Effects of childhood physical abuse on course and severity of substance abuse.

The present study sought to assess the course and severity of Substance Related Disorder (SRD) in relation to childhood physical abuse (CPA) using retrospective data on CPA and current indices of substance use, abuse, and related morbidity. A total of 642 patients were assessed, of whom 195 (30.4%) experienced CPA, were assessed in two university medical centers with Alcohol-Drug Programs located within departments of psychiatry. A research assistant obtained demographic data, family history of substance abuse, problems related to substance abuse, and treatment of substance abuse. Data on severity included two measures of SRD-associated problems (one patient-rated and one psychiatrist-rated), substance abuse vs. dependence, self-help activities, and previous treatment. The study found that patients with CPA were more likely to be women, have lower socioeconomic status, and have more extended family members with substance abuse. Their substance abuse was more severe on five out of six severity measures. Patients with CPA showed more lifetime treatment on three out of four measures. Physical abuse during childhood resulted in a more morbid course of substance abuse later in adulthood. Although female gender and lower SES were both associated with CPA, the relationships were separate (i.e., women did not have lower SES).     

Cardiac manifestations of cocaine abuse: a cross-sectional study of asymptomatic men with a history of long-term abuse of "crack" cocaine.

OBJECTIVES. The objective of this study was to evaluate the prevalence of cardiac abnormalities in young, asymptomatic long-term "crack" cocaine abusers. BACKGROUND. Although the cardiac complications of cocaine abuse have received widespread attention, the prevalence of cardiac abnormalities in asymptomatic long-term cocaine abusers is unknown. METHODS. History, physical examination, electrocardiogram (ECG) and echocardiogram were performed in 52 consecutive long-term cocaine abusers admitted to a drug rehabilitation program. Findings were compared with those in 14 age-matched normal volunteers and 14 age-matched normotensive patients admitted to a psychiatric service who had a pattern of smoking and alcohol consumption similar to that of the study patients. RESULTS. The ECG findings were abnormal in 29% of cocaine abusers, and included nonspecific ST-T wave changes in 15%, abnormal ST segment elevation in 10%, old inferior infarction in 2%, old anteroseptal infarction in 2% and abnormal precordial R wave progression in 10%. When compared with normal volunteers and control patients, cocaine abusers had increased left ventricular posterior wall thickness (1.12 vs. 0.76 and 0.85 cm, respectively, p < 0.0001), increased septal thickness (1.13 vs. 0.76 and 0.86 cm, p < 0.001) and higher left ventricular mass index (142 vs. 84 and 94 g/m2, p < 0.0001). Left ventricular diastolic filling variables did not differ significantly among the three groups. Diastolic filling variables were similar in cocaine abusers with and without left ventricular hypertrophy, and the prevalence of left ventricular hypertrophy did not differ significantly between those who used no alcohol or < 35 ml/week of alcohol and those who consumed > or = 500 ml/week of alcohol. Left ventricular segmental wall motion abnormalities were present in 11 subjects (21%) and the ejection fraction was decreased (< 0.45) in 2 (4%). CONCLUSIONS. Electrocardiographic and echocardiographic abnormalities are common in long-term cocaine abusers. Despite the frequent occurrence of left ventricular hypertrophy, Doppler-derived diastolic filling pattern was not altered. Concomitant alcohol use did not affect the prevalence of these abnormalities.     

Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks

This study examines the prevalence of physical and sexual abuse by intimate and commercial sexual partners among street-based sex workers and explores correlates of partner abuse by commercial partners using the following factors: sociodemographics, substance abuse, sexual behavior, and physical and sexual childhood abuse. One hundred thirteen street sex workers were recruited from December 1996 through May 1997 while receiving services from the Foundations for Research on Sexually Transmitted Diseases (FROST'D), a nonprofit organization based in New York City. Partner abuse is a common occurrence among street sex workers. Two of three street prostitutes have experienced lifetime physical or sexual abuse by either an intimate or commercial partner. In addition, one of eight reported physical and sexual abuse by both intimate and commercial partners during her lifetime. Women who were homeless in the last year, those who reported exchanging for drugs and money as their main source of income, used injection drugs in the past year and had sex in crack houses, and who were human immunodeficiency virus (HIV)-positive were more likely to be report combined physical and sexual abuse. Understanding the relationship between partner violence, victim's substance abuse, and HIV-risk behavior is important for the development of public policies and treatment and prevention strategies to address the constellation of problems that drug-using female street sex workers face.     

The robust association between childhood physical abuse and osteoarthritis in adulthood: Findings from a representative community sample

Objective

Research suggests a role of early‐life trauma in the development of arthritis. This study investigated the relationship between childhood physical abuse and osteoarthritis (OA) while controlling for age, sex, race, and socioeconomic status (SES), in addition to the following types of risk factors for OA: 1) concurrent childhood stressors, 2) adult health behaviors, and 3) depression.

Methods

Data from the provinces of Manitoba and Saskatchewan were selected from the 2005 Canadian Community Health Survey (n = 13,093). Respondents with missing arthritis data or with arthritis types other than OA were excluded (n = 1,985). Of the 11,108 remaining respondents, 6.9% (n = 854) reported childhood physical abuse by someone close to them, and 10.1% (n = 1,452) reported that they had been diagnosed with OA by a health professional. The regional‐level response rate was 84%.

Results

When adjusting for all 3 types of risk factors, a significant association between childhood physical abuse and OA was found (odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.21–2.00). In contrast, when adjusting for age, sex, race, and SES only, the OR was 1.99 (95% CI 1.57–2.52).

Conclusion

The association between childhood physical abuse and OA remained significant, even after controlling for many risk factors that may mediate the relationship. Further research is needed to investigate potential pathways through which arthritis develops as a consequence of childhood physical abuse.     

Factors related to abuse of older persons by relatives with psychiatric disorders

IntroductionAcross developed nations, elder abusers have been found to disproportionately have indicators of psychiatric disorders (PD); however, elder abuse by persons with PD has received almost no research attention. The present analysis examines the association of perpetrator, victim, and interaction factors with the occurrence of physical, financial, and psychological abuse of older persons, committed by relatives with PD.MethodsData are from a U.S. community recruited survey of 243 persons 55 years of age and older who report having an adult relative with PD. Multivariate logistic regression was performed examining the association of proposed factors with the occurrence of physical, financial, and psychological abuse.ResultsIn the past 6 months, 15%, 20%, and 42% of respondents reported experiencing physical, financial, and psychological abuse by relatives with PD, respectively. All forms of abuse co-occur at statistically significant levels. There is variation among factors associated with physical, financial, and psychological abuse; however, all types are associated with greater use of limit-setting practices and either regular attendance of mental health treatment or use of medications.ConclusionsEfforts to prevent abuse of older persons may benefit from linking suspected/substantiated elder abusers with PD to mental health treatment. Older persons engaging in high levels of limit-setting practices towards relatives with PD may benefit from being offered support and guidance regarding how to set limits in ways less likely to escalate conflict.     

The association between cannabis abuse and dependence and childhood physical and sexual abuse: evidence from an offspring of twins design

AIM: This study examines the association between childhood physical abuse (CPA) and sexual abuse (CSA) and the development of cannabis abuse and dependence among adolescents and young adults while controlling for genetic and environmental risk factors. DESIGN: To control for familial risk differences related to paternal drug dependence that might confound the relationship between CSA and CPA and cannabis abuse/dependence, we created four groups based on father's and uncle's substance use dependence (SUD) status reflecting different degrees of genetic and environmental risks to offspring: (i) high genetic, high environmental risk; (ii) high genetic, low environmental risk; (iii) medium genetic, low environmental risk; and (iv) low genetic, low environmental risk. PARTICIPANTS: Adolescent and young adult offspring of monozygotic and dizygotic US military veteran twin fathers (n = 819). MEASUREMENTS: Data on CPA and CSA, DSM-IV offspring cannabis abuse/dependence, other SUD and psychopathology and maternal and paternal SUD and psychopathology were collected via semi-structured telephone interview. FINDINGS: Twenty-three per cent of the offspring sample met life-time criteria for cannabis abuse/dependence and 8.55% and 12.82% reported CSA and CPA, respectively. Offspring exposed to CSA, but not CPA, were at significantly greater risk of developing cannabis abuse/dependence compared to those who had not experienced CSA (hazard ratio = 2.16; 95% confidence interval = 1.48-3.16) after controlling for genetic and familial environmental risk and offspring gender, alcohol abuse and dependence and conduct disorder. CONCLUSIONS: These results indicate that there are effects of CSA on development of cannabis abuse/dependence in addition to the genetic and familial environmental risk imparted by having a drug-dependent father.     

Male physical aggression as a function of alcohol, frustration, and subjective mood

An experiment tested the hypothesis that alcohol intoxication will increase aggression only if the subject is experiencing the intoxicated state as displeasing. Forty males drank either 0.8 mL of pure alcohol/kg body weight or a placebo drink and were then exposed to either a pleasant or an unpleasant mood manipulation. Following this, they were given the chance to aggress in a modified version of the Buss "aggression machine" paradigm. All subjects were observed under varying levels of frustration. Results indicated that alcohol-drinking subjects were more aggressive than placebo-drinking subjects, and that both intoxicated and sober subjects increased their aggression when frustrated. Intoxicated subjects in a pleasant mood were most aggressive under both provocative and nonprovocative conditions. The hypothesis was not supported and results are discussed in relation to different theoretical models and in relation to results from other similar studies.     

Suicidal behavior and history of substance abuse.

Substance abuse is frequently associated with suicidal behavior. However, it is unclear to what degree substance abuse in a family member is related to suicide. In the present study, personal and family histories of substance abuse were examined in 716 psychiatric emergency room patients. Suicide attempters, suicide ideators, and nonsuicidal controls were compared across demographic, clinical, and substance abuse variables. Results showed that suicidal patients differed from nonsuicidal controls on many of the dependent variables. Suicidal patients were more likely to be depressed and report a history of previous suicidal tendencies. Also, alcohol and drug abuse occurred more frequently in suicidal patients. Furthermore, a family history of alcohol abuse was reported more often by suicidal than nonsuicidal patients. These patterns of substance abuse in suicidal patients were especially prominent among older subjects. Results are discussed in terms of the implications for identifying psychiatric emergency room patients at risk for suicide.     

Dealing with drugs: heroin abuse as a social problem

Reported here are attitudes and perceptions regarding heroin control, prevention, and treatment obtained in a survey of community leaders in four high drug traffic and drug use neighborhoods in New York City. Studies in the past have focused on the causes and consequences of heroin use primarily from the standpoint of the drug user. Operationalizing the tenet that heroin abuse is a social problem, this study develops an ecological paradigm for analyzing the effects on neighborhoods of illicit drugs and of prevention, intervention, and treatment policies. The research was undertaken in 1981 for the New York State Heroin and Alcohol Study Commission. It demonstrates the importance of including community perspectives in policy decisions and the usefulness of a study group of community leaders as a reliable source of this information.     

Response rates in a survey of physical capacity among older persons.

A representative sample of 420 subjects aged 55 to 84 was sought for participation in a study of the relationship between physical activity and health. A stratified random sample with 35 subjects in each of 12 age-gender categories was designed, using lists generated consecutively until the target number for each category was reached. Although the protocol required walking and treadmill tests, 60.3 percent of those eligible participated, a figure comparable to that of NHANES II and superior to that of the Canada Fitness Survey. Participants were younger, more likely to be male, less likely to be currently married, and more likely to have had a white-collar job and some postsecondary education than were nonparticipants. Difficulties of obtaining subjects and methods for avoiding these difficulties include offering many opportunities to attend and determining accurately the reason for nonparticipation.     

Sexual aggression among White, Black, and Hispanic couples in the U.S.: alcohol use, physical assault and psychological aggression as its correlates

This article examines the prevalence of sexual aggression and its association with alcohol and other forms of violence, such as physical abuse and psychological aggression, in a national sample of married and cohabiting couples. These couples were part of a longitudinal study conducted in 1995 and 2000. The analyses include 406 White, 232 Black, and 387 Hispanic couples interviewed in 2000. Male-to-female sexual aggression rates ranged from 11% to 23% and female-to-male aggression rates ranged from 5.5% to 13.5%. Insisting on having sex without use of physical force and having sex without a condom are the two most frequently reported types of sexual aggression across all ethnic groups. Male and female perpetrated sexual aggression rates among Black couples were over 2 times the rate of White couples. Male perpetrated severe psychological aggression is a significant predictor of male sexual aggression. Female perpetrated severe psychological aggression predicted female sexual aggression. The study findings underscore the importance of addressing alcohol use and the presence of psychological abuse in the light of preventing other forms of violence including sexual aggression among couples.     

Social cognition and aggression in methamphetamine dependence with and without a history of psychosis

In substance use and psychotic disorders, socially problematic behaviours, such as high aggression may, in part, be explained by deficits in social cognition skills, like the detection of emotions or intentions in others. The aim of this study was to assess the magnitude of social cognition impairment and its association with aggression in individuals with methamphetamine (MA) dependence, methamphetamine-associated psychosis (MAP), and healthy controls (CTRL). A total of 20 MAP participants, 21 MA-dependent participants without psychosis, and 21 CTRL participants performed a facial morphing emotion recognition task (ERT) across four basic emotions (anger, fear, happiness and sadness) and the reading the mind in the eyes task (RMET), and completed the aggression questionnaire. Both MA-dependent groups showed impairment in social cognition in terms of lower RMET scores relative to CTRL participants (MA; p?=?.047; MAP: p?<?.001). Additionally, performance decrements were significantly greater in MAP (p?=?.040), compared to MA-dependent participants. While deficits in recognising emotional expressions were restricted to anger in the MA group (p?=?.020), a generalized impairment across all four emotions was observed in MAP (all p?≤?.001). Additionally, both patient groups demonstrated higher levels of aggression than CTRLs, yet no association was found with social cognition. This study supported the notion of deficits in recognising facial emotional expressions and inferring mental states of others in MA dependence, with additional impairments in MAP. Failure to detect an association between social cognitive impairment and aggressive behaviour may implicate independent disturbances of the two phenomena in MA dependence.     

High rates of alcohol use and history of physical and sexual abuse among women outpatients

A total of 189 consecutive new women patients were surveyed at an adult psychiatric outpatient clinic which did not have a specific program for the treatment of alcoholics. Twenty-seven patients (14%) reported a history of heavy alcohol consumption measured by scores of 10 or more on the Michigan Alcoholism Screening Test (MAST), but only 16 had a diagnosis of alcohol abuse or alcohol dependence made by a clinician. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the MAST than those with no such history. When the first abuse occurred before the age of 18 years and there was no recent reported abuse, the association of abuse and high MAST scores persisted, suggesting that early physical or sexual abuse may be associated with current levels of alcohol use.     

Lipoprotein (a) in childhood: correlations with family history of cardiovascular disease

The association between lipoprotein (a) [Lp(a)] and cardiovascular diseases is well known. Lp(a) is an independent risk factor for the development of atherosclerosis. Little information concerning Lp(a) during childhood is available. The aim of the present investigation was to determine the Lp(a) concentration in a cohort of children aged between 4 and 15 yr and to correlate Lp(a) with: a) overweight status; b) body fat distribution; c) family history of vascular diseases in their parents and grandparents. Six hundred and eighty-nine children (350 males, 339 females), were enrolled in the study. BMI as index of being overweight was calculated; the waist-to-hip ratio (WHR) and the waist-to-thigh ratio (WTR) were calculated to obtain two anthropometric indexes for the pattern of body fat distribution. The areas of visceral (VAT) and subcutaneous adipose tissue (SAT) were evaluated by MRI at the L4-L5 level in only 30 overweight subjects. The serum of Lp(a), total cholesterol (TC), HDL-cholesterol, LDL-cholesterol and triglycerides were evaluated in the whole population. Moreover, the same biochemical study was performed in 70 children's parents randomly chosen. A structured questionnaire was administered to the children's parents to investigate the presence of cardiovascular disease (CVD) in family stories. Our data show no Lp(a) serum differences between children according to sex, age and body composition. The strong correlation between the children's and the parents' Lp(a) concentrations and the occurrence of CVD in their grandparents suggests that Lp(a) represents an important independent early risk factor for the development of CVD in adulthood. Measurements of Lp(a) in childhood may help to evaluate this risk in subjects with family history of cardiovascular diseases.