Sexual abuse and the subsequent development of alcohol problems

Longitudinal assessment of heavy alcohol use and incapacitated sexual assault: A cross-lagged analysis

Researchers have argued there are bidirectional associations between heavy alcohol use and sexual assault; however, research in this area is inconclusive due to methodological differences, particularly in study design. The purpose of this study is to clarify the longitudinal associations between heavy alcohol use and incapacitated sexual assault among first-year college women, accounting for hypothesized autoregressive effects within each construct over their first year of college. A sample of 483 women completed regular surveys that assessed a range of health behaviors, including alcohol use and sexual behavior, during their first year of college. We used cross-lagged analyses to examine prospective associations between incapacitated sexual assault and heavy alcohol use (frequency of heavy episodic drinking and peak blood alcohol content). There were significant autoregressive effects, such that women who were engaging in heavier alcohol use as they entered college continued to be heavier alcohol users throughout their first year, and women with a history of assault at college entry were at greater risk for assault during their first year of college. There was a significant cross-lagged effect from precollege incapacitated assault to first-semester alcohol use after controlling for pre-college alcohol use. There were no significant cross-lag paths from alcohol use to subsequent incapacitated assault. Women with a history of incapacitated sexual assault engaged in heavier drinking during their transition to college, but heavy alcohol use did not predict subsequent assault risk.

Risk Factors for Sexual Victimization of Women

Using data drawn from a prospective study of 206 urban, predominantly low-income, African American women, sexually victimized before they turned 13 in the early 1970s, and a matched comparison group, this article explores whether child sexual abuse was a risk factor for revictimization and examines the role of other factors in the risk of victimization. Child sexual abuse before the age of 13 was not by itself a risk factor for adult victimization, but those who were also victimized as adolescents were at much greater risk of adult sexual victimization than other women. Additional risk factors included measures of sexual behavior and alcohol problems.

Association between maltreatment and polydrug use among adolescents

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.

The impact of child sexual abuse on the course of bipolar disorder: a systematic review

OBJECTIVES

The aim of this review was to elucidate the impact of child sexual abuse on all clinical phenomena that occur after the onset of bipolar disorder, including associated clinical features that are not part of the diagnostic criteria for the disorder.

METHODS

Five databases were searched and supplemented with a hand search of reference lists from retrieved papers. Study quality was assessed using a validated quality assessment tool. Blind assessments of study eligibility and quality were conducted by two independent researchers to reduce bias, minimize errors, and enhance the reliability of findings. Disagreements were resolved by consensus.

RESULTS

Eighteen studies that included a total of 2996 adults and youths with bipolar disorder and met the minimum quality criteria necessary to ensure objectivity and not invalidate results were analyzed. Across studies, child sexual abuse was strongly (and perhaps directly) associated with posttraumatic stress disorder; whereas it was less strongly (and perhaps indirectly) related to suicide attempts, alcohol and/or drug abuse or dependence, psychotic symptoms, and an early age of illness onset. In regard to the association between child sexual abuse and other clinical variables concerning the course of bipolar disorder, evidence was scant or conflicting.

CONCLUSIONS

Child sexual abuse is associated (either directly or indirectly) with some clinical phenomena that represent a more severe form of bipolar disorder. Although such a traumatic experience may directly affect the development of posttraumatic stress disorder, the effects of early sexual abuse on later suicidal behavior, substance abuse, and psychotic symptoms may operate through the mediating influences of certain psychopathological or neurobiological variables.

Child Maltreatment and Adult Substance Abuse: The Role of Memory

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.

Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

Lifetime victimization and past year alcohol use in a U.S. population sample of men and women drinkers

BACKGROUND

Research on alcohol use among victims of physical and sexual violence has focused mostly on women and alcohol use disorders. It is also limited by the relative lack of consideration of victimization over the lifetime and of population data on both men and women. We critically examined associations between lifetime victimization and diverse past year alcohol use patterns and problems and whether these associations differ for men and women.

METHODS

Population data from the 2005 U.S. National Alcohol Survey (NAS11, n=6919) are reported for 4256 adult men and women drinkers. Logistic regressions assessed associations between physical only or any sexual victimization experienced over the lifetime and past year heavy episodic drinking, drinking to intoxication, alcohol-related consequences and any alcohol use disorder. Models controlled for demographics and parental history of alcohol abuse and examined interactions of gender with victimization.

RESULTS

Associations between victimization experienced over the lifetime and all past year alcohol measures were significant for both men and women. These associations did not differ by type of lifetime victimization (physical only vs any sexual). The association of physical only victimization with drinking to intoxication was stronger for victimized vs non-victimized women compared to victimized vs non-victimized men. This gender difference ceased to be significant when specific victimization characteristics were controlled for.

CONCLUSIONS

Lifetime victimization is associated with increased risk for diverse alcohol use problems for both men and women. All prevention and treatment programs should screen men and women for lifetime victimization and diverse alcohol use problems.

Desire to dissociate: implications for problematic drinking in college students with childhood or adolescent sexual abuse exposure

Alcohol use to replace inadequate dissociative capabilities, or chemical dissociation, has been linked to college students with childhood or adolescent sexual abuse (CASA). Insofar as CASA-exposed persons experience a restricted range of dissociative capabilities, what remains relatively unclear is whether some desire to achieve greater dissociative experiences. Nonclinical levels of dissociative tendencies have positively predicted alcohol-related blackouts in CASA-exposed students, and dissociation mediated the relations between CASA and intoxication frequency. Although alcohol (similar to dissociation) can reduce physiological and psychological responses to stress, alcohol consumption may be prompted by a desire to dissociate rather than inadequate dissociative tendencies alone. To investigate this interpretation of the chemical dissociation phenomenon, researchers examined the mediating potential of dissociative tendencies using the Dissociative Experiences Scale-II (DES-II) as well as the desire to dissociate concept (ie, a modified version of the DES-II) on the relations between CASA exposure and problematic alcohol use in college students (N = 298). Results indicated that dissociation scores did not replicate previous mediation findings whereas desire to dissociate scores fully mediated CASA exposure and problematic alcohol use. Implications of the results are discussed including possible reasons why prior mediation results were not replicated as well as links to experiential avoidance.

Alcohol use as a potential mediator of forced sexual intercourse and suicidality among African American, Caucasian, and Hispanic high school girls

PURPOSE

Sexual assault on adolescent females is a major public health concern. The purposes of this study were to examine: (1) whether alcohol use mediates the relationship between forced sexual intercourse and suicidality in high-school girls, and (2) whether this mediation differs by ethnicity.

METHODS

Using cross-sectional data from the 2009 Youth Risk Behavior Survey (n = 6,294), we used logistic regression and simple mediation using the Sobel test for indirect effect for our analyses.

RESULTS

Overall rates for forced sexual intercourse, alcohol use, and suicidality were 10.9%, 56.6%, and 18%, respectively. Current alcohol use significantly mediated the relationship between forced sexual intercourse and suicidality in African American, Caucasian, and Hispanic high-school girls. Overall, 13% of variance in participants' suicidality can be accounted for by the indirect effect of forced sexual intercourse on suicidality through alcohol use. The amount of variance accounted for by alcohol use varied significantly by ethnicity, with the largest amount of variance (21%) accounted for suicidality in Hispanic girls.

CONCLUSION

In addition to its acute affects, alcohol use may serve as a general risk factor for suicidality in girls who have experienced forced sexual intercourse. Intervention programs targeting female adolescent sexual assault victims should include an alcohol use component.

Genetic moderators and psychiatric mediators of the link between sexual abuse and alcohol dependence

BACKGROUND/OBJECTIVE

This study used a case-control female sample to test psychiatric mediators and genetic moderators of the effect of sexual abuse on later alcohol dependence. The study also tested differences between alcohol dependent women with or without a history of sexual abuse on variables that might affect treatment planning.

METHODS

A case-control design compared 192 treatment-seeking alcohol dependent women with 177 healthy population controls. All participants were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality functioning. Markers were genotyped in the CRHR1, MAO-A and OPRM1 genes.

RESULTS

The association of sexual abuse with alcohol dependence was limited to the most severe category of sexual abuse involving anal or vaginal penetration. Of the five psychiatric disorders tested, anxiety, anorexia nervosa, and bulimia met criteria as potential mediators of the abuse-alcohol dependence association. Severe sexual abuse continued to have an independent effect on alcohol dependence status even after accounting for these potential mediators. None of the candidate genetic markers moderated the association between sexual abuse and alcohol dependence. Of alcohol dependent participants, those with a history of severe abuse rated higher on alcoholism severity, and psychiatric comorbidities.

CONCLUSION

Sexual abuse is associated with later alcohol problems directly as well as through its effect on psychiatric problems. Treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women.

Cycle of sexual assault and women's alcohol misuse

PURPOSE

To describe the complex relationship between sexual assault and alcohol misuse by female assault victims.

DATA SOURCES

Drawing on recent research and theoretical models from other social sciences, the author interjects a nursing perspective for this complex patient problem.

CONCLUSIONS

This review of theories and models, and the evidence that supports them, provides a way for nurses to conceptualize the relationship between sexual victimization and alcohol misuse as bidirectional or reciprocal.

IMPLICATIONS FOR PRACTICE

The evidence and models discussed here suggest that when patients present with sexual assault or alcohol misuse, nurses should assess and address the possibility of both conditions being present.

Sexual victimization in female and male college students: examining the roles of alcohol use, alcohol expectancies, and sexual sensation seeking

Alcohol and alcohol expectancies relate to sexual victimization. The present study examined these links in a sample of 407 predominantly Hispanic male and female college students, along the Mexico-US border. The study also examined the independent contribution of sexual sensation seeking to the prediction of victimization. Results showed that victimization was associated with alcohol risk, alcohol consumption-related problems, and positive alcohol expectancies. Importantly, sexual sensation seeking independently predicted victimization and did so after controlling for alcohol risk and expectancies. Our results suggest that associations among victimization, alcohol risk, and expectancies generalize to Hispanic women and men. The study's limitations are noted.

Forced sexual intercourse, suicidality, and binge drinking among adolescent girls

Although sexual assault victimization has been shown to predict suicidality, little is known about the mechanisms linking these two factors. Using cross-sectional data (N=6364) from the 2007 Youth Risk Behavior Survey, binge drinking significantly mediated the relationship between forced sexual intercourse and suicide for Hispanic (n=1915) and Caucasian (n=2928) adolescent females, but not for African American adolescent females (n=1521). Results suggest the need for closer monitoring of adolescent victims of sexual assault who also abuse alcohol to intervene in early suicide behaviors. Treatment and intervention programs should also be culturally sensitive to account for differences in reaction to sexual trauma among race/ethnicity. Implications for suicide prevention and alcohol intervention strategies as well as suggestions to clinical providers are discussed.

Assessing historical abuse allegations and damages

Practitioners may be called upon to assess adults who have alleged child abuse as a minor and are seeking reparations. Such assessments may be used by the courts to determine harm and assess damages related to their claim or testimony. Our clinical/research team has conducted many such evaluations and reported the findings pertaining to the psychological harm stemming from historical abuse in published studies. We use the opportunity provided by this new section on Practical Strategies to describe the role of the assessor, and to provide details concerning our methods for preparing these assessments and reporting the findings for the purpose of civil or criminal actions. Specific recommendations for wording of written reports are provided.

Child sexual abuse, post-traumatic stress disorder, and substance use: predictors of revictimization in adult sexual assault survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N=555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Posttraumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.

Disentangling the complex association between childhood sexual abuse and alcohol-related problems: a review of methodological issues and approaches

This review describes and evaluates methodological approaches aimed at unraveling the association between childhood sexual abuse (CSA) and later misuse of alcohol, which is complicated by the significant overlap between factors that elevate risk for CSA exposure and those that increase risk for problem alcohol use. We critique methods used to distinguish direct effects of CSA events on alcohol-related outcomes from the effects of risk factors frequently present in families in which CSA exposure occurs (e.g., parental alcohol-related problems). These methods include measurement and adjustment for potentially confounding factors and the use of co-twin designs. The findings across methodological approaches provide support for a CSA-specific risk for alcohol misuse, despite the significant contribution of family background factors to overall risk, but much work remains to be done before a comprehensive model for this association can be proposed. Additional directions for research, including the incorporation of measured genes and the use of longitudinal designs, are proposed to further efforts to model the pathways from CSA to alcohol-related problems.

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.

Childhood sexual abuse and the course of alcohol dependence development: findings from a female twin sample

Childhood sexual abuse (CSA) has been associated with increased risk for alcohol dependence (AD), but the extent to which CSA history may impact transitions in the course of AD development remains unclear. The current study examined the role of CSA in initiation of alcohol use and rate of progression from first drink to AD using a sample of 3536 female twins (mean age=21.6 years). Psychiatric diagnoses and alcohol use histories were obtained via telephone interviews using an adaptation of the SSAGA. The contribution of CSA to alcohol outcomes independent of familial influences was estimated by using co-twin AD status to adjust for familial liability to AD. CSA was associated with higher rates of both lifetime alcohol use and AD, but CSA-associated risk for consumption of first alcoholic drink was evident only at ages 12 and 13. Rate of transition from first alcohol use to AD did not differ by CSA status. Findings indicate that CSA and elevated risk for AD may be linked via early age at first drink and that progression from first drink to AD follows a similar course among women with and without histories of CSA.

Interpersonal violence among women seeking welfare: unraveling lives

OBJECTIVES

Exposure to violence is a widespread problem among women who receive welfare benefits. Research has focused on partner violence among women with children on Temporary Assistance for Needy Families (TANF), ignoring low-income women without dependent children who are eligible for General Assistance (GA).

METHODS

We report findings from a survey of 1235 women seeking TANF (N=1095) and GA (N=140) throughout a California county.

RESULTS

Estimates of recent physical, sexual, and severe violence were high in both populations. However, the highest rates occurred among women without children seeking GA, suggesting that they are at higher risk for sexual violence and more severe forms of physical violence, especially from intimate partners. This increased risk is partly accounted for by the co-occurrence of other serious health and social problems. In multivariate analyses, past-year violence was associated with substance use (adjusted odds ratio [AOR]=2.0, 95% confidence interval [CI] = 1.5, 2.9), recent homelessness (AOR = 1.9, 95% CI = 1.4, 2.6), family fragmentation including divorce or separation (AOR=3.1, 95% CI 1.8, 5.2), or foster care involvement (AOR=2.2, 95% CI=1.1, 4.5)

CONCLUSIONS

Welfare reform created TANF programs to address domestic violence. Women seeking GA may need similar services because of the high prevalence of violence.

Variables differentiating singly and multiply victimized youth: results from the National Survey of Adolescents and implications for secondary prevention

The authors examined variables differentiating singly and multiply victimized youth with a national household probability sample of 4,023 adolescents. Youth endorsing one episode (i.e., one incident or series of repeat incidents) of sexual or physical assault were classified as singly victimized (n = 435). Multiply victimized youth were those who endorsed multiple discrete episodes of sexual or physical assault and both sexual and physical assault (n = 396). For boys, heightened risk of multiple victimization was associated with family alcohol problems, Native American race, and earlier age at assault onset. For girls, increased multiple victimization risk was associated with family alcohol problems, older current age, and several characteristics of the initial assault episode-earlier age at onset, acquaintance perpetrator, chronicity, perceived life threat, and injury. Findings imply that secondary prevention programs may be strengthened by broadening risk-reduction strategies to address a greater range of victimization experiences. Additional implications for secondary prevention are discussed.

Motives to drink as mediators between childhood sexual assault and alcohol problems in adult women

Two models are proposed to relate maladaptive emotion regulation strategies and alcohol-related problems for women with a history of childhood sexual assault (CSA). The distress coping model suggests only one motive-drinking to cope with negative emotions-mediates the relationship between CSA and alcohol problems. The emotion regulation model suggests two motives mediate the relationship between CSA and alcohol problems: drinking to cope with negative emotions and drinking to enhance positive emotions. These models were tested in a random community sample of 697 women, ranging from 25 to 75 years old. Both motives partially mediated the relationship between CSA and alcohol problems. Effects were small, but reliable.

The forensic exam: assessing health characteristics of adult female victims of recent sexual assault

Sexual assault of women is a major problem in the United States, and information about characteristics of adult female sexual assault victims who report and undergo a forensic exam is lacking. This study describes the health characteristics of recent adult female sexual assault victims who received a forensic exam and/or prophylactic treatment at a sexual assault center located in a southern urban area.

Childhood sexual abuse, PTSD, and the functional roles of alcohol use among women drinkers

The present study investigated whether a history of childhood sexual abuse (CSA) or current post traumatic stress disorder (PTSD) was associated with alcohol-related expectancies and recalled effects of drinking reported by women in substance user treatment. The results indicate that CSA status was not associated with the alcohol-related expectancies or effects of drinking reported by women in substance user treatment. However, those currently manifesting PTSD were more likely than their peers without PTSD to report greater alcohol-related expectancies of tension reduction and having experienced greater positive enhancement from drinking. Theoretical and clinical implications of these findings are considered.

Early physical and sexual abuse associated with an adverse course of bipolar illness

BACKGROUND

There is growing awareness of the association between physical and sexual abuse and subsequent development of psychopathology, but little is known, however, about their relationship to the longitudinal course of bipolar disorder.

METHODS

We evaluated 631 outpatients with bipolar I or II disorder for general demographics, a history of physical or sexual abuse as a child or adolescent, course of illness variables, and prior suicide attempts, as well as SCID-derived Axis I and patient endorsed Axis II comorbidity.

RESULTS

Those who endorsed a history of child or adolescent physical or sexual abuse, compared with those who did not, had a history of an earlier onset of bipolar illness, an increased number of Axis I, II, and III comorbid disorders, including drug and alcohol abuse, faster cycling frequencies, a higher rate of suicide attempts, and more psychosocial stressors occurring before the first and most recent affective episode. The retrospectively reported associations of early abuse with a more severe course of illness were validated prospectively.

CONCLUSIONS

Greater appreciation of the association of early traumatic experiences and an adverse course of bipolar illness should lead to preventive and early intervention approaches that may lessen the associated risk of a poor outcome.

Concomitance between childhood sexual and physical abuse and substance use problems. A review

This review focuses on the apparent connection between childhood sexual or physical abuse (CSA, CPA) and later substance use problems (SUPs) among adolescents and adults. The rates of CSA among females with SUPs were found to be, on average, nearly two times higher than those found in the general population, and the rates of SUPs among women with CSA histories were found to be similarly elevated. The rates of CSA were not found to be elevated among males with SUPs, but men with histories of CSA were found to be at greater risk for SUPs than men in the general population. Women, girls, and boys with SUPs were found to have elevated rates of CPA relative to the general population, while adult males with SUPs were not found to have elevated rates of CPA. Concomitance rates were not found to vary systematically with regard to either the methodological quality of the studies included nor the year of study publication. Additional descriptive examination of selected studies indicates that among women, childhood abuse is likely to be a factor in the development of SUPs, but that the relationship is mediated by other psychiatric conditions, such as anxiety and depressive disorders.

The relationship of social support and economic self-sufficiency to substance abuse outcomes in a long-term recovery program for women

A growing literature suggests that women experience chemical dependency in a very different manner than men. Their needs in treatment may also vary. In particular, women with low incomes face greater economic hardship, and may be more subject to the influence of social support in maintaining recovery. Despite evidence for the relationship of both employment and social support in substance abuse treatment outcomes, many programs are reducing services and lengths of stay. The authors explored outcomes for fifty-nine women who attended long-term substance abuse treatment in a womens' facility that emphasized employment and economic self-sufficiency. Reductions in substance use were associated with an increase in economic autonomy. Improvement in other life domains was positively associated with measures of economic self-sufficiency. Women living in drug-free social environments had higher rates of abstinence and better overall functioning. At least among women who participated in our study, economic outcomes, substance use, and general functioning went hand-in-hand. Eliminating services such as employment assistance may, while reducing cost, also negatively impact outcomes among the most vulnerable clientele.