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Martin EL, Neelon B, Brady KT, Guille C, Baker NL, Ramakrishnan V, Gray KM, Saladin ME, McRae-Clark AL. Differential prevalence of Adverse Childhood Experiences (ACEs) by gender and substance used in individuals with cannabis, cocaine, opioid, and tobacco use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:190-198. [PMID: 36881810 DOI: 10.1080/00952990.2023.2171301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background: Adverse childhood experiences (ACEs) show a graded association with the development of substance use disorders (SUDs) and engagement in risky substance use behaviors. Women are overrepresented among individuals with more severe childhood adversity (≥4 types of ACEs) and may be at particular risk for aberrant substance use.Objectives: To assess the prevalence of ACEs among men and women with cannabis, opioid, cocaine, and tobacco use disorders.Methods: Non-treatment-seeking individuals participating in clinical addiction research at a single site completed the ACE questionnaire and provided a detailed substance use history. Data were analyzed using proportional odds models and logistic regression.Results: Most participants (424/565; 75%) reported at least one ACE, and more than one-quarter (156/565; 27%) reported severe childhood adversity. Relative to men (n = 283), women (n = 282) reported more ACEs (OR = 1.49; p = .01) and more experiences of emotional/physical abuse (OR = 1.52; p = .02), sexual abuse (OR = 4.08; p = .04), and neglect (OR = 2.30; p < .01). Participants in the cocaine (OR = 1.87; n = .01) and opioid (OR = 2.21; p = .01) use disorder, but not cannabis use disorder (OR = 1.46; p = .08), studies reported more severe adversity relative to the tobacco group. Relative to tobacco users, emotional/physical abuse (OR = 1.92; p = .02) and neglect (OR = 2.46; p = .01) scores were higher in cocaine users and household dysfunction scores were higher in opioid users (OR = 2.67; p = .01).Conclusion: The prevalence of ACEs differs with respect to both participant gender and primary substance used. Novel SUD treatment strategies that incorporate ACEs may be uniquely beneficial in specific subpopulations of people with SUDs.
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Affiliation(s)
- Erin L Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Parisi A, Jordan B, Jensen T, Howard MO. The impact of sexual victimization on substance use disorder treatment completion: A systematic review and meta-analysis. Subst Abus 2020; 43:131-142. [PMID: 32432522 DOI: 10.1080/08897077.2020.1748168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background:A significant proportion of individuals seeking treatment for substance use disorders (SUDs) have experienced sexual victimization, which has been shown to disrupt the efficacy of SUD treatment services. Objective: To evaluate the relationship between lifetime sexual victimization and SUD treatment completion. Methods: Relevant literature was identified through a systematic, computerized search of nine electronic databases (May 2018) and reference harvesting, yielding 15 peer-reviewed articles published between 1992 and 2017. Two authors independently conducted title and abstract screens, full-text reviews, data abstraction, and methodological appraisals. Risk of bias was assessed using a modified mixed-methods appraisal tool. Only nine studies met criteria for the meta-analysis, which used a random-effects model. Results: Included studies yielded mixed results regarding the impact of sexual victimization on treatment completion. The meta-analysis yielded a non-significant trend of survivors of sexual victimization having slightly lower odds of completing treatment. Conclusions: Findings from this systematic review and meta-analysis did not support the impact of sexual victimization on treatment completion. Methodological limitations of the extant literature limit cross-study comparisons. Future studies should document program-related factors to improve the ability to understand relationships affecting treatment completion.
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Affiliation(s)
- Anna Parisi
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brooke Jordan
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd Jensen
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew O Howard
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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3
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Kmett JA, Eack SM. Characteristics of Sexual Abuse Among Individuals With Serious Mental Illnesses. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:2725-2744. [PMID: 26856358 DOI: 10.1177/0886260516628811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The deleterious effects of sexual abuse (SA) are well documented, as many studies have found that SA can increase the risk for psychiatric disorders. While SA has been examined in multiple samples, no studies have examined the characteristics of SA in individuals with severe mental illnesses (SMI). This study examined the prevalence rate and characterized the nature of SA among individuals with SMI who were under psychiatric care in three different inpatient facilities. Utilizing data from the MacArthur Violence Risk Assessment Study, 1,136 individuals with SMI were assessed for SA histories, psychiatric diagnoses, and other demographics. Nearly half of this sample ( n = 511) identified SA histories, with almost half indicating that the person was a stranger or someone outside of the family unit. One third reported SA occurred "too many times to count," and approximately a third indicated the abuse consisted of intercourse, occurring at a mean age of 11.22 years. Results found that individuals with SA histories were often never married, Caucasian, female, had children, described themselves as psychologically unwell, and were commonly voluntary psychiatric admissions. Those with SA histories had significantly higher psychopathology and lower functioning, and were more likely to be diagnosed with depression but less likely to be substance dependent. Identifying SA characteristics in individuals with SMI is a critical component to successful treatment. Thorough screening and assessment of this common problem can help clinicians identify accompanying issues that may exacerbate SMI symptomology, and improve the prognosis for long-term outcomes.
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Regier PS, Monge ZA, Franklin TR, Wetherill RR, Teitelman A, Jagannathan K, Suh JJ, Wang Z, Young KA, Gawrysiak M, Langleben DD, Kampman KM, O'Brien CP, Childress AR. Emotional, physical and sexual abuse are associated with a heightened limbic response to cocaine cues. Addict Biol 2017; 22:1768-1777. [PMID: 27654662 DOI: 10.1111/adb.12445] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/08/2016] [Accepted: 08/02/2016] [Indexed: 12/24/2022]
Abstract
Drug-reward cues trigger motivational circuitry, a response linked to drug-seeking in animals and in humans. Adverse life events have been reported to increase sensitivity to drug rewards and to bolster drug reward signaling. Therefore, we hypothesized that cocaine-dependent individuals with prior emotional, physical and sexual abuse might have a heightened mesolimbic brain response to cues for drug reward in a new brief-cue probe. Cocaine-dependent human individuals (N = 68) were stabilized in an inpatient setting and then completed an event-related blood-oxygen-level dependent functional magnetic resonance imaging task featuring 500-ms evocative (cocaine, sexual, aversive) and comparator (neutral) cues. Responses to three questions about emotional, physical and sexual abuse from the Addiction Severity Index were used to divide the patients into subgroups (history of Abuse [n = 40] versus No Abuse [n = 28]). When subjects were grouped by the historical presence or absence of emotional, physical or sexual abuse, the Abuse group showed a heightened midbrain, thalamic, caudate, and caudal orbitofrontal cortex response to cocaine cues; a similar result was found in other evocative cues, as well. These findings are the first reported for a 500-ms cocaine-cue probe, and they highlight the ability of very brief evocative cues to activate the brain's motivational circuitry. Although all participants had severe cocaine use disorders, individuals reporting prior abuse had a heightened mesolimbic response to evocative cues. To our knowledge, this is the first study in humans linking a history of abuse to a brain vulnerability (heightened mesolimbic response to drug cues) previously shown to contribute to drug-seeking.
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Affiliation(s)
- Paul S. Regier
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Zachary A. Monge
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Teresa R. Franklin
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Reagan R. Wetherill
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Anne Teitelman
- School of Nursing; University of Pennsylvania; Philadelphia PA USA
| | - Kanchana Jagannathan
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Jesse J. Suh
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Ze Wang
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Kimberly A. Young
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Michael Gawrysiak
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Daniel D. Langleben
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Kyle M. Kampman
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Charles P. O'Brien
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Anna Rose Childress
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
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Dailey RM, Claus RE. The Relationship between Interviewer Characteristics and Physical and Sexual Abuse Disclosures among Substance Users: A Multilevel Analysis. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260103100404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data were collected at assessment for substance abuse treatment from 22 interviewers and 8,276 clients to assess the relationship between interviewer characteristics and disclosure of physical and sexual abuse. Characteristics examined were client and interviewer gender, race/ethnicity, and age. Multilevel regressions that adjusted for the clustering of clients within interviewers were compared to unadjusted logistic regressions to determine the effect of response similarity within clusters. Clustering accounted for only 2–5% of the unexplained variance; however, ignoring the clustering effect generated several misleading results. Adjusted models indicated that clients were more likely to disclose physical abuse to Caucasian interviewers than to African American interviewers and more likely to disclose sexual abuse to female interviewers than to male interviewers. Matching clients and interviewers on gender, race, and age did not increase disclosures of either physical or sexual abuse.
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Affiliation(s)
| | - Ronald E. Claus
- Missouri Institute of Mental Health, School of Medicine, University of Missouri, Columbia. Direct corresondence to Ronald Claus at
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6
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Sweeney S, Air T, Zannettino L, Galletly C. Gender Differences in the Physical and Psychological Manifestation of Childhood Trauma and/or Adversity in People with Psychosis. Front Psychol 2015; 6:1768. [PMID: 26635676 PMCID: PMC4655246 DOI: 10.3389/fpsyg.2015.01768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/04/2015] [Indexed: 11/13/2022] Open
Abstract
The link between childhood trauma and/or adversity and risk of psychosis is well known. Our aim was to determine the prevalence of childhood trauma and/or adversity in people who have psychotic disorders and to investigate the association between childhood trauma and/or adversity and a range of social and health measures. Participants (n = 391, 42% male) were specifically asked about any experience of childhood trauma and/or adversity. Respondents provided information about education, employment, physical health, and health service utilization. Univariate analyses revealed that childhood trauma and/or adversity was associated with poorer levels of self-reported physical health and social problems. This includes the experience of chronic pain, headaches, arthritis, asthma, and victimization/stigma in men. Participants with a childhood trauma and/or adversity history indicated higher rates of lifetime suicide attempts with women reporting more lifetime depressive symptoms. Multivariate analyses revealed differing profiles in relation to physical and psychological health variable between males and females. Males with the experience of childhood trauma and/or adversity were significantly more likely to report cardiovascular/stroke issues, migraines and anhedonia. Females with the experience of childhood trauma and/or adversity were more likely to report a lifetime history of elevated mood and to be married or in a de facto relationship. There has been very little research into the assessment and treatment of the effects of childhood trauma and/or adversity in adults with psychosis. Childhood trauma and/or adversity may contribute to higher rates of self-reported poor health in men and is associated with increased depression in women. Our findings suggest that interventions to address the effects of past trauma are urgently needed.
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Affiliation(s)
- Shaun Sweeney
- Discipline of Psychiatry, University of Adelaide, Adelaide SA, Australia
| | - Tracy Air
- Discipline of Psychiatry, University of Adelaide, Adelaide SA, Australia
| | - Lana Zannettino
- School of Nursing and Midwifery, Flinders University, Adelaide SA, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide SA, Australia
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7
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Min MO, Tracy EM, Park H. Impact of trauma symptomatology on personal networks among substance using women. Drug Alcohol Depend 2014; 142:277-82. [PMID: 25042762 PMCID: PMC4127087 DOI: 10.1016/j.drugalcdep.2014.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interpersonal trauma poses challenges and complications to the development and maintenance of personal networks of substance using women. Few studies have examined its effects on personal network support availability and quality of relationships, limiting our understanding of the social context in which substance using women with a history of trauma are embedded. METHODS Women with substance use disorders (SUD) who received treatment at three county-funded, women-only intensive treatment programs (N=375) were interviewed at intake and at follow ups 1, 6, and 12 months later. A network software program, EgoNet, elicited 25 network members per respondent, social support availability, and the quality of network relationship at each assessment. Trauma symptomatology was assessed with Trauma Symptom Checklist-40 at intake. RESULTS Findings from longitudinal mixed model analyses indicated that higher levels of trauma symptomatology were associated with both a negative, critical quality and less closeness in network relationships over the 12 month study period. However, trauma symptoms were not related to the number of network members reported as providing emotional, concrete, or sobriety support. Effects of trauma symptoms on the support availability in the network and the quality of network relationships were consistent over the follow-up period. CONCLUSIONS Findings highlight the potential role of trauma symptoms in determining the quality of relationships within personal networks among women with SUD, suggesting the need for routine mapping of network relationships throughout treatment.
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Affiliation(s)
- Meeyoung O Min
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH 44106, United States.
| | - Elizabeth M Tracy
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH 44106, United States
| | - Hyunyong Park
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH 44106, United States
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8
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Cerdá M, DiGangi J, Galea S, Koenen K. Epidemiologic research on interpersonal violence and common psychiatric disorders: where do we go from here? Depress Anxiety 2012; 29:359-85. [PMID: 22553006 PMCID: PMC3375609 DOI: 10.1002/da.21947] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Magdalena Cerdá
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York,Correspondence to: Magdalena Cerdá, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th St., New York, NY 10032.
| | - Julia DiGangi
- Department of Clinical Psychology, DePaul University, Chicago, Illinois
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Karestan Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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9
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Sikes A, Hays DG. The Developmental Impact of Child Abuse on Adulthood: Implications for Counselors. ADULTSPAN JOURNAL 2011. [DOI: 10.1002/j.2161-0029.2010.tb00069.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Heffner JL, Blom TJ, Anthenelli RM. Gender differences in trauma history and symptoms as predictors of relapse to alcohol and drug use. Am J Addict 2011; 20:307-11. [PMID: 21679261 DOI: 10.1111/j.1521-0391.2011.00141.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to determine whether there are gender-specific associations between trauma exposure and alcohol or drug relapse in alcohol-dependent adults. Participants were 51 men (n = 24) and women (n = 27) with alcohol dependence, 22 (43.1%) of whom relapsed during study participation. Severity of childhood trauma; number of lifetime events evoking fear, helplessness, or horror; and current trauma symptoms all predicted relapse in women, but not in men. These findings highlight the importance of assessing trauma history and providing treatment of trauma-related symptoms for individuals with alcohol and drug dependence, and for women in particular.
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Affiliation(s)
- Jaimee L Heffner
- Tri-State Tobacco and Alcohol Research Center, Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Ohio, USA.
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11
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Andrews CM, Dingcai Cao, Marsh JC, Shin HC. The Impact of Comprehensive Services in Substance Abuse Treatment for Women With a History of Intimate Partner Violence. Violence Against Women 2011; 17:550-67. [DOI: 10.1177/1077801211407289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete ( p = .016) and family services ( p = .023) in predicting substance use.
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12
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History of reported sexual or physical abuse among long-term heroin users and their response to substitution treatment. Addict Behav 2011; 36:55-60. [PMID: 20855171 DOI: 10.1016/j.addbeh.2010.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 08/09/2010] [Accepted: 08/23/2010] [Indexed: 11/23/2022]
Abstract
Opioid-dependent individuals with a history of abuse have exhibited worse mental and physical health compared to those without such a history; however, the evidence regarding the influence of abuse histories on addiction treatment outcomes are conflicting. In the present study, we identified history of physical or sexual abuse at treatment initiation in relation to drug use and health among long-term opioid-dependent individuals and we determined the relationship of abuse histories with treatment outcomes following substitution treatment. We analyzed data from a randomized controlled trial that compared the effectiveness of opioid-agonists in the treatment of chronic opioid dependence. The North American Opiate Medication Initiative (NAOMI) was conducted in Vancouver and Montreal (Canada) and provided oral methadone, injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A total of 112 (44.6%) participants reported a history of physical or sexual abuse at baseline. Participants with an abuse history reported a significantly higher number of chronic medical problems, suicide attempts, and previous drug treatments and had poorer psychiatric, family and social relations, and quality of life status compared to those without abuse histories. No differences in current and past substance use were found between those with and without abuse histories. Following 12 months of treatment, the participants with abuse histories improved to a similar degree as those without a history of abuse in all of the European Addiction Severity Index sub-scales, with the exception of medical status. The findings suggest that individuals with abuse histories were able to achieve similar outcomes as those without abuse histories following treatment despite having poorer scores in physical and mental health, social status and quality of life at treatment initiation. These findings suggest that the substitution treatments as provided in this study can benefit the most vulnerable and access needs to be expanded to reach this population.
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El-Bassel N, Gilbert L, Witte S, Wu E, Chang M. Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment. Subst Use Misuse 2011; 46:295-306. [PMID: 21303249 DOI: 10.3109/10826084.2011.523296] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.
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Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, New York 10027, USA.
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14
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Gil-Rivas V, Prause J, Grella CE. Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2009; 23:303-14. [PMID: 19586147 DOI: 10.1037/a0015355] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.
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Affiliation(s)
- Virginia Gil-Rivas
- Interdisciplinary Health Psychology, University of North Carolina at Charlotte, Charlotte, NC 28213, USA.
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15
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Bornovalova MA, Ouimette P, Crawford AV, Levy R. Testing gender effects on the mechanisms explaining the association between post-traumatic stress symptoms and substance use frequency. Addict Behav 2009; 34:685-92. [PMID: 19423233 DOI: 10.1016/j.addbeh.2009.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/18/2009] [Accepted: 04/09/2009] [Indexed: 11/19/2022]
Abstract
The present study examines gender differences in the mechanisms that explain the association between PTSD symptoms and substance use frequency in a sample of 182 urban substance users. Specifically, the current study examined gender differences in the role of two potential explanatory variables, namely, difficulties controlling impulsive behavior when distressed (IMP), and a lack of emotional awareness and clarity (AW/CLAR). Multiple-group path modeling (across males and females) was used to examine gender differences in the path coefficients from PTSD symptoms to IMP and AW/CLAR, and from these latter variables to drug use frequency. Results indicated that PTSD symptoms were associated with IMP and AW/CLAR, and these path coefficients did not vary by gender. However, gender differences emerged when considering the path coefficients from AW/CLAR and IMP to substance use frequency. Specifically, for women, the association between PTSD and substance use was partially explained by IMP, whereas for men, the association between PTSD and substance use was partially explained by AW/CLAR. The current study is the first to examine gender differences in mechanisms accounting for the association between PTSD and substance use frequency, and these results also support the value and importance of examining gender differences in mechanisms underlying PTSD-SUD comorbidity.
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Affiliation(s)
- Marina A Bornovalova
- University of Minnesota, Department of Psychology, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455-0344, United States.
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16
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Galvani S. Safety first? The impact of domestic abuse on women's treatment experience. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890600708225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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McKeganey N, Neale J, Robertson M. Physical and sexual abuse among drug users contacting drug treatment services in Scotland. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630412331317998] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Abstract
Family, network or couples-based therapies have been helping to support people with substance problems for decades. Their value in supporting a person to change their alcohol or drug use is clear. However, as links between substance use and domestic abuse are increasingly recognised, these approaches need to reflect on the potential safety risks they present to people taking part. The prevalence of domestic abuse among people receiving drug and alcohol services is considerably higher than general population estimates, yet this does not appear to have been adequately addressed in network therapies. This article suggests that this needs to change and that safety of service users needs to be at least as important as the intervention itself. It offers for debate a number of potential safety issues raised by network therapies where there is evidence of domestic abuse; it provides examples of three approaches used to marshal social and network support in substance interventions; and offers a number of suggestions for how network therapies can ensure their use remains safe and supportive where there is domestic abuse.
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Affiliation(s)
- Sarah A Galvani
- Institute of Applied Social Studies, University of Birmingham, Edgbaston, Birmingham, UK.
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19
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Poole N, Greaves L, Jategaonkar N, McCullough L, Chabot C. Substance use by women using domestic violence shelters. Subst Use Misuse 2008; 43:1129-50. [PMID: 18649235 DOI: 10.1080/10826080801914360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigated the connections between stressors, substance use, and experience of violence among women (N = 125) who accessed help from domestic violence shelters in British Columbia, Canada between October 2001 and June 2003. Changes in substance use and stressors following a shelter stay were explored, using both qualitative and quantitative methods. Women generally decreased their use of alcohol and stimulants, and this change was found to be integrally connected to social and structural supports made available to them. Future research that augments current stress models of addiction by considering social and structural factors that come into play in women's substance use and domestic violence is suggested. The study's limitations are noted.
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Affiliation(s)
- Nancy Poole
- British Columbia Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada.
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Schneider R, Cronkite R, Timko C. Lifetime physical and sexual abuse and substance use treatment outcomes in men. J Subst Abuse Treat 2008; 35:353-61. [PMID: 18342478 DOI: 10.1016/j.jsat.2008.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 01/15/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
Although lifetime physical and sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months postintake. Men with a history of physical or sexual abuse had more severe drug problems at intake, but by 6 months, there were no group differences in drug use. However, relative to men without an abuse history, men with a sexual abuse history had more severe psychiatric problems at all three time points and were more likely to report significant suicidality at intake and 6 months. Findings suggest that men with a history of sexual abuse benefit from SUD treatment, but additional intervention may be warranted to remedy persisting psychiatric distress.
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Affiliation(s)
- Renee Schneider
- Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA.
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21
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Arévalo S, Prado G, Amaro H. Spirituality, sense of coherence, and coping responses in women receiving treatment for alcohol and drug addiction. EVALUATION AND PROGRAM PLANNING 2008; 31:113-23. [PMID: 17825910 DOI: 10.1016/j.evalprogplan.2007.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine the role of spirituality, sense of coherence, and coping responses in relation to stress and trauma symptoms among women in substance abuse treatment. DATA SOURCES/STUDY SETTING Data for the present analyses were obtained from baseline interviews of 393 women in an urban area of Massachusetts. Interviews were conducted from April 2003 to September 2006. Participants came from four substance abuse treatment programs (three residential and one outpatient) participating in the Mother's Hope, Mind and Spirit Study, an evaluation of an intervention funded by the Substance Abuse and Mental Health Services Administration (SAMSHA). PRINCIPAL FINDINGS Stress was significantly associated with drug addiction severity and trauma symptoms were significantly related to alcohol addiction severity. Spirituality, sense of coherence, and coping responses did not mediate the relationship between perceived stress, and posttraumatic stress, and alcohol and drug addiction severity. However, negative and significant associations were found between perceived stress and spirituality, sense of coherence and coping responses, and between posttraumatic stress symptomatology and sense of coherence. CONCLUSION Enhanced substance abuse treatments that increase spirituality, sense of coherence, and coping responses may be beneficial in helping women in substance abuse treatment to manage stress and posttraumatic stress symptoms. However, further research is needed to identify the pathways through which spirituality, sense of coherence and coping responses may mediate the effects of stress and posttraumatic stress symptoms on alcohol and drug addiction severity.
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Affiliation(s)
- Sandra Arévalo
- Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Stearns Suite 503, Boston, MA 02115, USA.
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Min M, Farkas K, Minnes S, Singer LT. Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood. J Trauma Stress 2007; 20:833-44. [PMID: 17955535 DOI: 10.1002/jts.20250] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Structural equation modeling was used to examine the relationship of childhood trauma, educational level, and the use of avoidant coping on substance abuse and psychological distress in a community sample of 285 women. Results indicated that self-reported childhood trauma was significantly related to greater substance abuse and psychological distress, through educational attainment and avoidant coping strategies. Lower level of education affected substance abuse through greater use of avoidant coping, but had no significant relationship with psychological distress. Greater use of avoidant coping was related to increased substance abuse and greater psychological distress. Findings indicate the need for supportive educational strategies and interventions to teach coping skills in preventing substance abuse and longer-term psychological distress in children exposed to trauma.
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Affiliation(s)
- Meeyoung Min
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-7164, USA.
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23
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Gratz KL, Bornovalova MA, Delany-Brumsey A, Nick B, Lejuez CW. A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: the role of emotional nonacceptance. Behav Ther 2007; 38:256-68. [PMID: 17697851 DOI: 10.1016/j.beth.2006.08.006] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 08/31/2006] [Indexed: 10/23/2022]
Abstract
Despite the theorized centrality of experiential avoidance in abuse-related psychopathology, empirical examinations of the relationship between childhood abuse and experiential avoidance remain limited. The present study adds to the extant literature on this relationship, providing a laboratory-based investigation of the relationships between childhood sexual, physical, and emotional abuse, experiential avoidance (indexed as unwillingness to persist on 2 psychologically distressing laboratory tasks), and self-reported emotional nonacceptance among a sample of 76 inner-city treatment-seeking substance users. As hypothesized, results provide evidence for heightened experiential avoidance and emotional nonacceptance among individuals with moderate-severe sexual, physical, and emotional abuse (compared to individuals reporting none-low abuse). However, although emotional nonacceptance was associated with increased risk for experiential avoidance, it mediated the relationship between childhood abuse and experiential avoidance only for emotional abuse. As such, results suggest that one mechanism through which emotional abuse in particular leads to experiential avoidance is emotional nonacceptance. Findings suggest the utility of interventions aimed at decreasing experiential avoidance and promoting emotional acceptance among abused individuals.
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Affiliation(s)
- Kim L Gratz
- Center for Addictions, Personality, and Emotion Research and Department of Psychology, University of Maryland, College Park, MD 20742, USA.
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24
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Substance use among women in shelters for abused women and children. Programming opportunities. Canadian Journal of Public Health 2006. [PMID: 17120878 DOI: 10.1007/bf03405348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study explores changes in the use of alcohol and other substances by women in British Columbia as they moved into shelters for abused women and again three months later. We see this time as a key life transition, and potentially a rich opportunity for influencing women's substance use behaviour. The purpose of this study was to document changes in the level of use of alcohol and other substances and the levels of stress among women as they moved through shelters for abused women. METHODS Standardized questionnaires augmented by qualitative interviews were employed to measure alcohol and substance use, experiences of abuse, and levels and types of stressors facing women in this situation. FINDINGS Significant reductions in women's use of alcohol and stimulants were observed from Interview I to Interview II, but there was no significant reduction in use of other depressants or tobacco use. Levels of stress decreased and sources of stress changed for the women after the shelter experience. Stress connected to relationship with partners had the most significant decrease, followed by mental health, housing, and legal issues. Women reported barriers to accessing financial aid and services for substance use outside of the shelter. CONCLUSIONS Women's experiences of violence and substance use were found to be interconnected in complex ways and changes in substance use were affected by a range of influences, such as financial concerns, mothering, relationships, levels of social support, and physical and mental health issues. Substance-using women who have experienced violence are an underserved population and a multi-sectoral response designed to address psychosocial, relational, and structural issues could better help them improve their overall health.
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Zlotnick C, Johnson DM, Stout RL, Zywiak WH, Johnson JE, Schneider RJ. Childhood abuse and intake severity in alcohol disorder patients. J Trauma Stress 2006; 19:949-59. [PMID: 17195983 DOI: 10.1002/jts.20177] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In a sample of 336 patients with an alcohol use disorder, this study examined, whether patients with histories of childhood sexual abuse (CSA) and childhood physical abuse (CPA) compared to those without such histories have a greater severity of alcohol and other clinical difficulties. Whether lifetime posttraumatic stress disorder (PTSD) mediates the relationship between childhood abuse and clinical outcomes was explored. Results were that CSA was associated with earlier age of onset for alcohol disorder, greater Axis I comorbidity as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), more social and psychiatric problems, but lower drinking frequency. Childhood physical abuse was related to greater drinking consequences, social and psychiatric dysfunction, and Axis I comorbidity, but also lower drinking frequency. Posttraumatic stress disorder partially mediated the effect of both CSA and CPA on severity of psychiatric problems.
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Affiliation(s)
- Caron Zlotnick
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA.
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Abstract
This review explores gender differences in relapse and characteristics of relapse events in alcohol and substance use. For alcohol, relapse rates were similar across gender. Although negative mood, childhood sexual abuse, alcohol-related self-efficacy, and poorer coping strategies predicted alcohol relapse, gender did not moderate these effects. Gender did moderate the association between marriage and alcohol relapse. For women, marriage and marital stress were risk factors for alcohol relapse; among men, marriage lowered relapse risk. This gender difference in the role of marriage in relapse may be a result of partner differences in problem drinking. Alcoholic women are more likely to be married to heavy drinking partners than are alcoholic men; thus, alcoholic women may be put at risk of relapse by marriage and alcoholic men may be protected by marriage. There are fewer studies documenting gender differences in substance abuse relapse so conclusions are limited and tentative. In contrast to the lack of gender differences in alcohol relapse rates, women appear less likely to experience relapse to substance use, relative to men. Women relapsing to substance use appear to be more sensitive to negative affect and interpersonal problems. Men, in contrast, may be more likely to have positive experiences prior to relapse.
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Affiliation(s)
- Kimberly S Walitzer
- Research Institute on Addictions/University at Buffalo, 1021 Main St., Buffalo, NY 14203, United States.
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28
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Abstract
This study extends the work completed with pathological gamblers and substance abusers, looking at associations between a history of trauma and comorbid substance dependence, impulsivity, measures of problem severity, and personality variables. We studied 111 patients admitted to the gambling treatment program at the Brecksville VA Medical Center and found that 64% of gamblers reported a history of emotional trauma; 40.5%, physical trauma; and 24.3%, sexual trauma. Most of this trauma occurred in childhood. A history of trauma was associated with a greater relative frequency of suicide attempts and drug and alcohol dependence, more severe scores in measures of psychiatric distress, and limited effects on personality functioning.
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Affiliation(s)
- Otto Kausch
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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29
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Bartholomew NG, Courtney K, Rowan-Szal GA, Simpson DD. Sexual abuse history and treatment outcomes among women undergoing methadone treatment. J Subst Abuse Treat 2005; 29:231-5. [PMID: 16183472 DOI: 10.1016/j.jsat.2005.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 04/22/2005] [Accepted: 07/24/2005] [Indexed: 11/25/2022]
Abstract
Women entering drug abuse treatment programs who report a history of sexual abuse are also likely to report poorer psychosocial functioning, more drug-related problems, and more family-of-origin problems. This study investigates outcome differences at follow-up between women with and those without sexual abuse histories who were treated at an outpatient methadone treatment program. Follow-up interviews were conducted with 98 women, 40% of whom reported prior sexual abuse. Those with a history of sexual abuse who reported problems at intake with psychosocial functioning and family support continued to report such problems at follow-up as compared with the women without a history of sexual abuse. However, no difference was found at follow-up between women with and those without sexual abuse histories in terms of drug use, employment, criminality, or HIV-risky behaviors. The findings suggest that sexual abuse history alone cannot predict treatment outcomes for women in methadone treatment. The implications of these findings are discussed in terms of treatment process and services.
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Affiliation(s)
- Norma G Bartholomew
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA.
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30
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Pirard S, Sharon E, Kang SK, Angarita GA, Gastfriend DR. Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes. Drug Alcohol Depend 2005; 78:57-64. [PMID: 15769558 DOI: 10.1016/j.drugalcdep.2004.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 09/20/2004] [Accepted: 09/20/2004] [Indexed: 11/28/2022]
Abstract
More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. To achieve this goal, baseline characteristics, no-show for treatment status, post-treatment clinical outcomes, and treatment history were studied for subjects with lifetime history of abuse (47.3%) versus without. Abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index (ASI), and general level of functioning. The two groups endorsed different drugs as primary, with the abused group less frequently endorsing heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment.
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Affiliation(s)
- Sandrine Pirard
- Addiction Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 388 Commonwealth Avenue, Boston, MA 02115, USA.
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31
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32
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Boles SM, Joshi V, Grella C, Wellisch J. Childhood sexual abuse patterns, psychosocial correlates, and treatment outcomes among adults in drug abuse treatment. JOURNAL OF CHILD SEXUAL ABUSE 2005; 14:39-55. [PMID: 15914404 DOI: 10.1300/j070v14n01_03] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multisite study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Controlling for gender, compared to patients without CSA, patients reporting CSA were younger at entry into the current drug treatment, were more likely to be White, were more likely to have a comorbid mental disorder, be alcohol or cocaine dependent, had higher levels of criminal activities, had a higher level of problem recognition, and had a more negative peer influence. Controlling for these correlates, a history of abuse was related to a lower likelihood of posttreatment abstinence.
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Affiliation(s)
- Sharon M Boles
- UCLA Integrated Substance Abuse Program, Los Angeles, CA, USA.
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El-Bassel N, Gilbert L, Frye V, Wu E, Go H, Hill J, Richman BL. Physical and sexual intimate partner violence among women in methadone maintenance treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2004; 18:180-3. [PMID: 15238060 DOI: 10.1037/0893-164x.18.2.180] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although several studies have examined the relationship between intimate partner violence (IPV) and drug use among women in drug treatment programs, more information is needed to delineate differences, as a function of the specific drug used. Data from a random sample of 416 women attending methadone programs were analyzed to elucidate the differential associations between IPV and use of the following: marijuana only, cocaine only, heroin only, or cocaine and heroin. Prevalence of IPV among this sample far exceeded estimates from the general population. After adjusting for sociodemographic variables, use of cocaine only was significantly associated with an increased likelihood of experiencing IPV compared with no drug use. Similar results were found for women using both cocaine and heroin.
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Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY 10025, USA.
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Schumm JA, Hobfoll SE, Keogh NJ. Revictimization and interpersonal resource loss predicts PTSD among women in substance-use treatment. J Trauma Stress 2004; 17:173-81. [PMID: 15141791 DOI: 10.1023/b:jots.0000022624.53181.21] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.
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Affiliation(s)
- Jeremiah A Schumm
- Department of Psychology, Kent State University, Kent, Ohio 44242-0001, USA.
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Abstract
The purpose of the present study was to examine elderly patients, aged 60 and older, admitted to a residential gambling treatment program and to compare them to a younger cohort on a variety of mental health factors and measures. A retrospective chart review was performed for 37 elderly gamblers consecutively admitted to the Gambling Treatment Program of a VA center between December 1999 and December 2002. These elderly subjects were compared with a younger cohort of 98 gamblers. On intake, the gamblers completed the Addiction Severity Index (ASI) and a variety of mental health questionnaires. Compared to the younger cohort, elderly gamblers were more likely to be retired but demonstrated similar impairment on the ASI composite employment severity score. Elderly gamblers were just as likely as the younger gamblers to have a lifetime history of serious suicidal ideation. They were equally likely as the younger cohort to carry a psychiatric diagnosis, and depression was the most common diagnosis.
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MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Cohort Studies
- Comorbidity
- Depressive Disorder/diagnosis
- Depressive Disorder/epidemiology
- Depressive Disorder/psychology
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/epidemiology
- Disruptive, Impulse Control, and Conduct Disorders/psychology
- Gambling/psychology
- Hospitals, Veterans
- Humans
- Male
- Middle Aged
- Patient Admission
- Retrospective Studies
- Suicide, Attempted/psychology
- Suicide, Attempted/statistics & numerical data
- United States
- Veterans/psychology
- Veterans/statistics & numerical data
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Affiliation(s)
- Otto Kausch
- Louis Stokes Veterans Administration Medical Center, Brecksville Division, Veterans Addiction Recovery Center, 10000 Brecksville Road, Brecksville, OH 44141, USA.
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Effects of Gender, Sexual Victimization, and Duration of Alcohol and Other Drug Abuse on Treatment History. ALCOHOLISM TREATMENT QUARTERLY 2004. [DOI: 10.1300/j020v22n01_03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Grella CE, Joshi V. Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. CHILD MALTREATMENT 2003; 8:7-18. [PMID: 12568501 DOI: 10.1177/1077559502239610] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study reports on the effects of having a history of physical and/or sexual abuse on treatment processes and posttreatment abstinence among adolescents (N = 803) in a multisite study of drug treatment outcomes. A history of physical and/or sexual abuse was reported by 59% of the girls and 39% of the boys and was related to being White and having higher levels of comorbidity, exposure to other traumatic events, dependence on alcohol and marijuana, problem recognition, and negative peer or family influence. Abused adolescents had more service needs at treatment admission and there was some variation in treatment processes related to gender and abuse status. Youths with a history of physical abuse had a lower likelihood of posttreatment abstinence, except among those who had better rapport with their counselors. Attention to treatment processes and engagement strategies is crucial for treating youths in drug treatment who have a history of abuse.
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Affiliation(s)
- Christine E Grella
- UCLA Integrated Substance Abuse Programs, Neuropsychiatric Institute, USA
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Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull 2002; 128:851-885. [PMID: 12405135 DOI: 10.1037/0033-2909.128.6.851] [Citation(s) in RCA: 251] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention.
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Bartholomew NG, Rowan-Szal GA, Chatham LR, Nucatola DC, Simpson DD. Sexual abuse among women entering methadone treatment. J Psychoactive Drugs 2002; 34:347-54. [PMID: 12562102 DOI: 10.1080/02791072.2002.10399975] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Women who enter drug abuse treatment programs are likely to report histories of sexual abuse that may impact psychosocial functioning, retention, and outcomes. This study investigates differences at admission between women with and without sexual abuse histories who entered an outpatient methadone treatment program in Texas. In a sample of 137 women, 39% reported prior sexual abuse. Findings show that women with sexual abuse histories were more likely also to have experienced physical and emotional abuse, to report poorer family-of-origin relationships, and to report more drug-related problems. These clients also reported more depression, anxiety, thoughts of suicide, trouble concentrating, and trouble controlling violent behavior. Results are discussed in terms of the need for adequate assessment of abuse history at intake and the need for targeted outcome studies to better define the impact of past abuse on treatment participation and outcome.
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Affiliation(s)
- Norma G Bartholomew
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas 76129, USA.
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40
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Freeman RC, Collier K, Parillo KM. Early life sexual abuse as a risk factor for crack cocaine use in a sample of community-recruited women at high risk for illicit drug use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2002; 28:109-31. [PMID: 11853128 DOI: 10.1081/ada-120001284] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Subjects for this study were 1,478 community-recruited women sexual partners of male injection drug users who were participants in the National Institute on Drug Abuse (NIDA)-supported Women Helping to Empower and Enhance Lives (WHEEL) project. This study assessed the association between child/adolescent sexual abuse--including specific type of abuse and perpetrator of abuse--and lifetime crack use in this sample of women. About 64% of sample women had ever used crack; 56% had been sexually abused by age 18. In logistic regression analyses, any sexual abuse in childhood, penetrative sexual abuse in childhood, and sexual abuse by a family member in childhood were significantly associated with lifetime crack use. Sexual abuse in adolescence was indirectly associated with lifetime crack use through running away from home and rape in adulthood. Given that many of these subjects reported drug treatment experience, such programs may provide the best setting for helping women with both substance use and sexual abuse issues.
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Liebschutz J, Savetsky JB, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH. The relationship between sexual and physical abuse and substance abuse consequences. J Subst Abuse Treat 2002; 22:121-8. [PMID: 12039614 PMCID: PMC4861063 DOI: 10.1016/s0740-5472(02)00220-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study examines the relationship between a history of physical and sexual abuse (PhySexAbuse) and drug and alcohol related consequences. We performed a cross-sectional analysis of data from 359 male and 111 female subjects recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences (InDUC), measured negative life consequences of substance use. Eighty-one percent of women and 69% of men report past PhySexAbuse, starting at a median age of 13 and 11, respectively. In bivariate and multivariable analyses, PhySexAbuse was significantly associated with more substance abuse consequences (p < 0.001). For men, age < or =17 years at first PhySexAbuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse (p = 0.048). For women, the association of PhySexAbuse with substance use consequences was similar across all ages (p = 0.59). Future research should develop interventions to lessen the substance abuse consequences of physical and sexual abuse.
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Affiliation(s)
- Jane Liebschutz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA 02118, USA.
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Freeman RC, Parillo KM, Collier K, Rusek RW. Child and adolescent sexual abuse history in a sample of 1,490 women sexual partners of injection drug-using men. Women Health 2002; 34:31-49. [PMID: 11785856 DOI: 10.1300/j013v34n04_03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Subjects for this study were 1490 community-recruited women sexual partners of injection drug-using men who were interviewed in three U.S. cities during 1990-'92. Data were collected on respondents' childhood and adolescent sexual abuse history, identity of abuse perpetrators and duration of abuse. Over 56 percent of respondents reported a history of sexual victimization by age 18, including 39 percent who were abused before age 12 and over 53 percent who were victimized by abuse involving bodily contact by age 18. One in three women were victimized by unwanted penetration by age 18. White women more likely than African-American and Hispanic women to have been the victims of virtually every type of abusive act investigated here. Overall, nearly two out of three White women had experienced some form of sexual abuse by age 18, including almost 42 percent who were the victims of unwanted penetration by this age. Acts of forced sexual touching and penetration occurring in childhood were most likely to have been carried out by an uncle or other relative of the victim; family members were much less likely to be the perpetrators of adolescent contact abuse. Based on these findings, it appears that many in this special population of women are likely to be at substantial risk for some of the long-term effects of early life sexual abuse, including those that may reduce victims' ability to take preventive action against HIV risk. Recommendations are offered for those who function as caregivers to this population, including drug treatment personnel.
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Affiliation(s)
- R C Freeman
- NOVA Research Company, Bethesda, MD 20814, USA
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Outcome in Female Patients with Both Substance Use and Post-Traumatic Stress Disorders. ALCOHOLISM TREATMENT QUARTERLY 2000. [DOI: 10.1300/j020v18n03_11] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Physical and Sexual Abuse Among Women and Men with Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2000. [DOI: 10.1300/j020v18n03_02] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bonin MF, Norton GR, Asmundson GJ, Dicurzio S, Pidlubney S. Drinking away the hurt: the nature and prevalence of PTSD in substance abuse patients attending a community-based treatment program. J Behav Ther Exp Psychiatry 2000; 31:55-66. [PMID: 10983747 DOI: 10.1016/s0005-7916(00)00008-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prevalence of posttraumatic stress disorder (PTSD) was evaluated in 91 participants attending a community-based substance abuse program. The participants were classified as having PTSD, possible PTSD, or no PTSD using the modified PTSD symptom scale (MPSS; Falsetti, Resnick, H. S., Resnick, P. A. & Kilpatrick, 1993). These groups were then compared on measures of anxiety, depression, and fear using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index (ASI), and the Fear Questionnaire (FQ). The results showed that 52.8% of participants had either PTSD (37.4%) or possible PTSD (15.4%). Findings also showed that those with PTSD experienced more potentially traumatic events (e.g., rape, being beaten-up) compared to the possible PTSD and no PTSD participants. The PTSD group also reported significantly greater scores on the ASI, BAI, and BDI than did the no PTSD group, and greater scores on the ASI and BAI than did the possible PTSD group. Further, when using a discriminant function analysis, self-report measures correctly classified 70% of the PTSD group and 80% of a composite group of possible PTSD and no PTSD participants. Implications of these results are discussed.
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Affiliation(s)
- M F Bonin
- University of Winnipeg, Manitoba, Canada.
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Fiorentine R, Pilati ML, Hillhouse MP. Drug treatment outcomes: investigating the long-term effects of sexual and physical abuse histories. J Psychoactive Drugs 1999; 31:363-72. [PMID: 10681103 DOI: 10.1080/02791072.1999.10471766] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Individuals in drug treatment, particularly women, generally report high levels of past sexual and physical abuse. Although histories of sexual and physical abuse are associated with greater prevalence and severity of depression, anxiety, phobias, and interpersonal difficulties for individuals seeking substance-related treatment, several recent studies failed to show that prior sexual or physical abuse compromised short-term drug treatment outcomes. This study examined the possible effects of sexual and physical abuse on a wide array of behavioral domains over a two-year posttreatment period. The findings indicate few differences between those with and without past histories of such abuse in terms of drug use, drug treatment and 12-Step program participation, criminality, income sources, intimate relationships, family functioning, and psychiatric symptoms. There are specific exceptions, but they apply only to men. Overall, the findings indicate that the impact of sexual and physical abuse histories on relatively long-term treatment outcomes is minimal. Addressing the sexual and physical abuse histories of those seeking treatment for drug abuse may be justified on humanistic grounds, but it will not significantly improve the long-term effectiveness of drug treatment, nor will it substantially enhance the lives of those with histories of abuse.
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Affiliation(s)
- R Fiorentine
- UCLA Drug Abuse Research Center, Los Angeles, California 90025, USA
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