An Exploratory Study of Rape Survivors' Prescription Drug Use As A Means of Coping With Sexual Assault

Motivations for Misusing Opioids Among African Americans

BACKGROUND

A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations.

METHODS

This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida.

RESULTS

Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia).

CONCLUSIONS

This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.

Correlates of Sexual Victimization Among Community College Women

The current study documents the correlates associated with the severity of sexual victimization among women enrolled in a 2-year community college. Comparisons between women with a history of severe sexual victimization (i.e., rape and attempted rape), moderate sexual victimization (i.e., unwanted contact and sexual coercion), and no history of sexual victimization revealed that women with a history of severe sexual victimization endorsed more drinks per week, increased problem drinking behavior, and more use of drug before sex and higher levels of self-protective dating behaviors compared with women with no history of sexual victimization. These findings suggest that programs should target the intersection of alcohol and drug use as correlates of sexual victimization among community college women.

The impact of exposure to physical and sexual violence on opioid consequences among trauma-exposed individuals recruited from the community who use opioids

Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the USA. The current study evaluated the consequences associated with opioid use (e.g., physical, social, interpersonal, intrapersonal, and impulse control) as a function of a history of exposure to interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of exposure to sexual violence in the context of opioid use disorder treatment.

An examination of associations between sexual assault and health problems, depression or suicidal ideation in a large nationally representative cohort of male and female 20-30-year-olds

BACKGROUND

A long line of research has examined whether being the victim of sexual assault is associated with negative and maladaptive outcomes, but has mainly focused on women and girls.

AIMS

To replicate and extend prior research by examining whether various measures of sexual assault are related to physical ill-health, depression and/or suicidal ideation, regardless of sex or age of victim. Our research questions were (1) is sexual assault related to health problems, depression and suicidal ideation and (2) do these associations differ between men and women?

METHOD

We analyse data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a longitudinal study of a US nationally representative sample of nearly 21,000 young people recruited for the first wave of interviews when most of the participants were between ages 12 and 18 years. We used Wave 4 data, collected for participants who were in their 20s and 30s, on experience of both physical sexual assault and non-physical sexual assault and mental state, allowing for some characteristics measured in Wave 1. Allowing for missing data, sample sizes were between 6868 and 10,489 for the women and 6024 and 10,263 for the men.

RESULTS

Statistically significant associations were revealed between the physical and non-physical measures of sexual assault and the health problems scale, the depression scale and the measure of suicidal ideation. These associations remained statistically significant even after controlling for key covariates measured at Wave 1, including exposure to delinquent peers, poverty and demographic characteristics.

CONCLUSIONS

Sexual assault at some time and of whatever kind, although more commonly reported by women than men, is similarly associated with serious physical and mental health problems during their 20s and 30s. More sequencing detail is required for better prevention of harms.

The Impact of Physical and Sexual Violence on Opioid Consequences among Trauma- exposed Individuals Recruited from the Community who Use Opioids

Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the United States. The current study evaluated the consequences associated with opioid use as a function of history of interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of sexual violence in the context of opioid use disorder treatment.

Blame Attributions in Multiple Perpetrator Rape Cases: The Impact of Sympathy, Consent, Force, and Beliefs

Victims of multiple perpetrator rape (MPR) have been found to be an especially vulnerable group. This study examined effects of MPR and perpetrators' use of force on attributions of victim and perpetrator blame. In two large experiments (total N = 2,928), Swedish community members read scenarios depicting an MPR and subsequently made several ratings of blame, rape myth acceptance (RMA), just world beliefs, sympathy for the victim, perception of consent, and trust in the legal system. Data were analyzed with a multianalytical approach using both analyses of variance as well as exploratory analyses. In Experiment 1, more blame was attributed to a victim of MPR than a victim of a lone perpetrator rape (LPR). In Experiment 2, no effect of used force was found on levels of attributed blame. In both experiments, hierarchical multiple regression analyses indicated that four components, identified through principal components analyses, explained substantial shares of the variance in both victim and perpetrator blame. The best individual predictors were participants' perception of consent, sympathy for the victim, and RMA. The study shows the importance of studying participants' beliefs and attitudes about rape and that victim-blaming research needs both theory development and greater methodological awareness. Implications for victim support services are also discussed.

Demedicalizing the Aftermath of Sexual Assault: Toward a Radical Humanistic Approach

An entrenched assumption in the mental health field is that if left “untreated” the aftermath of sexual assault will inevitably lead to some diagnosable form of emotional distress. This assumption has focused the search for pathology on individual survivors rather than systems and led to societal pressure for medical or psychotherapeutic treatment following unwanted sexual experiences in the United States and globally. Humanistic psychology is grounded in an existential phenomenological approach that privileges agency and a sociopolitical context of lived experience. As such, it has great overlap with the social justice mission of liberation psychology and is well equipped to respond to sexual assault survivors and the oppressive and patriarchal systems that perpetuate gender-based violence. This article explores the rising use of neoliberal medicalized frameworks to respond to sexual assault in therapy, analyzing both positive and negative aspects of medicalization. Implications for responses to the global prevalence of sexual violence are discussed. Suggestions for alternative epistemic and therapeutic approaches that can be used by humanistic psychologists and that aim to enhance an appreciation for the context of survivor’s experiences are provided.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault

INTRODUCTION

Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA.

METHODS

Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms.

RESULTS

Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs.

CONCLUSIONS

Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.

Responding to Delayed Disclosure of Sexual Assault in Health Settings: A Systematic Review

Few adolescent and adult women seek out formal support services in the acute period (7 days or less) following a sexual assault. Instead, many women choose to disclose weeks, months, or even years later. This delayed disclosure may be challenging to support workers, including those in health-care settings, who lack the knowledge and skills to respond effectively. We conducted a systematic literature review of health-care providers' responses to delayed disclosure by adolescent and adult female sexual assault survivors. Our primary objective was to determine how health-care providers can respond appropriately when presented with a delayed sexual assault disclosure in their practice. Arising out of this analysis, a secondary objective was to document recommendations from the articles for health-care providers on how to create an environment conducive to disclosing and support disclosure in their practice. These recommendations for providing an appropriate response and supporting disclosure are summarized.

Silenced suffering: the need for a better understanding of partner sexual violence

This article has two overall goals. First, to examine the current state of sexual violence research to highlight several shortcomings in the knowledge on partner sexual violence. Second, to describe several factors to consider in future research to facilitate a more in-depth understanding of partner sexual violence. Shortcomings of the research on partner sexual violence include (1) overreliance on dichotomous yes/no representations of sexual violence experiences; (2) lack of, or inadequate documentation of the scope and nature of partner sexual violence; (3) inadequate ways to account for impairment of consent under different circumstances; (4) difficulties in discriminating unwanted from nonconsensual sexual activities; and (5) limited information about the role sexual violence plays in the larger context of coercive control. In order to facilitate a more in-depth understanding of partner sexual assault, there is a need (1) to better understand the scope and nature of partner sexual assault and (2) to better understand the role partner sexual violence plays in coercive control. By improving the measurement of this phenomenon, victims, researchers, practitioners, and those involved in the justice system might be better equipped to respond to sexual violence among intimate partners.

The Non-Medical Use of Prescription Drugs and Lifetime Experiences of Sexual Victimization Among College Men

The non-medical use of prescription drugs (NMUPD) has been linked with many negative outcomes in previous studies. Recent literature has begun to examine the role of NMUPD among sexual victimization survivors. The present study examined the associations between NMUPD, recreational drug use, and experiences of sexual victimization among college men. Undergraduate men (n = 253) elected to take an online survey examining drug use and lifetime sexual victimization experiences. A total of 17% of the sample reported instances of being sexually victimized in their lifetime across four domains (being coerced, threatened, physically forced, or taken advantage of while incapacitated). Results indicate that, across all domains of sexual victimization, non-medical sedative use was robustly associated with sexual victimization in a multivariate model controlling for recreational drug use and demographics. No other non-medically used drug class (anxiolytics, pain medications, and stimulants) was associated with experiences of sexual victimization in the multivariate model. Results expand past literature by illustrating specific drug classes used by survivors of sexual victimization. Implications for interventions for male sexual victimization survivors are discussed.

Patterns of drug and alcohol use associated with lifetime sexual revictimization and current posttraumatic stress disorder among three national samples of adolescent, college, and household-residing women

Sexual revictimization (experiencing 2 or more rapes) is prevalent and associated with increased risk for posttraumatic stress disorder (PTSD) and substance use. However, no national epidemiologic studies have established the prevalence or relative odds of a range of types of substance use as a function of sexual victimization history and PTSD status. Using three national female samples, the current study examined associations between sexual revictimization, PTSD, and past-year substance use. Participants were 1763 adolescent girls, 2000 college women, and 3001 household-residing women. Rape history, PTSD, and use of alcohol, marijuana, other illicit drugs, and non-medical prescription drugs were assessed via structured telephone interviews of U.S. households and colleges in 2005-2006. Chi-square and logistic regression were used to estimate the prevalence and odds of past-year substance use. Relative to single and non-victims: Revictimized adolescents and household-residing women reported more other illicit and non-medical prescription drug use; revictimized college women reported more other illicit drug use. Past 6-month PTSD was associated with increased odds of drug use for adolescents, non-medical prescription drug use for college women, and all substance use for household-residing women. Revictimization and PTSD were associated with more deviant substance use patterns across samples, which may reflect self-medication with substances. Findings also could be a function of high-risk environment or common underlying mechanisms. Screening and early intervention in pediatric, primary care, and college clinics may prevent subsequent rape, PTSD, and more severe substance use.

The use of alcohol mixed with energy drinks and experiences of sexual victimization among male and female college students

Much research has documented negative associations with the consumption of alcohol mixed with energy drinks (AmED). To date, few research studies have examined the relation between AmED and sexual victimization. Furthermore, research on sexual victimization among men is less studied. The present study employed a sample of 253 men and 545 women to examine the differential associations between AmED consumption and sexual victimization as a function of gender. Results from this study suggest that AmED consumption is robustly associated with being sexually victimized among men, but not women. These results were robust while controlling for demographic factors and other substance use. Results add to the literature on sexual victimization by potentially identifying a new high-risk drinking behavior among males who have been sexually victimized.

Sexual victimization and anxiety and mood disorders: a case-control study based on the Danish registry system

Aims This study aimed to examine the relationship between rape and the subsequent psychiatric diagnosis of any anxiety or mood disorder.

METHOD

Data from the Danish Civil Registration System and the Danish Psychiatric Central Register were used to identify a sample of female victims who had visited a centre for rape victims during an index year and their subsequent psychiatric records were compared with a matched control group.

RESULTS

While controlling for demographic variables and previous psychiatric disorders, the effect of sexual victimization increased the likelihood of a subsequent diagnosis of an anxiety disorder but not a mood disorder.

CONCLUSION

Sexual victimization significantly increases the likelihood of experiencing an anxiety disorder, and therefore victims require post-assault information and support.

Adolescent Sexual Assault and the Medical and Nonmedical Use of Prescription Medication

Previous research has documented an association between sexual victimization and prescription medication use among adults. The purpose of this study was to determine whether such a relationship was present for adolescent girls when considering sexual victimization by a peer and the use of four drug classes for medical and nonmedical reasons. The study was based on a secondary analysis of a cross-sectional Web-based, self-administered survey of female students from a middle and high school (n = 490). As predicted, sexual victimization increased the likelihood of non-medical prescription medication use of opioid analgesics and sedative medication, although these relationships varied based on the severity of sexual assault. Findings are discussed in light the importance of increasing awareness among health professionals, researchers, and the wider community of the increased risk for prescription medication abuse among adolescent girls who have a history of sexual violence.

Family structure as a risk factor for women's sexual victimization: a study using the Danish registry system

This study estimated the risk of sexual victimization associated with different family structures. Based on the Danish Civil Registration System, all female visitors to the Centre for Rape Victims (CRV) at the University Hospital in Aarhus, during a two-year period (January 2005 to December 2006) were identified (N = 214) along with a control group (N = 4,343) that was matched by age and residential location. The family structure in the preceding year was used as a predictor variable in a logistic regression model. Results indicted that, compared to those who were married with children at home, being single with children at home significantly increased the likelihood of having visited the CRV. This is consistent with the research literature that has shown that single women with children are at risk for disadvantage on a range of socioeconomic and psychological factors as well as at risk for interpersonal violence.

Motivations for non-medical prescription drug use: a mixed methods analysis

Despite a dramatic increase in the nonmedical use of prescription drugs among illicit drug users, their motives for abusing prescription drugs are still largely unknown. The objective of this study was to (a) determine the motivations for engaging in the nonmedical use of prescription opioids and sedatives among street-based illicit drug users, methadone maintenance patients, and residential drug treatment clients; (b) examine associations between prescription drug abuse motivations and gender, age, race/ethnicity, and user group; and (c) examine associations between specific motivations and prescription drug abuse patterns. Quantitative surveys (n = 684) and in-depth interviews (n = 45) were conducted with a diverse sample of prescription drug abusers in South Florida between March 2008 and November 2009. The three most common motivations reported were "to get high," "to sleep," and "for anxiety/stress." There were age, race/ethnicity, and gender differences by motives. Prescription drug abuse patterns were also found to be associated with specific motivations. Although additional research is needed, these findings serve to inform appropriate prevention and treatment initiatives for prescription drug abusers.

General Practice Utilization After Sexual Victimization: A Case Control Study

There is a growing research literature that indicates that sexual victimization results in increased physical health problems and health service utilization. This study aimed to examine the relationship between attendance at a center for rape victims and frequency of contact with general practitioners. The study used matched case-control design, and information about general practitioner use over a 7-year period was drawn from the Danish Civil Registration System. There was a sustained increase in health care use for those who had used the center for rape victims compared to the control group.

Mental health and rape history in relation to non-medical use of prescription drugs in a national sample of women

The current study examined prevalence and correlates of non-medical use of prescription drugs (NMUPD), with particular emphasis on lifetime history of rape and PTSD as risk associates. Interviews conducted via telephone using Computer-Assisted Telephone Interviewing technology, resulting in a nationally representative sample of 3001 non-institutionalized, civilian, English or Spanish speaking women (aged 18-86 years) residing in households with a telephone. Demographic characteristics, rape history, general health/mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had misused a prescription drug. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set then entered into final multivariable logistic regression to determine significant predictors of past-year NMUPD. NMUPD was endorsed by 5.5% of the sample (n=164). Final multivariable model showed that Lifetime Posttraumatic Stress Disorder, other forms of substance use/abuse, and a history of drug or alcohol facilitated rape were significantly associated with increased likelihood of NMUPD. Risk reduction efforts targeting non-medical prescription drug use among women who have experienced traumatic events and/or abuse substances are warranted. Trauma-focused interventions for drug or alcohol facilitated rape victims should include treatment or prevention modules that specifically address NMUPD.