Childhood Maltreatment and Substance Use Disorders Among Men and Women in a Nationally Representative Sample

Assistant Professor, Departments of Community Health Sciences, Psychiatry, and Family Social Sciences, University of Manitoba, Winnipeg, Manitoba.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 11/2012; 57(11):677-686.
Source: PubMed


To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample.

Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders.

All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect.

This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.

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    • "), which is a fully-structured interview appropriate to be used by clinicians as well as trained lay interviewers (Afifi et al., 2011). Substance use disorders considered were abuse of and/or dependence on alcohol, nicotine, sedatives, tranquilizers, opioids, amphetamines, cannabis, hallucinogens, cocaine, and heroin (Afifi et al., 2012). "
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    ABSTRACT: Background: Intimate partner violence (IPV) is a major problem with serious physical and mental health consequences. Adverse childhood experiences (ACEs), including emotional, physical or sexual abuse, witnessing parental violence, or living with someone who has mental illness, a substance abuse (SA) or incarceration history have been linked to violence and psychopathology. However, the mediational pathways for these relationships are not understood. Objective: To determine the mediational role of posttraumatic stress disorder (PTSD), substance abuse (SA), and depression in the association between ACEs and intimate partner violence (IPV) perpetration. Methods: Data were obtained from the National Epidemiologic Survey on Alcohol Related Conditions (2004-2005) (N=34,653). Exploratory factor analysis (EFA) was used to determine latent factors for ACEs, and IPV perpetration. Mediation analysis was used to determine the mediational roles of PTSD, SA, and depression in the association between ACEs and past year IPV perpetration in three separate models. Results: Approximately 57% of respondents were exposed to at least one ACE, and approximately 6% reported IPV perpetration in the past year. EFA of ACEs indicated three factors: sexual abuse, neglect/other abuse, and parental psychopathology. EFA of IPV perpetration indicated one factor. PTSD (p=0.000), depression (p=0.000) and SA (p<0.003) partially mediated the association between all three ACE factors and IPV perpetration Conclusions: Intervention programs targeting IPV perpetrators, should consider addressing ACEs, which have far-reaching effects across the lifespan, along with PTSD, SA, and depression as key focal points.
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    • "These data suggest that maltreatment in childhood may result in enduring differences in brain function that are associated with negative affective states and reduced adaptive emotional processing in adulthood. Given the consistent evidence that maltreatment increases the risk of substance abuse (e.g., Afifi et al. 2012), these results raise the possibility that limbic connectivity and concomitant emotional distress foster the development of methamphetamine abuse as a means of drug-induced emotion regulation (cf. Baicy and London 2007). "
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    ABSTRACT: Introduction Childhood maltreatment, a well-known risk factor for the development of substance abuse disorders, is associated with functional and structural abnormalities in the adult brain, particularly in the limbic system. However, almost no research has examined the relationship between childhood maltreatment and brain function in individuals with drug abuse disorders. Methods We conducted a pilot study of the relationship between childhood maltreatment (evaluated with the Childhood Trauma Questionnaire; Bernstein and Fink 1998) and resting-state functional connectivity of the amygdala (bilateral region of interest) with functional magnetic resonance imaging in 15 abstinent, methamphetamine-dependent research participants. Within regions that showed connectivity with the amygdala as a function of maltreatment, we also evaluated whether amygdala connectivity was associated positively with negative affect and negatively with healthy emotional processing. Results The results indicated that childhood maltreatment was positively associated with resting-state connectivity between the amygdala and right hippocampus, right parahippocampal gyrus, right inferior temporal gyrus, right orbitofrontal cortex, cerebellum, and brainstem. Furthermore, connectivity between the amygdala and hippocampus was positively related to measures of depression, trait anxiety, and emotion dysregulation, and negatively related to self-compassion and dispositional mindfulness. Conclusions These findings suggest that childhood maltreatment may contribute to increased limbic connectivity and maladaptive emotional processing in methamphetamine-dependent adults, and that healthy emotion regulation strategies may serve as a therapeutic target to ameliorate the associated behavioral phenotype. Childhood maltreatment warrants further investigation as a potentially important etiological factor in the neurobiology and treatment of substance use disorders.
    Full-text · Article · Nov 2014 · Brain and Behavior
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    ABSTRACT: Objective: The purpose of this study was to examine the relationship between childhood maltreatment and alcohol use disorders (AUDs), treatment utilization, and barriers to treatment in a national sample of emerging adults. Multiple types of maltreatment were examined, including childhood emotional abuse and neglect. Method: The analyses are based on data from 18- to 25-year-olds (N = 4,468) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions. Results: Adjusted for sociodemographic characteristics, we found that childhood maltreatment was associated with a greater likelihood of an AUD and a greater likelihood of accessing treatment, although these relationships were no longer significant once psychiatric comorbidities and other substance use disorders were included as control variables. We also found significant interaction effects for age; differences in the prevalence of AUDs among those who experienced physical abuse and multiple types of maltreatment were larger for the older age group. Finally, among those with AUDs, maltreatment was associated with specific perceived barriers to treatment. Conclusions: The current findings highlight childhood maltreatment, including emotional abuse and neglect, as important correlates of AUDs among emerging adults but indicate that these relationships may be accounted for by other psychiatric comorbidities. Barriers to treatment among individuals with AUDs may reflect maltreatment experiences and should be addressed in both policy and practice.
    Full-text · Article · Mar 2013 · Journal of studies on alcohol and drugs
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