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

Childhood maltreatment histories, alcohol and other drug use symptoms, and sexual risk behavior in a treatment sample of adolescents

OBJECTIVES

We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems.

METHODS

Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings.

RESULTS

Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse.

CONCLUSIONS

Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment.

[Alcohol and drug consumption in students exposed to the Dawson College shooting: a gender-based analysis]

OBJECTIVE

To study alcohol and drug addiction incidence in students exposed to the Dawson College shooting within the 18 months following the event, to identify the precursors of a psychoactive substance addiction development while considering the severity of event exposure, and to examine whether alcohol use, 18 months after the event, is related to any of the various posttraumatic stress disorder (PTSD) symptom groups.

METHOD

The population of this study was comprised of all the Dawson College students at the time of the event. Analyses were conducted with 854 students enrolled in the college at the time of the shooting.

RESULTS

Five per cent of women and 7% of men showed, for the first time in their life, a problem with substance addiction following the shooting. In men, young age, lifetime suicidal ideation, and having seen the killer during the shooting are the main precursors of incident accident cases. None of the studied precursors were significant in women. Men and women were also different in terms of PTSD symptoms predicting alcohol use 18 months after the shooting.

CONCLUSION

The study highlights the importance of considering a person's sex when studying their psychoactive substance use following a trauma.

The influence of gene-environment interactions on the development of alcoholism and drug dependence

Alcoholism and drug dependence are common psychiatric disorders with a heritability of about 50%; therefore genetic and environmental influences are equally important. Early-life stress is a predictor of adolescent problem drinking/drug use and alcohol/drug dependence in adulthood, but moderating factors governing the availability of alcohol/drug are important. The risk-resilience balance for addiction may be due in part to the interaction between genetic variation and environment stressors (G × E); this has been confirmed by twin studies of inferred genetic risk. Measured genotype studies to detect G × E effects have used a range of alcohol consumption and diagnostic phenotypes and stressors ranging from early-life to adulthood past year life events. In this article, the current state of the field is critically reviewed and suggestions are put forth for future research.

Do drinking motives mediate the association between sexual assault and problem drinking?

Sexual assault and problem drinking are both prevalent in college women and are interrelated. Findings from cross-sectional research indicate that motives to drink to decrease negative affect (coping motives) or to increase positive affect (enhancement motives) are partial mediators of the sexual assault-problem drinking relation. However, no published longitudinal studies have examined these relations. The current study tests a longitudinal model and examines coping and enhancement motives as potential mediators. Participants were 131 female undergraduates who completed baseline measures of self-reported sexual assault victimization and problem drinking. Coping and enhancement motives were measured at three-month follow up; problem drinking was measured at six-month follow-up. Analyses using structural equation modeling (SEM) indicated direct and indirect paths in the sexual assault-problem drinking relation. Zero-order correlations indicated significant, positive relations among drinking motives, sexual assault, and drinking variables. Longitudinally, mediation was evident for coping but not enhancement motives. Ultimately, findings were most consistent with self-medication hypotheses about the sexual assault - problem drinking relation - i.e., drinking in order to gain relief from symptoms or problems.

Longitudinal trajectories of posttraumatic stress disorder symptoms and binge drinking among adolescent girls: the role of sexual victimization

PURPOSE

Many studies have documented associations among sexual victimization (SV), posttraumatic stress disorder (PTSD) symptoms, and alcohol use; however, few have examined these associations longitudinally among adolescents. The present study evaluated the effect of SV on the longitudinal trajectory of PTSD symptoms and binge drinking (BD) among adolescent girls, a population known to have high rates of SV and alcohol use.

METHODS

Participants (N = 1,808 at wave 1) completed interviews regarding PTSD symptoms, BD, and SV experiences over approximately 3 years.

RESULTS

Multilevel modeling revealed decreases in PTSD symptoms over the course of the study; however, compared with nonvictims, adolescents who were sexually victimized reported greater PTSD symptoms at wave 1 and maintained higher levels of PTSD symptoms over the course of the study after controlling for age. SV reported during the study also predicted an acute increase in PTSD symptoms at that occasion. BD increased significantly over the course of the study; however, SV did not predict initial BD or increases over time. SV reported during the study was associated with acute increases in BD at that occasion, although this effect diminished when participants reporting substance-involved rape were excluded.

CONCLUSIONS

SV was associated with immediate and long-lasting elevations in PTSD symptoms, but not with initial or lasting elevations in BD over time, suggesting that adolescent victims have yet to develop problematic patterns of alcohol use to cope with SV. However, SV was associated with acute increases in PTSD symptoms and BD, suggesting a need for BD interventions to reduce alcohol-related SV.

Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: associations with self-reported child maltreatment and sexual risk behaviors

Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

Coping motives as a mediator of the relationship between sexual coercion and problem drinking in college students

Sexually coercive experiences, heavy alcohol use, and alcohol-related problems occur at relatively high base rates in college populations. As suggested by the self-medication hypothesis, alcohol consumption may be a means by which one can reduce negative affect or stress related to experiences of sexual coercion. However, few studies have directly tested the hypothesis that coping motives for drinking mediate the relation between sexual assault and problem drinking behaviors, and no published studies have tested this in men. The current study tested this hypothesis using structural equation modeling in a sample of 780 male and female undergraduates. Results revealed that coping motives partially mediated the relation between sexual coercion and drinking and alcohol-related negative consequences. In addition, direct and indirect paths between sexual coercion and drinking were found for men whereas only indirect paths were found for women. Results provide support for self-medication models of drinking and suggest the importance of exploring gender differences in mechanisms for drinking.

The cumulative impact of sexual revictimization on emotion regulation difficulties: an examination of female inmates

The present study examined associations between child sexual abuse (CSA), adult sexual victimization, and emotion regulation difficulties in a sample of 168 incarcerated women. Approximately 50% of the participants reported CSA, 54% reported adult sexual victimization, and 38% reported sexual revictimization (i.e., CSA and adult victimization). Revictimized women reported significantly greater difficulties with several facets of emotion regulation when compared to singly victimized and nonvictimized women. Interestingly, singly victimized women did not demonstrate greater emotion regulation deficits when compared to nonvictims. Findings suggest that the negative impact of victimization experiences on adult emotion regulation abilities may be cumulative. Furthermore, they highlight the potential importance of assessing and targeting emotion regulation difficulties among child abuse and adult sexual victimization survivors.

Rape, sex partnership, and substance use consequences in women veterans

The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

The role of early life stress as a predictor for alcohol and drug dependence

RATIONALE

Genetic and environmental influences on the development of alcohol and drug dependence are equally important. Exposure to early life stress, that is unfortunately common in the general population, has been shown to predict a wide range of psychopathology, including addiction.

OBJECTIVE

This review will look at the characteristics of early life stress that may be specific predictors for adolescent and adult alcohol and drug dependence and will focus on studies in humans, non-human primates and rodents.

RESULTS

Experiencing maltreatment and cumulative stressful life events prior to puberty and particularly in the first few years of life is associated with early onset of problem drinking in adolescence and alcohol and drug dependence in early adulthood. Early life stress can result in permanent neurohormonal and hypothalamic-pituitary-adrenal axis changes, morphological changes in the brain, and gene expression changes in the mesolimbic dopamine reward pathway, all of which are implicated in the development of addiction. However, a large proportion of children who have experienced even severe early life stress do not develop psychopathology indicating that mediating factors such as gene-environment interactions and family and peer relationships are important for resilience.

CONCLUSIONS

There appears to be a direct pathway from chronic stress exposure in pre-pubertal children via adolescent problem drinking to alcohol and drug dependence in early adulthood. However, this route can be moderated by genetic and environmental factors. The role that gene-environment interactions play in the risk-resilience balance is being increasingly recognized.

Incapacitated rape and alcohol use in White and Asian American college women

This study examined the role of Asian ethnicity as a moderator of drinking outcomes associated with alcohol-related sexual assault (incapacitated rape). Participants were 5,467 Asian American and White college women. Results found the overall MANOVA for ethnicity and incapacitated rape (IR) interactions to be significant. Asian American participants with no history of IR had fewer drinking problems than White American participants with no history of IR. Asian American participants with IR histories had more drinking problems than White Americans with IR histories. Findings indicate Asian Americans who experience IR may be at increased risk for negative alcohol outcomes.

Stress and African American Women’s Smoking/Drinking to Cope

Associations of urban poverty-related stress with smoking and drinking to cope and the moderating role of kin social support were assessed in African American women. Findings revealed that among a sample of 101 poor African American women residing in economically and socially disadvantaged neighborhoods, depressive symptoms and relationship stress were significantly associated with smoking. Similarly, perceptions of neighborhood crime were marginally associated with alcohol use. Kinship support was hypothesized to buffer women from the deleterious impacts of stress. The results revealed that kin social support moderated the association of poverty-related stress with smoking and drinking. For women with higher levels of kin support, the positive association of neighborhood crime and drinking was less apparent compared with women with low support. Also, the links between relationship stress, depressive symptoms, and smoking were less apparent for women with higher kin support compared with those with lower support. Findings are discussed in terms of the need for additional research on the social networks available to economically disadvantaged African American families and the manner in which networks operate.

Child maltreatment, alcohol use and drinking consequences among male and female college students: An examination of drinking motives as mediators

Although the relationship between child maltreatment and alcohol use and drinking problems is well established, the mechanisms involved in this relationship remain largely unknown and research has focused primarily on women. Using the Modified Drinking Motives Questionnaire-Revised (M-DMQ-R; Grant, Stewart, O'Connor, Blackwell & Conrod, 2007), drinking motives were examined as mediators in the relationship between childhood maltreatment and alcohol consumption and consequences among male and female college student drinkers (N = 218, 60.6% women). Participants completed questionnaires assessing child maltreatment, drinking motives, alcohol consumption and alcohol consequences. Enhancement motives in particular mediated the relationship between childhood abuse and alcohol consequences for men, whereas coping-depression motives mediated this relationship for women. Implications of these findings for alcohol interventions and future research are discussed, along with limitations of the present study.

Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: role of experiencing violence, feeling safe on campus, and perceived stress

OBJECTIVE

To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns.

METHODS

A random representative sample of university students (n=988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences.

RESULTS

Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR=2.0; 95% CI: 1.1-3.9), more frequent negative AOD consequences (beta=5.5, SE=1.4, p<0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR=6.6; 95% CI: 3.0-14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students.

CONCLUSIONS

Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students.

The relation between interpersonal violence and substance use among a sample of university students: examination of the role of victim and perpetrator substance use

OBJECTIVE

To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.

METHODS

A random sample of students (N=1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.

RESULTS

Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p's<0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR's=2.0-5.1). Among females, most forms of substance use were associated with sexual victimization (OR's=2.4-4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.

CONCLUSIONS

Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.

Drinking motives as mediators in the relation between personality disorder symptoms and alcohol use disorder

Research shows high comorbidity between Cluster B Personality Disorders (PDs) and Alcohol Use Disorders (AUDs). Studies of personality traits and alcohol use have identified coping and enhancement drinking motives as mediators of the relation among impulsivity, negative affectivity or affectivity instability, and alcohol use. To the extent that certain PDs reflect extreme expression of these traits, drinking motives were hypothesized to mediate the relation between PD symptoms and presence/absence of an alcohol use disorder (AUD). This hypothesis was tested using a series of cross-sectional and prospective path models estimating the extent that coping and enhancement drinking motives mediated the relation between cluster A, B, and C PD symptom counts and AUD diagnosis among a sample of 168 young adults between ages 18 and 21. Enhancement motives mediated the cross-sectional relation between Cluster B symptoms and AUD. Prospectively, enhancement motives partially mediated the relation between Cluster B personality symptoms and AUD through the stability of Year 1 AUD to Year 3 AUD. Results suggest that enhancement motives may be especially important in understanding the relation between Cluster B personality disorders and AUDs.

Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults

The authors examined associations between a personal history of childhood maltreatment and the perceived stress and stress-coping styles of recently abstinent and treatment-engaged cocaine dependent adults. Fifty men and 41 women at an inpatient treatment and research facility were administered the short form of the Childhood Trauma Questionnaire (D. P. Bernstein & L. Fink, 1998; D. P. Bernstein et al., 2003), the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstein, 1983), and the COPE Questionnaire (C. S. Carver, M. R. Scheier, & J. K. Weintraub, 1989). Simple and multiple linear regression analyses were used to analyze relationships while adjusting for relevant covariates. Findings indicate that overall childhood maltreatment severity was significantly associated with greater perceived stress and greater use of avoidance stress-coping strategies. These findings suggest that having a history of childhood maltreatment may influence how recently abstinent cocaine dependent individuals experience and cope with stress. Stress and stress-coping focused interventions may be particularly indicated for cocaine dependent individuals with histories of childhood maltreatment.

Domestic violence and alcohol use: trauma-related symptoms and motives for drinking

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.

Relation of physiological reactivity and perceived coping to substance use disorders

We examined the interaction between a form of subjective emotional reactivity (perceived coping) and physiological reactivity in relation to risk for substance use disorders. Skin conductance responses to unpredictable white noise blasts were collected from 110 men and women who also rated their perceived coping to the blasts and underwent semi-structured interviews to assess psychiatric symptoms. Reported inability to cope in conjunction with low skin conductance reactivity were related to higher symptom counts of alcohol and cannabis use disorders as well as antisocial personality disorder symptoms. The findings highlight the potential importance of the interface between cognitive/emotional and physiological processes as they relate to risk for substance use disorders and perhaps other externalizing disorders.

Domestic violence and alcohol use: trauma-related symptoms and motives for drinking

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.

Incapacitated rape and alcohol use: a prospective analysis

This study examined timing of alcohol-related sexual assaults (incapacitated rape) in relation to both alcohol consumption and alcohol-related negative consequences. The sample was drawn from a randomly selected pool of college students across three campuses (n=1238) followed over a three year time period. 91% of students never experienced an incapacitated rape, 2% reported an incapacitated rape prior to the first assessment point (n=30), and 6% reported one over the course of the study (n=76). Results indicated that incapacitated rape was associated with higher alcohol use and more negative consequences in the years prior to the assault. Incapacitated rape was also associated with higher alcohol use and more negative consequences during the year in which the rape took place and subsequent years, with highest rates measured for the year of the rape. These results suggest alcohol use can function as both risk factor and consequence of sexual victimization.