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Childhood Trauma and Substance Dependence
Abstract
Exposure to childhood maltreatment and trauma has a strong relationship with onset and development of substance use disorders. The purpose of this chapter is to review important models and mechanisms that explain pathways from childhood trauma to substance misuse and dependence. This chapter integrates findings from several cross-sectional and longitudinal studies conducted in this area with a focus on three main categories of explanatory mechanisms and models: (1) neurocognitive mechanisms; (2) negative reinforcement and self-medication mechanisms; and (3) psychosocial development mechanisms. Each section describes the dominant models and explanatory mediators that link childhood trauma to substance use disorders. In the final section, the clinical implications and directions for future studies are presented.
... Research identifying the key predictors of affective symptoms in this special population will generate implications for the design of interventions that can better assist Chinese drug users to achieve the "optimal" intervention outcomes. Further, the complex associations among early trauma, impulsivity, psychological resilience, and affective symptoms among substance users have been gaining increased attention (Edalati, 2020;Goldstein et al., 2013;Oshri et al., 2011). In general, research predominately based on Western samples has indicated that (a) the rates of mood and disruptive disorders are higher in individuals with substance abuse problems and (b) substance abusers typically demonstrate a psychological profile characterized by high early trauma exposure, poor impulse control, and impaired resilience (Cuomo et al., 2008;Pani et al., 2010;Rogers et al., 2010;Shin et al., 2015;Wong et al., 2006). ...
Objective: Childhood emotional maltreatment (CEM) has been widely linked to later affective symptoms. What still remains inadequately understood are the potential nuanced differences in the consequences of childhood emotional abuse (CEM-A) versus childhood emotional neglect (CEM-N) and the implicated mechanisms. Research with non-Western, clinical samples also remains scarce. Thus, we examined the associations of CEM-A and CEM-N with later affective symptoms among Chinese male drug users and tested impulsivity and psychological resilience as potential mediators and moderators. Method: Structural equation modeling analyses were conducted with survey data obtained from 239 Chinese male adult drug users who were in a rehabilitation center. Results: The mediating rather than the moderating hypotheses were supported. CEM-A was found to be positively associated with subsequent depressive and anxious symptoms through a positive association with impulsivity. In contrast, CEM-N was positively associated only with subsequent depressive symptoms via a negative association with psychological resilience. In addition, CEM-A was also found to be directly associated with later depressive and anxious symptoms. Conclusions: CEM may pose a threat to later affective well-being partly through contributing to intrapersonal vulnerabilities as well as compromising intrapersonal strengths. Differentiating CEM-A and CEM-N appears to be critical for revealing the understudied specificity and nuance that may be inherently within such effects. Drug use treatment services should sensitively attend to the affective sequelae of CEM. Interventions targeted at the modification of impulsivity and the facilitation of psychological resilience may be effective in diminishing the affective consequences of CEM among drug users.
... Research identifying the key predictors of affective symptoms in this special population will generate implications for the design of interventions that can better assist Chinese drug users to achieve the "optimal" intervention outcomes. Further, the complex associations among early trauma, impulsivity, psychological resilience, and affective symptoms among substance users have been gaining increased attention (Edalati, 2020;Goldstein et al., 2013;Oshri et al., 2011). In general, research predominately based on Western samples has indicated that (a) the rates of mood and disruptive disorders are higher in individuals with substance abuse problems and (b) substance abusers typically demonstrate a psychological profile characterized by high early trauma exposure, poor impulse control, and impaired resilience (Cuomo et al., 2008;Pani et al., 2010;Rogers et al., 2010;Shin et al., 2015;Wong et al., 2006). ...
Our interest is in the development of gratitude as a moral virtue, and its variability across different cultural contexts. Given psychology's overreliance on samples collected from the United Sates, Western Europe, and Australasia, we contrasted patterns of age-related expressions of gratitude among a sample of U.S. 7- to 14-year-old children with those from same-age samples from Brazil, China, Russia, South Korea, and Turkey (N = 2,540, 54.7% female, Mage = 10.61 years). The U.S. sample was diverse (n = 730: Black 26.4%, White 40.4%, Latinx 19.9%, Asian 3.8%, Other 1.6%, Missing 7.0%; 55.7% female, Mage = 10.52 years). The remaining samples were largely homogeneous by ethnicity. Our data were gathered using one quantitative scale to measure variations in the extent of gratitude that children expressed, and one qualitative measure to assess variability in the types of gratitude expressed by children of different ages. Both measures were chosen for their fit with the definition of virtuous gratitude. Hypotheses that the U.S. sample would differ from the others in extent and type of gratitude were largely supported. However, age-related differences in the type of gratitude expressed were similar across societies (e.g., in most samples older children were less likely to express concrete gratitude and more likely to express connective gratitude). Our results reveal the importance of treating gratitude as a virtue that develops during childhood and that is influenced by one's cultural group. Reliance on samples from a limited set of cultures is thus to be avoided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Perceived stress plays an important role in the development and course of psychiatric disorders and early dropout from treatment. This study examined the effect of different types of childhood maltreatment on the current perceived stress level of patients with concurrent substance use and psychiatric disorders. One hundred patients (25% females) were recruited from a residential center for treatment of concurrent substance use and psychiatric disorders and assessed for the histories of childhood maltreatment and level of perceived stress. Results indicated that all types of childhood maltreatment (emotional and physical neglect, and emotional, physical and sexual abuse) were associated with elevated levels of perceived stress regardless of demographic characteristics, diagnoses of psychiatric disorders, and length of stay in the center. Findings support the need for additional targeted interventions for managing perceived stress and improving emotional regulation and coping skills in psychiatric patients with childhood maltreatment histories.
Several school-based prevention programmes have been developed and used to prevent, delay, or reduce substance misuse, and related problems among community samples of adolescents. However, findings indicate that many of these interventions are associated with null, small, or mixed effects in reducing adolescent substance misuse, in particular for those mostly at risk of transitioning to substance use disorders. These findings highlight the need to shift the focus of substance use prevention efforts toward intervention strategies which directly target high-risk adolescents. The Preventure programme was designed to target four personality risk factors for substance misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article reviews findings from the previous trials of personality-targeted interventions (i.e., Preventure programme) with adolescents and discuss the promises and benefits of these interventions for targeting community samples of high-risk adolescents at school level for reducing substance misuse and related mental health problems. Findings indicated that this programme has been successful in reducing the rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with the effects last for up to 3 years. These interventions were also associated with a 25% reduction in likelihood of transitioning to mental health problems, such as anxiety, depression, suicidal ideation, and conduct problems. The programme is particularly beneficial for youth with more significant risk profiles, such as youth reporting clinically significant levels of externalizing problems, and victimized adolescents. A key strength of the Preventure programme is that it is embedded in the community and provides substance use intervention at school level to the general samples of high-risk adolescents who might not otherwise have access to those programmes.
Adolescents involved with the child welfare system are at a high risk of early initiation of substance use and development of substance use disorders. However, there is an enormous gap between the needs and availability of the intervention programmes for prevention and treatment of substance use problems in at-risk adolescents involved in the child welfare system. In the present article, we first review the prevalence of substance use problems and risk and protective factors for substance misuse among adolescents in the child welfare system. We then discuss the available interventions for reducing substance use problems in these populations, and the promises of personality-targeted interventions for reducing substance use problems in adolescents involved in the child welfare system, and the gap in research and practice. Acknowledgments:
Objective:
Exposure to adverse childhood experiences (ACEs) is highly prevalent among homeless individuals and is associated with negative consequences during homelessness. This study examined the effect of ACEs on the risk of criminal justice involvement and victimization among homeless individuals with mental illness.
Methods:
The study used baseline data from a demonstration project (At Home/Chez Soi) that provided Housing First and recovery-oriented services to homeless adults with mental illness. The sample was recruited from five Canadian cities and included participants who provided valid responses on an ACEs questionnaire (N=1,888).
Results:
Fifty percent reported more than four types of ACE, 19% reported three or four types, 19% reported one or two, and 12% reported none. Rates of criminal justice involvement and victimization were significantly higher among those with a history of ACEs. For victimization, the association was significant for all ten types of ACE, and for justice involvement, it was significant for seven types. Logistic regression models indicated that the effect of cumulative childhood adversity on the two outcomes was significant regardless of sociodemographic factors, duration of homelessness, and psychiatric diagnosis, with one exception: the relationship between cumulative childhood adversity and criminal justice involvement did not remain significant when the analysis controlled for a diagnosis of posttraumatic stress disorder and substance dependence.
Conclusions:
Findings support the need for early interventions for at-risk youths and trauma-informed practice and violence prevention policies that specifically target homeless populations.
Maltreatment-related childhood adversity is the leading preventable risk factor for mental illness and substance abuse. Although the association between maltreatment and psychopathology is compelling, there is a pressing need to understand how maltreatment increases the risk of psychiatric disorders. Emerging evidence suggests that maltreatment alters trajectories of brain development to affect sensory systems, network architecture and circuits involved in threat detection, emotional regulation and reward anticipation. This Review explores whether these alterations reflect toxic effects of early-life stress or potentially adaptive modifications, the relationship between psychopathology and brain changes, and the distinction between resilience, susceptibility and compensation. © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
Background:
Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. A number of researchers have suggested that the pattern of normative brain changes that occurs during this period not only predisposes adolescents to engage in risk behaviours, such as experimentation with drugs, but that they additionally make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico-basal-ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition.
Findings and conclusions:
We identify certain neurocognitive and personality/comorbidity-based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability.
Specific personality dimensions may increase susceptibility to alcohol misuse by encouraging motives for drinking that are associated with risky alcohol use. In the current study, we examined associations between personality risk factors (hopelessness (HOP), anxiety sensitivity (AS), sensation seeking (SS), and impulsivity (IMP)) and drinking motives (coping, conformity, enhancement, and social motives) in a sample of high-risk youth receiving child protection services. These personality factors were assessed using the Substance Use Risk Profile Scale (SURPS) and drinking motives were assessed using the Drinking Motives Questionnaire-Revised (DMQ-R). The structural validity of the DMQ-R was first explored in this novel sample of high-risk adolescents using principal components analysis. Correlational analyses showed that HOP and IMP were associated with drinking to cope with negative emotions, and AS was associated with drinking to conform. Unexpectedly, enhancement motives were not related to any of the personality dimensions. This suggests that youth receiving child welfare services who are high in the described personality risk factors drink primarily for negative reinforcement.
Childhood maltreatment has been shown to increase the risk of a range of psychiatric disorders including substance use disorders (SUDs) and is associated with the onset, course and severity of illness. We review the evidence for alterations in brain structure and neurocognitive processing in individuals who have experienced childhood maltreatment, focusing specifically on changes related to reward processing, executive functioning and affect processing. Changes in these neurocognitive systems have been documented in adults presenting with SUDs, who are typically characterized by heightened subcortico-striatal responses to salient stimuli and impairments in fronto-cingulate regulation. Maltreatment-specific effects in these processing domains may account for the particularly severe clinical presentation of SUDs in adults with histories of maltreatment in childhood. The findings are considered in relation to the theory of latent vulnerability, which contends that alterations in these neurocognitive systems may reflect calibration to early risk environments that in turn increases the risk of developing of SUDs later in life.
Exposure to childhood maltreatment (CM) is associated with increased risk for developing substance use disorders (SUDs). CM exerts negative effects on cognitive abilities including intellectual performance, memory, attention, and executive function. Parallel cognitive impairments have been observed in SUDs. Hence, limited studies have examined the mediating effect of cognitive impairments in the relationship between CM and SUDs. In addition, most studies used concurrent self-report assessments in adult populations. Longitudinal studies that investigated the long-term consequences of CM on psychopathology, including SUDs, throughout childhood, adolescence, and adulthood are rare. Thus, the underlying developmental pathways between CM and SUDs are not clearly understood. In this article, we review the evidence that cognitive impairments mediate, at least in part, the relationship between CM and development of SUDs and propose a model that explains how CM increases the risk for SUDs through the development of a cognitive framework of vulnerability.
© The Author(s) 2015.
We examined the hypothesis that exposure to childhood maltreatment increases the vulnerability to Adult Victimization (AV) in a homeless population (N = 500). We also investigated the effects of specific types (emotional, physical, and sexual) and cumulative experience of childhood maltreatment on AV, and whether gender moderates these relationships. All three groups with AV experience (emotional, physical, and sexual) indicated higher exposure to childhood abuse and cumulative maltreatment, and those who were sexually victimized as an adult showed higher exposure to childhood neglect. In addition, exposure to childhood maltreatment had type-specific and cumulative effects on AV. Exposure to all types of childhood abuse maintained a strong direct association with AV, regardless of demographic characteristics, including age, ethnicity, marital status, education level, and housing situation. In addition, exposure to physical neglect showed a significant relationship with Adult Sexual Victimization. Cumulative experience of childhood maltreatment was consistently associated with cumulative risk of experiencing AV. Gender had no significant effect on these relationships. Findings suggest that intervention programs in homeless population should consider the history of childhood maltreatment and its characteristics to increase the effectiveness of intervention strategies for AV in this population.
a b s t r a c t Specific personality dimensions may increase susceptibility to alcohol misuse by encouraging motives for drinking that are associated with risky alcohol use. In the current study, we examined associations between personality risk factors (hopelessness (HOP), anxiety sensitivity (AS), sensation seeking (SS), and impulsivity (IMP)) and drinking motives (coping, conformity, enhancement, and social motives) in a sample of high-risk youth receiving child protection services. These personality factors were assessed using the Substance Use Risk Profile Scale (SURPS) and drinking motives were assessed using the Drink-ing Motives Questionnaire-Revised (DMQ-R). The structural validity of the DMQ-R was first explored in this novel sample of high-risk adolescents using principal components analysis. Correlational analyses showed that HOP and IMP were associated with drinking to cope with negative emotions, and AS was associated with drinking to conform. Unexpectedly, enhancement motives were not related to any of the personality dimensions. This suggests that youth receiving child welfare services who are high in the described personality risk factors drink primarily for negative reinforcement.
This project describes application of an evidenced-based, trauma-informed treatment framework, Attachment, Regulation and Competency (ARC), with complexly traumatized youth in residential treatment. The processes of implementing the ARC model into clinical and milieu programming at two residential treatment programs are described. Particular attention is paid to system-level processes and strategies for embedding ARC in a sustainable manner. Pilot data demonstrated a significant relation between use of ARC and reductions in PTSD symptoms, externalizing and internalizing behaviors, and the frequency of restraints used across programs. Preliminary findings contribute to an emerging empirical basis for the ARC model and are supportive of its clinical utility as a practice in the residential context. Next steps include: a) expanding the study findings by conducting controlled efficacy research, b) examining system level variables as mediators of change, and c) describing the full operation stage of implementation of the ARC framework.
Childhood Emotional Maltreatment (CEM) has adverse effects on medial prefrontal cortex (mPFC) morphology, a structure that is crucial for cognitive functioning and (emotional) memory, and which modulates the limbic system. In addition, CEM has been linked to amygdala hyperactivity during emotional face processing. However, no study has yet investigated the functional neural correlates of neutral and emotional memory in adults reporting CEM. Using fMRI, we investigated CEM-related differential activations in mPFC during the encoding and recognition of positive, negative, and neutral words. The sample (N=194) consisted of patients with depression and/or anxiety disorders and Healthy Controls (HC) reporting CEM (n=96), and patients and HC reporting No Abuse (n=98). We found a consistent pattern of mPFC hypoactivation during encoding and recognition of positive, negative, and neutral words in individuals reporting CEM. These results were not explained by psychopathology or severity of depression or anxiety symptoms, nor by gender, level of neuroticism, parental psychopathology, negative life events, antidepressant use, or decreased mPFC volume in the CEM group. These findings indicate mPFC hypoactivity in individuals reporting CEM during emotional and neutral memory encoding and recognition. Our findings suggest that CEM may increase individuals' risk to the development of psychopathology on differential levels of processing in the brain; blunted mPFC activation during higher order processing and enhanced amygdala activation during automatic/lower order emotion processing. These findings are vital in understanding the long-term consequences of CEM.
Objective:
Childhood maltreatment increases risk for psychopathology. For some highly prevalent disorders (major depression, substance abuse, anxiety disorders, and posttraumatic stress disorder) a substantial subset of individuals have a history of maltreatment and a substantial subset do not. The authors examined the evidence to assess whether those with a history of maltreatment represent a clinically and biologically distinct subtype.
Method:
The authors reviewed the literature on maltreatment as a risk factor for these disorders and on the clinical differences between individuals with and without a history of maltreatment who share the same diagnoses. Neurobiological findings in maltreated individuals were reviewed and compared with findings reported for these disorders.
Results:
Maltreated individuals with depressive, anxiety, and substance use disorders have an earlier age at onset, greater symptom severity, more comorbidity, a greater risk for suicide, and poorer treatment response than nonmaltreated individuals with the same diagnoses. Imaging findings associated with these disorders, such as reduced hippocampal volume and amygdala hyperreactivity, are more consistently observed in maltreated individuals and may represent a maltreatment-related risk factor. Maltreated individuals also differ from others as a result of epigenetic modifications and genetic polymorphisms that interact with experience to increase risk for psychopathology.
Conclusions:
Phenotypic expression of psychopathology may be strongly influenced by exposure to maltreatment, leading to a constellation of ecophenotypes. While these ecophenotypes fit within conventional diagnostic boundaries, they likely represent distinct subtypes. Recognition of this distinction may be essential in determining the biological bases of these disorders. Treatment guidelines and algorithms may be enhanced if maltreated and nonmaltreated individuals with the same diagnostic labels are differentiated.
Background: Childhood maltreatment has been found to play a crucial role in the development of psychiatric disorders. However, whether childhood maltreatment is associated with structural brain changes described for major depressive disorder (MDD) is still a matter of debate. The aim of this study was to investigate whether patients with MDD and a history of childhood maltreatment display more structural changes than patients without childhood maltreatment or healthy controls. Methods: Patients with MDD and healthy controls with and without childhood maltreatment experience were investigated using high-resolution magnetic resonance imaging (MRI), and data were analyzed using voxel-based morphometry. Results: We studied 37 patients with MDD and 46 controls. Grey matter volume was significantly decreased in the hippocampus and significantly increased in the dorsomedial prefrontal cortex (DMPFC) and the orbitofrontal cortex (OFC) in participants who had experienced childhood maltreatment compared with those who had not. Patients displayed smaller left OFC and left DMPFC volumes than controls. No significant difference in hippocampal volume was evident between patients with MDD and healthy controls. In regression analyses, despite effects from depression, age and sex on the DMPFC, OFC and hippocampus, childhood maltreatment was found to independently affect these regions. Limitations: The retrospective assessment of childhood maltreatment; the natural problem that patients experienced more childhood maltreatment than controls; and the restrictions, owing to sample size, to investigating higher order interactions among factors are discussed as limitations. Conclusion: These results suggest that early childhood maltreatment is associated with brain structural changes irrespective of sex, age and a history of depression. Thus, the study highlights the importance of childhood maltreatment when investigating brain structures.
For the first time, research on implicit cognitive processes relevant for the understanding of addictive behaviors and their prevention or treatment is brought together in one volume! The Handbook of Implicit Cognition and Addiction features the work of an internationally renowned group of contributing North American and European authors who draw together developments in basic research on implicit cognition with recent developments in addiction research. Editors Reinout W. Wiers and Alan W. Stacy examine recent findings from a variety of disciplines including basic memory and experimental psychology, experimental psychopathology, emotion, and neurosciences.
Background:
Childhood maltreatment is a major risk factor for psychopathology. However, some maltreated individuals appear remarkably resilient to the psychiatric effects while manifesting the same array of brain abnormalities as maltreated individuals with psychopathology. Hence, a critical aim is to identify compensatory brain alterations that enable resilient individuals to maintain mental well-being despite alterations in stress-susceptible regions.
Methods:
Network models were constructed from diffusion tensor imaging and tractography in physically healthy unmedicated 18- to 25-year-old participants (N = 342, n = 192 maltreated) to develop network-based explanatory models.
Results:
First, we determined that susceptible and resilient individuals had the same alterations in global fiber stream network architecture using two different definitions of resilience: 1) no lifetime history of Axis I or II disorders, and 2) no clinically significant symptoms of anxiety, depression, anger-hostility, or somatization. Second, we confirmed an a priori hypothesis that right amygdala nodal efficiency was lower in asymptomatic resilient than in susceptible participants or control subjects. Third, we identified eight other nodes with reduced nodal efficiency in resilient individuals and showed that nodal efficiency moderated the relationship between maltreatment and psychopathology. Fourth, we found that models based on global network architecture and nodal efficiency could delineate group membership (control, susceptible, resilient) with 75%, 82%, and 80% cross-validated accuracy.
Conclusions:
Together these findings suggest that sparse fiber networks with increased small-worldness following maltreatment render individuals vulnerable to psychopathology if abnormalities occur in specific nodes, but that decreased ability of certain nodes to propagate information throughout the network mitigates the effects and leads to resilience.
Adolescence is a transitional period of development characterized by critical changes in physical, neural, cognitive, affective, and social functions. Studies investigating the underlying mechanisms of substance use at levels of self-report, brain response, and behavioral data are generally consistent with suggestions from dual-process model that differential growth rates of frontally mediated control and striato-frontal reward processing are related to a heightened risk of substance use during adolescence. However, social theories highlight the important role of social context and environment in which adolescents grow up and suggest that growing up in an unfavorable environment and in particular exposure to adverse childhood experiences play a huge role in how this vulnerability is translated into actual risk. In this review, we provide a summary of recent theories that examine a number of key individual and social and environmental risk factors underlying risk for early initiation and escalation of substance misuse. We also present a model that expands the dual-process model to incorporate the role of negative self-concept and negative affect associated with growing up in an unfavorable environment and their interactions with cognitive control and inhibition to further explain vulnerability to early initiation and development of substance misuse in adolescents.
This study was designed to address two research questions. The first research question asked whether physical abuse victimization at the hands of parents/guardians, bullying victimization at the hands of peers, and the abuse x bullying interaction encouraged early involvement in substance misuse. The second research question inquired as to whether the victimization‒substance misuse relationship was mediated by variables proposed by various theories and research studies-specifically, cognitive impulsivity, negative affect, and low self-esteem. A moderated mediation hypothesis was tested in a group of 865 (417 boys, 448 girls) schoolchildren from the Illinois Study of Bullying and Sexual Violence who were 10 to 15 years of age at the time of initial contact. A path analysis performed with three waves of data revealed that physical abuse and bullying victimization predicted substance misuse with mediation by cognitive impulsivity, but there was no evidence of moderation. On the basis of these results, it was concluded that victimization, whether through parental physical abuse or peer bullying, increases cognitive impulsivity, and that cognitive impulsivity, in turn, encourages early involvement in substance misuse. The practical implications of these results are that interventions designed to counter cognitive impulsivity and encourage cognitive control may be effective in preventing children traumatized by physical abuse and bullying from entering the early stages of a drug or substance using lifestyle.
Homeless individuals are at higher risk of criminal justice involvement (CJI) and victimization compared to their housed counterparts. Exposure to childhood maltreatment (CM; e.g., abuse, neglect) is one of the most significant predictors of CJI and victimization among homeless populations. The aim of this systematic review was to synthesize current knowledge regarding the relationship between CM and CJI and victimization among homeless individuals. Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methods, a systematic search was performed using PsycINFO, MEDLINE, Embase, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature for published studies investigating the relationship between CM and CJI and victimization among homeless samples. We identified 20 studies that met the inclusion criteria. Findings showed that across the majority of studies, CM, and in particular childhood physical (CPA) and sexual (CSA) abuse, is associated with increased risk of both CJI and victimization, regardless of various important factors (e.g., sociodemographic characteristics, psychiatric disorders, substance use). These findings support the need for prevention and treatment for "families at risk" (i.e., for intimate partner violence, child abuse and neglect) and also document the need for trauma-informed approaches within services for homeless individuals. Future research should focus on prospective designs that examine victimization and CJI in the same samples.
While many studies have identified a significant relation between child maltreatment and adolescent substance use, the developmental pathways linking this relation remain sparsely explored. The current study examines posttraumatic stress (PTS) symptoms, mother-child relationships, and internalizing and externalizing problems as potential longitudinal pathways through which child maltreatment influences adolescent substance use. Structural equation modeling was conducted on 883 adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The pathways of PTS symptoms linked physical and sexual abuse to substance use, and the pathways of mother-child relationships linked emotional abuse and neglect to substance use. None of the four types of maltreatment affected substance use via internalizing or externalizing problems. The findings suggest that intervention efforts aimed at addressing posttraumatic stress symptoms and improving mother-child relationship quality may be beneficial in reducing substance use among adolescents with child maltreatment histories.
Introduction:
Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation.
Materials and methods:
Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children.
Results:
Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance.
Conclusions:
Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.
Emerging developmental perspectives suggest that adverse rearing environments promote neurocognitive adaptations that heighten impulsivity and increase vulnerability to risky behavior. Although studies document links between harsh rearing environments and impulsive behavior on substance use, the developmental hypothesis that impulsivity acts as mechanism linking adverse rearing environments to downstream substance use remains to be investigated. The present study investigated the role of impulsivity in linking child abuse and neglect with adult substance use using data from (a) a longitudinal sample of youth (Study 1, N = 9,421) and (b) a cross-sectional sample of adults (Study 2, N = 1,011). In Study 1, the links between child abuse and neglect and young adult smoking and marijuana use were mediated by increases in adolescent impulsivity. In Study 2, indirect links between child abuse and neglect and substance use were evidenced via delayed reward discounting and impulsivity traits. Among impulsivity subcomponents, robust indirect effects connecting childhood experiences to cigarette use emerged for negative urgency. Negative urgency, positive urgency, and sensation seeking mediated the effect of child abuse and neglect on cannabis and alcohol use. Results suggest that child abuse and neglect increases risk for substance use in part, due to effects on impulsivity. Individuals with adverse childhood experiences may benefit from substance use preventive intervention programs that target impulsive behaviors.
Responses from N=60,598 interviews from the 2010 Behavioral Risk Factor Surveillance System (the 10 states and the District of Columbia that included the optional Adverse Childhood Experience (ACE) module) were used to test whether associations between childhood adversity and adult mental health and alcohol behaviors vary by race/ethnicity and sex. ACE items were categorized into two types - household challenges and child abuse. Outcomes were current depression, diagnosed depression, heavy drinking and binge drinking. Logistic regression models found ACEs significantly associated with depression and excessive alcohol use, but sex did not moderate any relationships. Race/ethnicity moderated the relationship between ACEs and heavy drinking. In stratified analyses, compared to those not exposed to ACEs, non-Hispanic blacks who experienced either type of ACE were about 3 times as likely to drink heavily; Non-Hispanic whites who experienced child abuse or both ACE types were 1.5-2 times as likely to drink heavily; and Hispanics who experienced household challenges or both ACE types were 1.2 and 11 times as likely to report heavy drinking. ACEs impact depression and excessive alcohol use similarly across men and women. With the exception of heavy drinking, ACEs appear to have the same association with excessive alcohol use across race/ethnicity. It may be prudent to further investigate why the relationship between ACEs and heavy drinking may differ by race/ethnicity such that prevention strategies can be developed or refined to effectively address the needs of all sub-groups.
Introduction:
The social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.
Methods:
Analyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age=18years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age=36years) marijuana use.
Results:
Confirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.
Conclusions:
Results support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.
Bullying perpetration and peer victimization has long been considered an important social and clinical problem. Children and adolescents who are bullied are at increased risk for mental health problems. The aim of this study was to investigate the relationship between self-esteem and bullying behavior (i.e. perpetration and peer victimization) using meta-analytic procedures. Online databases up to June 2014 were searched, and bibliographies of retrieved studies were examined, for studies that examined the association between self-esteem and bullying perpetration/peer victimization in children and adolescents. From an original pool of 936 studies, 121 non duplicated studies were identified that met criteria for inclusion. Possible moderators (e.g. age, source of bullying assessment, year of publication, etc.) were also examined. In the analyses, using a random-effects model, it was found that peer victimization is negatively associated with self-esteem, with a mean effect size of r = ? 0.27. A negative but trivial association was also found (r = ? 0.07) between bullying behavior and self-esteem. Results of various sensitivity analyses revealed these effects to be robust, with little evidence of selection (publication) bias. The implications of the meta-analytic findings for future research on bullying perpetration and peer victimization prevention are discussed.
The purpose of this study is to assess the relative mediating effects of impulsivity and emotion dysregulation in the relationship between childhood maltreatment and motives for opiate use. Seventy four adolescent users of Tramadol, a synthetic opiate, were recruited from a boot camp for de-addiction and rehabilitation services for the study. Data were collected between May, 2014 to November, 2014. Participants completed assessments of childhood abuse history, difficulties regulating emotions, impulsiveness and motives for substance use as well as a socio-demographic information sheet. The results of the current study indicate that types of abuse may be associated with particular outcomes and can inform treatment planning for substance users. Findings from bootstrap mediator analyses indicated that emotion dysregulation, but not impulsiveness, mediated the relationship between childhood emotional abuse and expansion and enhancement motives for substance use. The current study provides preliminary evidence that difficulties regulating emotions may function as a mechanism linking prior childhood experiences of emotional abuse to subsequent motives for substance use. Clinical implications of these findings suggest that targeting emotion dysregulation problems may be an effective adjunct in the treatment of childhood emotional abuse adolescent victims at risk for substance use.
Background:
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods:
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage.
Results:
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions:
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
For decades, evidence has shown an undeniable connection between childhood trauma and chronic adverse reactions across the lifespan (Bilchik & Nash, 2008; Perry, 2001; Perry, 2006). Childhood traumatic experiences are associated with serious and persistent, long-term physical, psychological, and substance abuse issues. In addition to adverse effects on physical health, research indicates that early childhood trauma has particularly adverse effects on adolescent self-esteem, coping skills, school performance, self-regulation, critical thinking, self-motivation, and the ability to build healthy relationships (O’Connell, Boat, & Warner, 2009). A traumatic event is a dangerous or distressing experience, outside the range of usual human experience that overwhelms the capacity to cope and frequently results in intense emotional and physical reactions, feelings of helplessness and terror, and threatens serious injury or death (The National Child Traumatic Stress Network [NCTSNET], 2014). Approximately five million children each year in the United States experience some type of traumatic experience (Perry, 2006). Nationwide community studies estimate between 25% and 61% of children and adolescents have a history of at least one exposure to a potentially traumatic event and 38.5% of American adults claim to have experienced at least one traumatic event before the age of 13 (Briggs et al., 2012; Gerson & Rappaport, 2013). According to results of a 2002-2003 survey of 900 New York City adolescents, 24% reported a history of witnessing someone being shot, 12% reported exposure to someone being killed, and 51% reported witnessing someone being beaten or mugged (O’Connell et al., 2009). Each year, 2-3 million children are victims of maltreatment, a type of trauma, including physical and/or sexual abuse (U.S. Department of Health and Human Services, 2014; Perry, 2006). Compared to the general population, youth in foster care are significantly more likely to have experienced violence, specifically abuse and/or neglect (Burns et al., 2004). It is estimated that approximately 90-percent of children in foster care have experienced a traumatic event, with nearly half reporting exposure to four or more types of traumatic events (Stein et al., 2001). Given the widespread prevalence of traumatic exposures, it is important for the mental health professionals working with foster care youth, to be aware of the prevalence and various types of trauma that are most common. Focus in treatment is typically on behavioral and emotional reactions rather than addressing the context of these symptoms, including trauma exposure histories and trauma-specific reactions. Clinicians must maintain awareness of the frequency and impact of childhood traumatic experiences on subsequent behaviors and overall functioning. Clinicians should appreciate the link between how traumatized children understand the world and interact with others differently from other children and how to provide appropriate treatment for children with a history of traumatic exposures. Practitioners must remain alert to symptoms that may suggest a history of trauma and must have an understanding of the difficulties adolescents may face regulating their emotions and behavior, as a symptom of a past traumatic experience. The failure to address trauma through screening, assessment, and treatment has major implications for long-term public health costs and services.
The first purpose of this chapter is to identify the risk and protective factors related to adolescent drug use, emphasizing the importance of the parent–child relationship. The framework is derived from family interactional theory. Operating within a developmental perspective, we explore the interrelations of risk and protective factors related to drug use. A second goal of the chapter is to elucidate the protective factors that mitigate adolescents' vulnerability to drug use, as well as enhance other protective factors. Finally, we consider the implications of etiological research on the risk and protective factors and their interactions for prevention and treatment based on a number of major studies undertaken since the mid-1990s.
The overall purpose of the present study was to investigate the moderating role of Executive Function and Future Orientation in the relationship between implicit associations/explicit outcome expectancies and substance use in grade 8 adolescent students. Participants from grade 8 (13-14 years old) completed cued association tasks that measure implicit substance use associations and explicit substance use outcome expectancies. They then completed substance use measures, as well as three measures of substance use problems: the CRAFFT, AUDIT, and CUDIT. In a separate session, participants completed the Substance Use Risk Profile Scales (SURPS), and the Executive Function measures of response inhibition (Go/No-Go Task), working memory (Self-OrderedPointing Task, SOPT), and reward sensitivity (Donkey Task, a revised version of the Iowa Gambling Task). Lastly, they completed the Future Orientation Questionnaire. Moderation analyses were conducted using Generalized Linear Regression (GLzM). Results confirmed previous research showing that associations and outcome expectancies, as well as Impulsivity, predict substance use and abuse. The findings suggested moderation effects of response inhibition (Go/No-Go performance) and reward sensitivity (Donkey Task performance). Contrary to previous reports working memory (SOPT performance) did not moderate implicit memory association effects. In a novel demonstration, Future Orientation has moderating effect on associations and outcome expectancies with substance use in adolescents. Overall, the results suggest that the relationship between the development of executive functions and future orientation with associative learning is important in the development of adolescent substance use and abuse. The intention is that these findings will provide insights useful for the development of prevention programs
Seeking Safety is designed to continually attend to both PTSD and substance use disorders (SUD). Both are treated at the same time by the same clinician. This integrated model contrasts with a sequential model in which the client is treated for one disorder and then the other. The multiple needs, impulsivity, and intense affect of PTSD/SUD clients can lead to derailed sessions if the clinician does not create clear structure. Each topic in Seeking Safety is independent of the others and can be conducted as a single session or over multiple sessions, depending on the client's length of stay and needs. There are no particular coping skills or topics that clients must master, but rather they are offered a wide variety to choose from. The treatment is flexible to allow clients' most important concerns to be kept primary, to allow adaptation to a variety of settings, to respect clinicians' judgments, and to encourage clinicians to remain inspired and interested in the work. These concerns are believed paramount for a population such as this, where the risks of client drop out and clinician burnout are high. The suggestions for selecting a Seeking Safety clinician are also described.
Adolescence is characterized by heightened risk-taking, including substance misuse. These behavioral patterns are influenced by ontogenic changes in neurotransmitter systems, particularly the dopamine system, which is fundamentally involved in the neural coding of reward and motivated approach behavior. During adolescence, this system evidences a peak in activity. At the same time, the dopamine (DA) system is neuroplastically altered by substance abuse, impacting subsequent function. Here, we describe properties of the dopamine system that change with typical adolescent development and that are altered with substance abuse. Much of this work has been gleaned from animal models due to limitations in measuring dopamine in pediatric samples. Structural and functional neuroimaging techniques have been used to examine structures that are heavily DA-innervated; they measure morphological and functional changes with age and with drug exposure. Presenting marijuana abuse as an exemplar, we consider recent findings that support an adolescent peak in DA-driven reward-seeking behavior and related deviations in motivational systems that are associated with marijuana abuse/dependence. Clinicians are advised that (1) chronic adolescent marijuana use may lead to deficiencies in incentive motivation, (2) that this state is due to marijuana's interactions with the developing DA system, and (3) that treatment strategies should be directed to remediating resultant deficiencies in goal-directed activity.
Childhood emotional abuse has been linked to problematic alcohol use in later life but there is a paucity of empirically based knowledge about the developmental pathways linking emotional abuse and alcohol use in young adulthood. Using a community sample of young individuals aged 18-25 (N=268; female 52%), we performed structural equation modeling to investigate whether emotional abuse influences alcohol use through urgent personality trait and to determine pathways for these effects in a multivariate context. We also examined variations in these pathways by four different alcohol use outcomes including frequency of alcohol use, binge drinking, alcohol-related problems, and alcohol use disorders (AUD). The present study found that emotional abuse was related to urgency, which in turn influenced four types of alcohol use. Urgency may play a significant role in linking childhood maltreatment to alcohol use in young adulthood.
Copyright © 2015. Published by Elsevier Ltd.
Although there is a long history of research examining relationships between intrapersonal factors and adolescent substance use, such relationships have not always been clearly delineated. The present study focused on three factors generally associated with physical and mental well being: dispositional optimism, hope, and self-esteem. These constructs were examined in relation to a social influence model as applied to the deterrence of substance use. A cross-sectional study was undertaken employing adolescents (n = 1,985) representative of a multi-racial/ethnic population. The results suggest that optimism, hope, and self-esteem are determinants of avoiding substance use, with the effects of these variables being mediated by attitudes, perceived norms, and perceived behavioral control. Additionally, the structural equation modeling analysis suggests a more general protective dimension predominantly accounts for the relationships between the personality factors and the mediators of avoiding substance use. These findings suggest efforts to prevent substance use may be more effective if they address more global intrapersonal factors in conjunction with the more immediate determinants of substance use.
During adolescence, functional and structural changes in the brain facilitate the transition from childhood to adulthood. Because the cortex and the striatum mature at different rates, temporary imbalances in the frontostriatal network occur. Here, we investigate the development of the subcortical and cortical components of the frontostriatal network from early adolescence to early adulthood in 60 subjects in a cross-sectional design, using functional MRI and a stop-signal task measuring two forms of inhibitory control: reactive inhibition (outright stopping) and proactive inhibition (anticipation of stopping). During development, reactive inhibition improved: older subjects were faster in reactive inhibition. In the brain, this was paralleled by an increase in motor cortex suppression. The level of proactive inhibition increased, with older subjects slowing down responding more than younger subjects when anticipating a stop-signal. Activation increased in the right striatum, right ventral and dorsal inferior frontal gyrus, and supplementary motor area. Moreover, functional connectivity during proactive inhibition increased between striatum and frontal regions with age. In conclusion, we demonstrate that developmental improvements in proactive inhibition are paralleled by increases in activation and functional connectivity of the frontostriatal network. These data serve as a stepping stone to investigate abnormal development of the frontostriatal network in disorders such as schizophrenia and attention-deficit hyperactivity disorder. Hum Brain Mapp, 2014. © 2014 Wiley Periodicals, Inc.
Child maltreatment is a risk factor for substance abuse in adulthood. This study examines whether memory of maltreatment is a necessary link in the path leading from prospectively measured childhood maltreatment to adult substance use problems. Official Child Protective Services reports and adult retrospective recall of childhood maltreatment were used to predict illegal drug use and alcohol problems in adulthood controlling for covariates. Memory was a necessary link in the path between prospective reports of maltreatment and alcohol problems, and an important link in the path between prospective reports and illegal drug use. Implications for prevention and treatment are discussed.
It is well established that childhood maltreatment is an important predictor of marijuana use, but few studies have examined the mechanisms underlying this relationship. The current study examines marijuana motives as mediators of the relationship between childhood maltreatment and marijuana use in a sample of young adults. In addition, pathways from childhood maltreatment to emotion dysregulation, coping motives, and marijuana use were explored. Participants were 125 young adults (ages 19-25, 66.9% female) recruited through online community advertising. All participants completed questionnaires assessing childhood maltreatment, emotion dysregulation, marijuana motives, past year and past three-month marijuana use, and marijuana problems. Correlational analyses revealed bivariate relationships between childhood maltreatment, emotion dysregulation, marijuana motives and marijuana problems (rs=.24-.50). Mediation analyses revealed that coping motives mediated the relationship between childhood maltreatment and marijuana problems, and emotion dysregulation was associated with marijuana problems both directly and indirectly via coping motives. The present findings highlight emotion dysregulation and coping motives as important underlying mechanisms in the relationship between childhood maltreatment and marijuana problems.
While many long-term correlates of child sexual abuse (CSA) have been identified, theories to explain the development of these correlates have received little empirical validation. The process of experiential avoidance is one theory that has been proposed to account for many of the correlates of CSA. The purpose of the current study was twofold: (1) To attempt to develop a more complex measure of experiential avoidance in women with and without a CSA history, and (2) to explore variables related to two of the long-term correlates of CSA, general psychological distress and high risk sexual behavior. Levels of current distress, high-risk sex, and experiential avoidance were examined in 257 undergraduate females (mean age 20.0) using self-report questionnaires. The results of the current study indicate that CSA survivors report higher levels of experiential avoidance and high-risk sexual behavior with persons other than their primary partners. Implications of these findings for theory development, therapy with CSA survivors, and HIV prevention programs are discussed.
Background: This investigation examined the relationship between trauma, psychiatric symptoms and urinary free cortisol (UFC) and catecholamine (epinephrine [EPI], norepinephrine [NE], dopamine [DA]) excretion in prepubertal children with posttraumatic stress disorder (PTSD) secondary to past child maltreatment experiences (n = 18), compared to non-traumatized children with overanxious disorder (OAD) (n = 10) and healthy controls (n = 24).Methods: Subjects underwent comprehensive psychiatric and clinical assessments and 24 hour urine collection for measurements of UFC and urinary catecholamine excretion. Biological and clinical measures were compared using analyses of variance.Results: Maltreated subjects with PTSD excreted significantly greater concentrations of urinary DA and NE over 24 hours than OAD and control subjects and greater concentrations of 24 hour UFC than control subjects. Post hoc analysis revealed that maltreated subjects with PTSD excreted significantly greater concentrations of urinary EPI than OAD subjects. Childhood PTSD was associated with greater co-morbid psychopathology including depressive and dissociative symptoms, lower global assessment of functioning, and increased incidents of lifetime suicidal ideation and attempts. Urinary catecholamine and UFC concentrations showed positive correlations with duration of the PTSD trauma and severity of PTSD symptoms.Conclusions: These data suggest that maltreatment experiences are associated with alterations of biological stress systems in maltreated children with PTSD. An improved psychobiological understanding of trauma in childhood may eventually lead to better treatments of childhood PTSD.
Despite consistent support for Hammen's (1991, 1992) stress generation model of depression and support for the adverse effects of childhood emotional maltreatment on later functioning and vulnerability to depression, the relation between the two is unclear. Therefore, the primary aim of the current study of young adults was to examine whether changes in recent negative life events would mediate versus moderate the relation between childhood emotional maltreatment and prospective changes in depressive symptoms. We also examined whether the stress generation effect was specific to depressive symptoms. Changes in recent negative events mediated the relation between childhood emotional maltreatment and changes in depressive symptoms. Additionally, initial depressive symptoms, but not anxiety symptoms, contributed to prospective changes in negative life events.
This systematic review analyzes the role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011. Ten papers examined gender as a moderating variable. Results on gender differences were mixed. When studies that found no gender effects were compared with studies that did identify gender effects, differences in measurement, sample composition, and developmental timing of outcomes were identified. This review also examines how gender effects are assessed. Implications and limitations of these findings are discussed. Areas for future research are identified.
This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD (vs. non-PTSD) reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Additionally, significant positive associations were found between both childhood physical and emotional (but not sexual) abuse on the one hand and dimensions of emotion dysregulation on the other. Further analyses indicated that difficulties controlling impulsive behaviors when distressed accounted for the associations of both childhood physical and emotional abuse with probable PTSD status. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.