Examining the role of psychological distress in linking childhood maltreatment and alcohol use in young adulthood

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents

BACKGROUND

Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts.

OBJECTIVE

The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents.

PARTICIPANTS AND SETTING

A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey.

METHODS

Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems.

RESULTS

CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives.

CONCLUSIONS

The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.

The Associations of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review

Introduction

Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years.

Methods

The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022.

Results

The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review.

Conclusion

This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.

Associations of childhood maltreatment with binge eating and binge drinking in emerging adult women

Background

Binge drinking and binge eating are prevalent, frequently co-occurring, high-risk behaviors among emerging adult women, each with physical and psychological consequences. The mechanisms driving their co-occurrence are not well understood, though a history of adverse childhood experiences (ACEs) may increase the risk for both binge behaviors.

Objective

To assess the association between ACE subtypes and individual and co-occurring binge drinking and eating in emerging adult women.

Participants and Setting

A diverse sample of women participating in the population-based study EAT 2018: Eating and Activity over Time (N = 788; aged 18-30; 19% Asian, 22% Black, 19% Latino, and 36% White).

Methods

Multinomial logistic regression estimated associations among ACE subtypes (i.e., sexual abuse, physical abuse, emotional abuse, household dysfunction), and binge drinking, binge eating, and their co-occurrence. Results are reported as predicted probabilities (PP) of each outcome.

Results

Over half of the sample (62%) reported at least one ACE. In models mutually adjusted for other ACEs, physical and emotional abuse showed the strongest associations with binge behaviors. Experiences of physical abuse had the strongest association with a ten-percentage point higher predicted probability of binge drinking (PP = 37%, 95% [CI 27-47%]) and seven-percentage point higher PP of co-occurring binge eating and drinking (PP = 12%, 95% CI [5-19%]). Emotional abuse had the strongest association with an 11-percentage point higher PP binge eating only (PP = 20%, 95% CI [11-29%]).

Conclusions

This study found childhood physical and emotional abuse to be particularly relevant risk factors for binge drinking, binge eating, and their co-occurrence among emerging adult women.

Do Coping Motives and Perceived Impaired Control Mediate the Indirect Links from Childhood Trauma Facets to Alcohol-Related Problems?

INTRODUCTION

The Self-Medication Hypothesis suggests that individuals drink to alleviate undesirable affective states. Behavioral Economics Theory states that individuals deprived of resources (i.e., physically neglected) consume more reinforcing substances when they are available than others. Childhood trauma may indirectly increase impaired control over alcohol (IC; drinking beyond one's own intentions) and thereby increase alcohol use and problems through the employment of coping-motives.

METHOD

A structural equation model that included sex as a covariate examined mediated paths with 612 university students.

RESULTS

Men were less likely to be emotionally abused and were more likely to use greater amounts of alcohol than women did. Physical neglect was directly linked to both more IC and alcohol use. Emotional and sexual abuse were directly linked to more coping motives. Both emotional and sexual abuse were indirectly linked to more alcohol use and its related problems through increased coping motives and IC.

CONCLUSIONS

Consistent with Behavioral Economics Theory, there was a direct link between physical neglect and IC. We also found partial support for the Self-Medication Hypothesis regarding the emotional and sexual abuse trauma dimensions; they indirectly contributed to alcohol use and its related problems via the mediating mechanisms of more coping motives and IC. Our findings suggest coping motives could be a therapeutic target for intervention among those sexually or emotionally abused.

The association between child maltreatment and problematic alcohol use in adulthood in a large multi-ethnic cohort: the HELIUS study

AIMS

There is evidence that child maltreatment is associated with problematic alcohol use later in life. However, previous epidemiological studies that have examined the link between child maltreatment and adult problematic alcohol use have not considered ethnic differences. Therefore, the purpose of the current study was to investigate the relationship between child maltreatment and adult problematic alcohol use among six ethnic groups in the Netherlands, in a large, urban sample.

METHODS

This study used baseline data from the Healthy Life in an Urban Setting (HELIUS) study: a large-scale, multi-ethnic prospective cohort study conducted in Amsterdam, the Netherlands. Child maltreatment, current problematic alcohol use and several potential confounders (e.g. parental alcohol use) were assessed in participants (N = 23 356) of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. With logistic regression analyses, we examined effect modification by ethnicity on the association between child maltreatment and problematic alcohol use. Furthermore, we explored effect modification by ethnicity for specific types of child maltreatment, namely: physical, sexual and psychological abuse and emotional neglect.

RESULTS

Effect modification by ethnicity was present. Stronger associations between child maltreatment and problematic alcohol use were found in all ethnic minority groups compared to the Dutch reference group. Particularly strong associations between all four types of child maltreatment and alcohol use problems were found for the Moroccan origin group.

CONCLUSIONS

This study adds to a growing body of evidence that child maltreatment is associated with problematic alcohol use in adulthood. In addition, our findings indicate that ethnicity impacts this relationship. Although problematic alcohol use was more prevalent in the Dutch origin group, associations with child maltreatment were stronger in ethnic minority groups. Future studies on child maltreatment and alcohol use problems should also examine ethnic disparities and should further unravel how these disparities can be explained.

Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care

Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.

Effects of multiple adverse childhood experiences on substance use in young adults: A review of the literature

BACKGROUND

Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood.

METHODS

This review describes research focused on the relationship between ACE and substance use among young adults. Two databases were searched for studies published from 1998 to 2021 that assess the relationship between ACE and substance use among young adults. Of the 1474 articles identified in the search, 43 met the inclusion criteria.

RESULTS

Consensus across reviewed studies is that the relationship between ACE and substance use demonstrated in the general adult population is evident in young adults, although effects varied by demographic variables such as gender and ethnic background.

CONCLUSIONS

The need for standardized measures across studies, racial/ethnic considerations, and the importance of building trauma informed prevention programs targeting this age group are discussed.

An Exploration of Practitioners' Perceptions and Beliefs About Trauma-Informed Youth Drug Prevention Programs: a Qualitative Study

Adverse childhood experiences (ACEs), such as childhood maltreatment and household dysfunction, have been linked to adolescent substance use. As a result, there exists a pressing need for trauma-informed, substance use preventive intervention for adolescents with a history of ACEs. The primary aim of this qualitative study is to increase our understanding of practitioners' perceptions of substance use among ACE-exposed youth and their views on trauma-informed adolescent substance use prevention programs. The present study conducted six focus groups (N = 32) among current child and adolescent health and human service providers in a mid-Atlantic urban area. The focus groups explored the practitioners' views on the main reasons that youth with a history of ACEs use illicit substances and suggestions on components, constructs, or techniques of trauma-informed substance use prevention programs and perceived barriers in implementing such programs. Transcripts of the focus groups were analyzed using open coding and subsequent axial coding, which was followed by thematic analysis. Thematic analysis identified ten themes within three categories, including the etiology of substance use among ACE-exposed youth, barriers to preventing substance use among ACEs-exposed youth, and suggested program components for trauma-informed prevention programs. These findings provide support for developing a preventive intervention that addresses trauma symptoms and overall skill buildings to prevent substance use among ACE-exposed youth. Teaching skills to cope with trauma symptoms, enhancing knowledge about the signs and symptoms of trauma, and improving key social and emotional learning competencies might be important and effective strategies to curb substance use among ACE-exposed youth.

Preventing E-cigarette use among high-risk adolescents: A trauma-informed prevention approach

Exposure to childhood trauma increases the risk of tobacco use during adolescence. Recent studies have also reported potentially increased vulnerabilities to electronic cigarette (e-cigarette) use among youth with a history of childhood trauma. While empirical evidence supporting the relationship between childhood trauma and adolescent e-cigarette use is emerging, few effective preventive interventions are available to curb e-cigarette use among adolescent victims of childhood trauma. This article reviews current evidence with respect to how childhood trauma could increase risk for nicotine dependence and e-cigarette use in adolescent populations. Furthermore, this paper describes the development, design, and implementation of Rise Above (RA), a randomized, controlled trial of a trauma-informed, e-cigarette preventive intervention. Lessons learned are also discussed, including the challenges of implementing evidence-informed prevention work within communities vulnerable to traumatic events.

Childhood maltreatment, motives to drink and alcohol-related problems in young adulthood

BACKGROUND

Young adults with a history of child maltreatment (CM) are often vulnerable to alcohol-related problems. Drinking motives have been widely studied to explain alcohol-related problems in young adulthood.

OBJECTIVES

The aims of the current study were to examine the link between CM and alcohol-related problems and to test whether CM is indirectly related to alcohol-related problems via different types of drinking motives.

PARTICIPANTS AND SETTING

Two hundred eight participants were recruited in a mid-Atlantic urban area (M age = 19.7, 78.4 % female) via advertisements placed throughout the community.

METHODS

Participants completed self-report measures of CM (Childhood Trauma Questionnaire), types of drinking motives (the Drinking Motives Questionnaire Revised Short Form), and alcohol-related problems (Rutgers Alcohol Problem Index). Structural equation modeling (SEM) was used to test whether CM was associated with alcohol use, both directly and indirectly, through drinking motives.

RESULTS

We found that both coping (β = 0.53,p < 0.001) and enhancement drinking motives (β = 0.15, p = 0.031) were associated with alcohol-related problems. Additionally, CM was related to alcohol-related problems indirectly via coping motive (β = 0.11, p = 0.028).

CONCLUSION

Young adults with a history of CM may use alcohol to cope with trauma-related negative emotionality. Targeting emotional distress in CM-exposed individuals may be helpful in preventing and treating alcohol-related problems in this vulnerable population.

Validation of the AUDIT scale and factors associated with alcohol use disorder in adolescents: results of a National Lebanese Study

BACKGROUND

This study objective was to evaluate the prevalence of alcohol use disorder (AUD) and related factors (smoking, internet addiction, social anxiety, child abuse, and bullying) among a representative sample of Lebanese adolescents, and to validate and confirm psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT).

METHODS

A cross-sectional study, conducted between January and May 2019, enrolled 1810 adolescents aged between 14 and 17 from schools of all Lebanese districts. From the total number of schools, a proportionate number was selected in each district. AUD was defined as a high AUDIT score (≥8; score range 0-40). A principal component analysis technique to confirm the validity of the construct of the AUDIT scale score was done and a confirmatory analysis to assess the structure of the instrument was conducted. Spearman correlation was used for linear correlation between continuous variables. The Mann-Whitney test was used to compare the means of two groups, while the Kruskal-Wallis test was used to compare three groups or more. A stepwise linear regression was conducted, taking the AUDIT total score as the dependent variable and taking child abuse (psychological, sexual, physical and verbal), cigarette and waterpipe smoking dependence, bullying, social phobia, and internet addiction as independent variables.

RESULTS

The mean AUDIT score was 6.46 ± 8.44 and high risk of AUD was found in 507 (28.0%) adolescents [95% CI 0.259-0.301]. One factor solution of the AUDIT scale was found after running the factor analysis (αCronbach = 0.978). Higher AUDIT scores were significantly associated with higher cigarette (Beta = 0.527; p < 0.001) and waterpipe (Beta = 0.299; p < 0.001) dependence, higher childhood sexual abuse (Beta = 0.656; p < 0.001) and neglect (Beta = 0.126; p < 0.001), higher bullying victimization (Beta = 0.236; p < 0.001).

CONCLUSION

Alcohol use disorder among Lebanese adolescents seems to be associated with several factors, such as cigarette and waterpipe dependence, parents' divorce, higher internet addiction, bullying victimization, and childhood sexual abuse and neglect. Parents and healthcare professionals could use this data for early interventions.

Childhood physical abuse and emotional neglect are specifically associated with adult mental disorders

Background: Childhood adversities and trauma (CAT) are associated with adult mental disorders. Nevertheless, although CAT of different domains mostly co-occurs, and co-morbidity is common, the associations between CAT and mental disorders, when taking these interrelations into account, are not well known.Aims: We aimed to study differential associations between the five core domains of CAT and current axis-I disorders, taking into consideration their interrelations.Methods: Four hundred and fifteen outpatients attending adult primary (n = 255) and psychiatric care (n = 160) were assessed with the Trauma and Distress Scale (TADS) and the Mini International Neuropsychiatric Interview (MINI). Associations between CAT core domains and diagnostic categories were examined by path analyses.Results: At least some infrequent experience of CAT (83.6%), mostly of neglect, and current mental disorders (49.4%), mostly depression, was frequent, as were co-morbidities and co-occurrence of CAT domains. Considering these interrelations in a path model of excellent fit, physical abuse predicted depressive, manic, psychotic and anxiety disorders, whereas emotional neglect predicted depressive, anxiety and substance misuse disorders.Conclusions: Of all five CAT core domains, physical abuse and emotional neglect had the strongest association with adult psychiatric disorders and might have transmitted earlier reported main effects of other CAT domains onto mental disorders.

Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015

Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.

Effect of childhood adversities on alcohol problems is mainly mediated by depression

BACKGROUND AND OBJECTIVES

We aimed to study how five childhood adversities and trauma (CAT) core domains: emotional abuse (EmoAb), physical abuse (PhyAb), sexual abuse (SexAb), emotional neglect (EmoNeg), physical neglect (PhyNeg), associate with alcohol problems (APs), and whether there are any gender differences in these associations.

METHODS

Altogether, 690 adult participants drawn from the general population completed a mailed questionnaire, including the trauma and distress scale, as an indicator of CAT, and questions concerning sociodemographic background, depressive symptoms, and APs.

RESULTS

In univariate analyses, male gender, middle age, divorced/separated marital status and lower education, frequency of use of alcohol, previous treatment for mental problems, as well as depressive symptoms and CAT domain scores were associated with APs. Of the CAT domains, females reported more EmoAb and SexAb than males, but there was no gender difference in other CAT domains and depressive symptoms. In multivariate analyses, when the effects of background characteristics were controlled, CAT sum and all its domains had indirect effects via depressive symptoms on APs with no significant direct effect except in females, in whom PhyAb and SexAb associated directly with APs even when the effects of other CAT domains were taken into account.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

All CAT domains associate extensively with APs. Generally, their effect on APs is mainly mediated via depressive symptoms. In females, PhyAb and SexAb also have a considerable direct effect on APs. In treating individuals with CAT experiences and alcohol problems, treatment of depression is also important. (Am J Addict 2018;XX:1-9).