use or problems. There were no significant findings with CSA and marijuana use outcomes.DiscussionCoping motives might be an important potential target for future marijuana interventions in persons with childhood physical abuse.     

Risk factors in the relationship between gender and crack/cocaine

Female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than on any other drug. Additionally, female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than their male counterparts, despite no consistent difference demonstrated in use and dependence across other drugs. Because no published work has empirically examined the factors underlying this link between females and crack/cocaine, the current study examined the role of theoretically relevant personality and environmental variables. Among 152 (37% female) individuals in a residential substance-use treatment program, females evidenced greater use of crack/cocaine (current and lifetime heaviest) and were significantly more likely to evidence crack/cocaine dependence than their male counterparts. In contrast, no gender differences were found for any other substance across alcohol, cannabis, and hallucinogens (including PCP). Surprisingly, females were more impulsive than their male counterparts, with impulsivity serving as a risk factor in the relationship between gender and crack/cocaine dependence and lifetime heaviest use. Females also evidenced higher levels of negative emotionality and childhood abuse, but neither variable served as a risk factor in the relationship between gender and crack/cocaine dependence or use. Limitations and future directions are discussed, including the need for further exploration of impulsivity across its various dimensions as well as the inclusion of additional variables such as social context variables to account more fully for this complex link between gender and crack/cocaine.     

Using the Bivariate Dale Model to jointly estimate predictors of frequency and quantity of alcohol use

OBJECTIVE: This study demonstrates the usefulness of the Bivariate Dale Model (BDM) as a method for estimating the relationship between risk factors and the quantity and frequency of alcohol use, as well as the degree of association between these highly correlated drinking measures. METHOD: The BDM is used to evaluate childhood sexual abuse, along with age and gender, as risk factors for the quantity and frequency of beer consumption in a sample of driving-while-intoxicated (DWI) offenders (N = 1,964; 1,612 men). The BDM allows one to estimate the relative odds of drinking up to each level of ordinal-scaled quantity and frequency of alcohol use, as well as model the degree of association between quantity and frequency of alcohol consumption as a function of covariates. RESULTS: Individuals who experienced childhood sexual abuse have increased risks of higher quantity and frequency of beer consumption. History of childhood sexual abuse has a greater effect on women, causing them to drink higher quantities of beer per drinking occasion. CONCLUSIONS: The BDM is a useful method for evaluating predictors of the quantity-frequency of alcohol consumption. SAS macrocode for fitting the BDM model is provided.