Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Giving Voice to Women with Substance Use Disorder: Findings from Expressive Writing About Trauma

Background

Trauma exposure is a risk factor for substance use disorders (SUD) among women. This study explores written content from an expressive writing (EW) intervention conducted within a residential SUD program to examine themes across trauma experiences and characterize their deep insight into such experiences.

Materials and Methods

This qualitative study is a secondary data analysis of written content of the first writing session from women (n = 44) randomized to an EW condition while in residential SUD treatment.

Results

Nearly all participants (72.7% African American; mean age 37.3 years) reported a significant trauma event (93.2%) with an average of 3.7 types of trauma events (54.4% had a current posttraumatic stress disorder diagnosis). Four primary themes emerged: (1) trauma across the lifespan; (2) loss of safety; (3) altered self-concept; and (4) desire to move on. Most participants identified interpersonal trauma, especially at an early age, as well as parental neglect and physical and/or sexual violence. These themes indicate a pattern of interpersonal betrayal and paint a picture of trauma and the subsequent "rippling effect" such that the physical, mental, and emotional consequences were often as impactful as the event itself. However, there was also a desire to move on and gain a sense of normalcy.

Conclusions

Findings highlight the importance of the written word and addressing underlying trauma in addiction treatment to facilitate healing and the woman's desire to move on.

Polyvictimization and Psychological Outcomes Among North Korean Refugee Women

Korean refugee women are at risk of multiple violent victimizations throughout the migration phases. However, migration's association with mental health outcomes has received little scholarly attention. This study examined North Korean refugee women's exposure to polyvictimization-exposure to both gender-based violence (GBV) and intimate partner violence (IPV)-and explored whether polyvictimization is associated with an increased risk of psychological symptoms. Data from a snowball sample of 212 North Korean refugee women were analyzed. Polyvictimization was operationalized as No victimization (0), Only GBV (1), Only IPV (2), and Both GBV and IPV (3). The associations between polyvictimization and depression, suicidal ideation, suicide attempt, and alcohol use disorder were analyzed with multivariate analyses. Results demonstrated that 46.2% experienced GBV in either North Korea or intermediary countries, and 30.9% were victims of IPV from their current intimate partner in South Korea. Approximately 25% were victims of both GBV and IPV. Multivariate analyses revealed that GBV was the most critical factor for mental health outcomes. North Korean refugee women with only GBV or GBV and IPV had significantly higher depressive symptoms and suicidal ideation severity than those without violence victimization. Risk of suicide attempt was also significantly higher among those with only GBV (OR = 16.52, p = .015) or both GBV and IPV (OR = 9.96, p = .048) than those without any violence victimization. Implications for future research and interventions among North Korean refugee women are also discussed.

A longitudinal analysis on determinants of problem drinking among Korean women: focusing on a gender perspective

Background

In recent years, female drinking has been on the rise worldwide, and this trend can be observed in Korea as well. Accordingly, this study aimed to examine the heterogeneous longitudinal changes in drinking patterns among Korean women, while also exploring the determinants of these changes. In particular, the study identified the gender perspective-related determinants of the classified patterns of problem drinking.

Methods

Data on 4615 adult women who participated in the Korea Welfare Panel Study (KOWEPS) for 3 years (2018–2020) were analyzed longitudinally using SPSS Statistics 22.0 and M-plus 7.0. The changes in female drinking patterns were analyzed using latent class growth analysis. Subsequently, multinomial logistic regression analysis was performed to identify the predictive factors affecting the changes in drinking patterns.

Results

Latent class analysis yielded three classes: “low problem drinking/decreased,” “moderate problem drinking/maintained,” and “high problem drinking/increased.” Of the participants, 80.4% were in the first class, 14.5% in the second, and 5.1% in the third. After controlling for sociodemographic and psychosocial factors, we found: i) domestic violence, work–family balance stress, and gender role perception were not statistically significant for the “moderate problem drinking/maintained” class; lower levels of depression (odds ratio; OR = .750, p < .05) and higher levels of satisfaction with social relationships (OR = 1.257, p < .05) increased the probability of belonging to the “moderate problem drinking/maintained” group compared to the low problem drinking/decreased class; ii) in the “high problem drinking/increased” class, relative to the low problem drinking/decreased class, experience of domestic violence (OR = 1.857, p < .05), work–family balance stress (OR = 1.309, p < .05), and gender role perception (OR = .705, p < .05) were significant predictors of drinking behavior.

Conclusions

Problem drinking in Korean women demonstrated heterogeneous patterns of change, with gender-specific factors being the main predictors of this change. Therefore, this study developed a strategy for reducing the harmful effects of female drinking, which considers the characteristics of the changes in women’s drinking patterns as well as factors from the gender perspective.

Identification of Domestic Violence Service Needs Among Child Welfare-Involved Parents With Substance Use Disorders: A Gender-Stratified Analysis

The current study examined the prevalence and associations of a need for domestic violence services among child welfare-involved mothers and fathers with substance use disorders. Data were drawn from 2,231 child welfare-involved parents in Illinois with an identified substance use disorder. Approximately 42% of mothers and 33% of fathers with a substance use disorder had a concurrent need for domestic violence services. The sample was stratified by gender and logistic regression models were fit to determine the adjusted odds of an identified need for domestic violence services. For both mothers and fathers, the strongest association was an additional need for mental health services. Age, education status, alcohol use, marijuana use, and a reported history of physical violence victimization were also associated with a need for domestic violence services among mothers, while race, age, marital status, annual income, alcohol use, cocaine use, and a reported history of physical violence perpetration were associated with a need for domestic violence services among fathers. The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare-involved parents with identified substance use disorders, and that associations with this need vary by gender.

Dimensions of childhood trauma and their direct and indirect links to PTSD, impaired control over drinking, and alcohol-related-problems

INTRODUCTION

Post-Traumatic Stress Disorder (PTSD) develops after experiencing events that evoke fear, helplessness, or horror. The Hyperarousablity Hypothesis suggests that those with PTSD may drink more to dampen physiological reactivity. We examined the direct and indirect relationships between childhood trauma (e.g., physical-neglect, emotional-abuse, physical-abuse, sexual-abuse) versus an emotionally-supportive-family on PTSD, impaired control over drinking (IC), alcohol-use, and alcohol-related-problems. IC reflects consuming more alcohol than one originally intended.

METHODS

We fit a multiple-group SEM to data on 835 participants. Mediational analyses were conducted by using the (K = 20,000) bootstrap technique with confidence intervals.

RESULTS

Physical-neglect was directly linked to more IC among both genders. Emotional abuse was also found to be directly linked to more PTSD among both genders. Furthermore, PTSD was directly linked to more impaired control over alcohol use (IC) among both genders. Mediational analyses showed that physical-neglect was indirectly linked to more alcohol-related-problems through increased IC. Having an emotionally supportive family was directly linked to fewer PTSD symptoms among women. For both genders, emotional abuse was indirectly linked to more alcohol-related-problems through more PTSD symptoms, impaired control over alcohol use difficulties, and in turn, more alcohol-use. Sexual abuse was indirectly linked to increased alcohol-related- problems through increased PTSD symptoms and more IC, and in turn, more alcohol-use among men.

CONCLUSIONS

Recalled childhood trauma (sexual and emotional abuse) may contribute to PTSD symptoms and dysregulated drinking. In conclusion, our data suggest that reducing PTSD symptoms may assist individuals in regaining control over their drinking.

One size doesn't fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway

BACKGROUND

For persons with substance use disorders (SUDs), 12-step groups (TSGs) are the most available and used peer-based recovery resource, worldwide. However, disengagement is common, and attrition may partly be due to practices and procedures within these groups that are unacceptable to a portion of the population with SUDs. Our overall aim was to identify problematic issues related to Narcotics Anonymous (NA) participation in Norway, to inform addiction professionals' strategies when referring persons to addiction-related self-help groups (SHGs).

METHODS

In this qualitative study, we interviewed ten individuals who had previously participated regularly in NA for at least 6 months, to examine their reasons for disengagement. We interpreted the interviews using thematic analysis.

RESULTS

We identified three themes: (1) 'The model did not fit', either the strategies utilized in NA (e.g., meeting format and step working) or NA's explanatory model of addiction, (2) 'Negative experiences spurred frustration', and (3) 'The safe place can become a cage'. The respondents believed that a main aim of recovery was reintegration into society, such that SHG participation should not be an end goal, but rather a platform for normalization back into society. Despite their negative experiences and strong critique, respondents still regarded NA as a valuable recovery resource, but pointed out that one size does not fit all.

CONCLUSION

Addiction professionals should recognize possible problems related to TSG participation, to help prevent negative experiences and possible harms to individuals. Professionals should also inform individuals about alternative support groups, to help them find the recovery resource best suited to them.

Posttraumatic stress disorder symptoms, relationship quality, and risky alcohol use among trauma-exposed students

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for alcohol use disorder (AUD), in part due to the use of alcohol as a coping strategy. High quality romantic relationships can buffer individuals against risk for psychopathology; however, no studies have evaluated romantic relationship quality in risk for PTSD-AUD in non-clinical samples. The current study examined the main and interactive effects of PTSD symptoms and romantic relationship quality on alcohol consumption (i.e., past 30-day alcohol use quantity, frequency, and binge frequency) and alcohol-related consequences in a sample of 101 college students (78.2% women) with a history of interpersonal trauma (i.e., physical/sexual assault, excluding intimate partner violence) who reported being in a romantic relationship. Relationship quality significantly moderated the association between PTSD symptom severity and alcohol use quantity (B = -0.972, p = .016) and alcohol-related consequences (B = -0.973, p = .009), such that greater PTSD symptoms were associated with greater alcohol use quantity and consequences among those low, but not high, in relationship quality. The interaction between PTSD symptom severity and relationship quality in relation to binge drinking was marginally significant (B = -0.762, p = .063), and relationship quality did not significantly moderate the association between PTSD symptom severity and alcohol use frequency. The main effect of PTSD symptom severity was significantly associated with alcohol-related consequences, but no other alcohol outcomes; the main effect of relationship quality was not associated with alcohol use outcomes or consequences. High quality romantic relationships may serve as a buffer for young adults at risk for alcohol problems.

Clinical Trials for Stimulant Use Disorders: Addressing Heterogeneities That May Undermine Treatment Outcomes

In recent years, use of cocaine and amphetamines and deaths associated with stimulants have been on the rise, and there are still no FDA-approved medications for stimulant use disorders. One contributing factor may involve heterogeneity. At the neurobiological level, dual dopamine dysfunction may be undermining medication efficacy, suggesting a need for combination pharmacotherapies. At the population level, individual variability is expressed in a number of ways and, if left unaddressed, may interfere with medication efficacy. This chapter reviews studies investigating medications to address dopamine dysfunction, and it also identifies several prominent heterogeneities associated with stimulant (and other substance) use disorders. The chapter has implications for improving interventions to treat stimulant use disorders, and the theme of individual heterogeneity may have broader application across substance use disorders.

Exposure to Violence and Substance Use Treatment Outcomes Among Female Patients

BACKGROUND

Many female substance use patients have experienced violence in the past, with most estimates showing the majority of patients reporting violent experiences at some point. Prior experience with violence has been linked to increased severity of substance use, and this may contribute to more challenges in the path to recovery.

OBJECTIVES

Existing research has confounded the timing at which violence has occurred with the type of violence to which patients have been exposed. The current study was conducted to specify the extent to which the timing of exposure and the type of violence were associated with substance use after discharge from treatment.

METHODS

Data were collected from 3,439 female patients included in the Comprehensive Assessment and Treatment Outcome Research (CATOR) system.

RESULTS

With regard to the type of exposure, findings indicated female patients who were exposed to multiple forms of violence (i.e. physical and sexual) displayed the greatest severity of substance use upon treatment initiation, as well as the greatest likelihood for use following discharge from treatment. In terms of the timing, female patients who experienced violence at various time points (i.e. before and after 18 years of age) displayed the greatest severity of substance use, but patients who experienced violence after 18 years of age had the highest probability of substance use following discharge from treatment. Conclusions/Importance: Clinicians should collect information related to these important details as treatment protocols are developed, and as patients are connected to aftercare services to minimize post-treatment substance use.

Emotional, physical and sexual abuse are associated with a heightened limbic response to cocaine cues

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.

Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study

OBJECTIVE

To examine whether trauma and posttraumatic stress disorder (PTSD) are differentially associated with binge and hazardous patterns of drinking among women and men.

METHODS

Secondary analysis of the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); the analytic sample included 31,487 respondents (54.6% female) without past-year alcohol abuse/dependence. Participants' trauma-exposure/PTSD status was characterized as: no exposure to trauma in lifetime (reference), lifetime trauma exposure, PTSD before past-year, or past-year PTSD. Past-year binge and hazardous drinking were examined with multinomial logistic regression models (past-year abstinence was modeled as the non-event); models included the main effects of trauma-exposure/PTSD status and gender, the trauma-exposure/PTSD status-by-gender interaction, psychiatric comorbidity, and socio-demographic covariates.

RESULTS

The gender-specific effects of trauma, before past-year PTSD, and past-year PTSD were significantly elevated for all drinking behaviors in women (range of odds ratios (ORs) = 1.8-4.8), and for some drinking behaviors in men (range of ORs = 1.3-2.0), relative to no trauma exposure. Trauma exposure was more strongly associated with high-frequency binge drinking, low-frequency binge drinking, and non-binge drinking among women as compared to men. Past-year PTSD was also more strongly associated with low-frequency binge drinking and non-binge drinking among women compared to men. Findings for hazardous drinking followed a similar pattern, with significant gender-related differences in ORs for hazardous drinking and non-hazardous drinking observed with respect to trauma exposure and past-year PTSD..

CONCLUSION

Mental health practitioners should be mindful of the extent to which trauma-exposed individuals both with and without PTSD engage in binge and hazardous drinking, given the negative consequences associated with these patterns of drinking..

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

BACKGROUND AND OBJECTIVES

This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment.

METHODS

Alcohol-dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly 1 year after discharge.

RESULTS

Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning 1 year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes.

Invited commentary: disclosure of gender-based violence in developing countries

The evolving concept of gender-based violence (GBV) is a multifaceted issue of public health significance. Until recently, most studies examining GBV have been conducted in North America. In this issue of the Journal, Palermo et al. (Am J Epidemiol. 2014;179(5):602-612) report their secondary analyses involving approximately 300,000 women from 24 developing countries who participated in Demographic and Health Surveys between 2004 and 2011. The focus of their article is on the prevalence and determinants of disclosure of GBV to formal authorities, including health care or legal professionals, police, and nongovernmental organizations. Their results indicate a wide gap between prevalence of GBV (40%) and GBV disclosure (7%), implying an underestimation of GBV that ranges from 11- to 128-fold, depending on the region and type of reporting. The extent of underreporting of GBV also varied according to personal characteristics such as age, marital status and urban or rural residence. GBV has been linked to a myriad of health problems, and it has been shown that health care utilization is considerably higher among women who have experienced GBV. Primary and secondary prevention efforts should continue to target GBV, and creative ways of addressing GBV nondisclosure should take into account regional variations and personal characteristics of affected women.

The role of illicit substance use in a conceptual model of intimate partner violence in men undergoing treatment for alcoholism

Illicit substance use (ISU) predicts intimate partner violence (IPV) above and beyond alcohol use and other known IPV correlates. Stuart and colleagues (2008) provided evidence for a theoretical framework by which ISU contributes both directly and indirectly to IPV. We sought to replicate and extend their findings using data from 181 married or cohabiting heterosexual couples in which the male had recently begun a substance abuse treatment program and met criteria for alcohol dependence (97%) or abuse (3%). Using SEM, we found that (a) Stuart et al.'s model provided a good fit to the data; (b) men's cocaine use and women's sedative use emerged as particularly relevant to their respective perpetration of IPV; (c) a positive association between men's antisociality and physical aggression was mediated by increased stimulant use; and (d) the specific pattern of IPV predicted by women's sedative use differed across levels of aggression severity. These findings not only highlight the direct role of ISU in relationship aggression, but also support a larger theory-driven model comprising various proximal and distal precursors of IPV.

Childhood adversity, serotonin transporter (5-HTTLPR) genotype, and risk for cigarette smoking and nicotine dependence in alcohol dependent adults

BACKGROUND

This study examined the extent to which cigarette smoking and nicotine dependence in adults with alcohol dependence (AD) are associated with adverse childhood experiences. Gender, social support, and an allelic variant in the gene encoding the serotonin transporter (5-HTTLPR) were examined as moderators of this relationship.

METHODS

The Semi-Structured Assessment for the Genetics of Alcoholism - Version II (SSAGA-II) was used to assess DSM-IV diagnoses and cigarette smoking characteristics as well as traumatic life events and social support during childhood in 256 AD men (n=149) and women (n=107).

RESULTS

An increase in number of adverse childhood events was associated with heightened risk of cigarette use and nicotine dependence. 5-HTTLPR genotype, gender, and social support did not significantly moderate the relationships among childhood adversity and ever-smoking or nicotine dependence.

CONCLUSIONS

Results extend previous findings to suggest that childhood adversity is strongly related to risk for ever-smoking and nicotine dependence in AD individuals. Additional research is needed to examine other potential genetic and environmental moderators and mediators of the relationships among smoking, alcohol use, and childhood trauma.

Gender differences in trauma history and symptoms as predictors of relapse to alcohol and drug use

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.

Exposure to traumatic events among treatment-seeking, alcohol-dependent women and men without PTSD

The authors examined lifetime exposure to a range of traumatic events in 106 abstinent, treatment-engaged (85% residential; 15% outpatient), alcohol-dependent women (n = 53) and men without current or lifetime posttraumatic stress disorder. Alcohol-dependent women reported greater severity of childhood trauma, but similar lifetime exposure to traumatic events compared with men. Alcohol-dependent women without cocaine abuse or TB (n = 10) reported greater severity of childhood trauma than women with (n = 43), and men with (n = 21) or without (n = 32) cocaine abuse or dependence. Results extend previously observed gender differences in trauma histories among alcohol-dependent adults and point to potential gender- and substance-specific drug co-addiction effects that may have been influenced by trauma exposure.

What are the needs of alcohol dependent patients with a history of sexual violence? A case-register study in a metropolitan region

BACKGROUND

Sexual violence has become increasingly apparent as a factor determining more complex treatment needs in patients with substance abuse. However, empirical evidence on specific patterns of differences between patients with and without a history of sexual violence is scarce.

METHODS

Our sample consisted of alcohol dependent outpatients treated during a two-year period in a German metropolitan region. The analysis was based on a local case register and included all patients for whom information on lifetime sexual violence was available (N=1981; 33.4% female). In a case-control design, patients with a history of sexual violence were compared to patients without such experiences regarding a wide range of clinical and social factors indicative of potential needs.

RESULTS

More than 35% of the female patients and 6% of the male patients reported a history of sexual violence. Victims differed from non-victims across a variety of domains, including psychiatric symptoms and suicide attempts, legal problems, financial and family problems, previous use of services, and need for additional services during the current treatment. Patient gender emerged as a significant moderator of several of these associations.

CONCLUSIONS

The findings indicate that an effort needs to be made to link addiction treatment, other parts of the health care system, and further institutions, such as family services and parts of the legal system, so that the complex needs of this vulnerable population can be met in an adequate way.

A randomized trial of individual and couple behavioral alcohol treatment for women

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH).

History of physical or sexual abuse and participation in 12-step self-help groups

OBJECTIVES

Although 12-step groups are an important resource for managing substance use problems, their efficacy for patients with a physical or sexual abuse history is unknown.

METHODS

In the present study, patients with a history of physical or sexual (n = 122) or no (n = 143) abuse were interviewed at entry to outpatient substance use treatment at the Veterans Administration.

RESULTS

After adjusting for baseline substance use, physical or sexual abuse was associated with more attendance at and involvement in 12-step groups. Participation in 12-step groups predicted abstinence at one year, regardless of abuse history.

CONCLUSIONS

Limitations and implications are discussed.

Posttraumatic stress disorder, alcohol use, and physical health concerns

PTSD is a risk factor for alcohol problems and both in turn have been independently associated with increased health problems. However, it is unclear whether alcohol use moderates the relationship between PTSD and health. Participants were battered women (N = 336) recruited from local domestic violence shelters and non-shelter victim-assistance agencies. A 2 (PTSD diagnosis) x 3 (abstainer, infrequent/light, regular/heavy drinking) ANCOVA was conducted, with injuries and length of abuse as covariates and health concerns as the dependent variable. Main effects for PTSD and alcohol use were significant but not the interaction. Women with PTSD reported the greatest number of health concerns. Women who abstained from drinking and those who drank regularly/heavily reported more health concerns than the infrequent/light drinkers. Health concerns associated with PTSD do not appear to be due to problem drinking. In addition, infrequent/light drinking, even for women with PTSD, may be associated with fewer health concerns.

Women's childhood and adult adverse experiences, mental health, and binge drinking: the California Women's Health Survey

BACKGROUND

This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.

MATERIALS AND METHODS

Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.

RESULTS

The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood.

CONCLUSION

Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.

Lifetime physical and sexual abuse and substance use treatment outcomes in men

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.

Lifetime exposure to potentially traumatic events in a sample of alcohol-dependent patients in Poland

Recent studies show a high prevalence of traumatic events in samples of patients with a substance use disorder. In the present study, the lifetime exposure to potentially traumatic events (PTEs) was estimated in a sample of 458 patients recruited at 17 randomly chosen alcohol-dependence treatment units in the public healthcare sector in Poland. Eighty percent of the patients reported a history of at least one potentially traumatic event. Sixty percent of them reported experiencing more than one probable trauma. However, only the patients who experienced physical assault reported worse clinical severity in posttraumatic stress and alcohol-use related symptomatology. The findings confirm the importance of trauma assessment in alcohol-dependent patients and the inclusion of trauma-related issues in the treatment of alcohol dependence.

Policy on reintegration of women with histories of substance abuse: a mixed methods study of predictors of relapse and facilitators of recovery

Background

The predominant U.S. policy approach toward individuals with substance abuse problems has relied on stigma and punishment by withholding access to education, cash assistance, housing, social support, and normal social roles. In contrast to this approach, the theory of reintegrative shaming asserts that providing individuals with the opportunity to reconnect with society is more effective in reducing potential to relapse to crime and drug abuse. Strategies that promote such reconnection include expanding access to basic needs and supportive relationships along with increasing opportunities to fully participate in mainstream social roles.

Methods

The present cross-sectional study examined the predictors of relapse and the facilitators of recovery in a sample of 325 women with histories of substance abuse. Analysis of secondary data, collected as part of a national cross-site study, employed a mixed methods approach conducting (1) logistic regression to examine the predictors of relapse and (2) an inductive qualitative analysis of responses from open-ended items to explore the women's perceptions of barriers to and facilitators of recovery.

Results

Results suggest that lower levels of instrumental support, affective support, and participation in normal roles (such as parent, employee, student, and citizen) are significant predictors of relapse to drug use and criminal behaviors. Qualitative findings support the quantitative results, revealing that participating women perceived the variables of support and role participation as critical in facilitating their recovery. They also noted the importance of individual characteristics such as optimism and strength and emphasized the significance of their relationship with their children in motivating them to avoid relapse. Findings suggest that punitive policies toward women with substance abuse histories may be ineffective.

Conclusion

The author concludes that current policies designed to withhold access to basic needs such as housing, education, cash assistance, and positive relationships may deprive women with histories of substance abuse of the means to reconnect with society. Policies that promote access to basic needs and offer avenues for women to participate in normal societal roles should be more fully explored.

The impact of early trauma and abuse on residential substance abuse treatment outcomes for women

This study examines the impact of early abuse on the functioning and the 12-month treatment outcomes of 146 homeless addicted women who entered residential substance abuse treatment. Sixty-nine percent of the women reported exposure to childhood physical, sexual, or emotional abuse; the majority reported multiple forms of abuse. Comparisons of abused and nonabused women revealed significant differences in childhood, adolescent, and adult functioning, indicative of the pervasive detrimental effects of early abuse. Female survivors of childhood abuse did not improve in treatment as much as their nonabused peers in psychological functioning (p < .001), substance abuse (p < .01), or continuing trauma exposure (p < .01) . The findings suggest the importance of adapting models of residential substance abuse treatment to address concurrent issues related to trauma history. Additional research is needed to identify effective integrated treatment approaches for this population and to explore the independent and interconnected pathways linking trauma history and outcome.

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

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

Childhood abuse and intake severity in alcohol disorder patients

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.

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

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

Predisposing and Precipitating Factors for Suicide Among Alcoholics: Empirical Review and Conceptual Integration

Alcohol dependence is a potent risk factor for suicide. Accordingly, alcoholics should be targeted in suicide prevention efforts. This article reviews the literature on suicide among alcoholics and provides a model that may inform research, clinical work, and prevention efforts. In this model, we propose that aggression/impulsivity, severe alcoholism, negative affect, and hopelessness are key predisposing factors for suicide among alcoholics. We propose that major depressive episodes and stressful life events, particularly interpersonal difficulties, are key precipitating factors. We also integrate these constructs in a model that proposes that many acts of suicide among alcoholics may be viewed as acts of reactive aggression executed in the midst of distress over a lost or threatened relationship. Empirical evidence for the model is discussed along with its limitations. The next generation of research on alcoholism and suicide should include a focus on the interpersonal anlage of suicide in this population.

Seeking Safety Plus Exposure Therapy: An Outcome Study on Dual Diagnosis Men

This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues include self-harm, suicidality, perpetration of violence against others, and HIV risk behaviors. This study appears to be the first outcome trial to address a sample of civilian men with PTSD and SUD using manualized psychosocial treatment. It evaluates a novel combination treatment, Seeking Safety plus Exposure Therapy-Revised. The former is a coping skills treatment designed for PTSD and SUD; the latter is an adaptation of Foa's exposure therapy, modified for PTSD and SUD. In this small sample (n = 5) outpatient pilot trial, patients with current PTSD and current SUD were offered 30 sessions over five months, with the option to select how much of each type of treatment they preferred. Outcome results showed significant improvements in drug use; family/social functioning; trauma symptoms; anxiety; dissociation; sexuality; hostility; overall functioning; meaningfulness; and feelings and thoughts related to safety. Trends indicating improvement on 11 other outcome variables were also found. Treatment attendance, satisfaction, and alliance were extremely high. The need for further evaluation using more rigorous methodology is discussed.

Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes

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.

Psychiatric Comorbidity in Treatment-Seeking Alcoholics: The Role of Childhood Trauma and Perceived Parental Dysfunction

BACKGROUND

This study among treatment-seeking alcoholics examined the relationship between childhood abuse (sexual abuse only [CSA], physical abuse only [CPA], or dual abuse [CDA]) and the presence of comorbid affective disorders, anxiety disorders, and suicide attempts, controlling for the potential confounding effects of other childhood adversities (early parental loss, witnessing domestic violence, parental alcoholism, and/or dysfunction) and adult assault histories.

METHOD

We assessed 155 (33 females, 122 males) treatment-seeking alcoholics using the European Addiction Severity Index, the Structured Trauma Interview, and the Composite International Diagnostic Interview.

RESULTS

The severity of childhood abuse was associated with posttraumatic stress disorder (PTSD) and suicide attempts in females and with PTSD, social phobia, agoraphobia, and dysthymia in males. Among men, multiple logistic regression models showed that CPA and CDA were not independently associated with any of the examined comorbid disorders or with suicide attempts. However, CSA independently predicted comorbid social phobia, agoraphobia, and PTSD. For the presence of comorbid affective disorders (mainly major depression) and suicide attempts, maternal dysfunctioning was particularly important. CSA also independently contributed to the number of comorbid diagnoses. For females, small sample size precluded the use of multivariate analyses.

CONCLUSION

Childhood abuse is an important factor in understanding clinical impairment in treated alcoholics, especially regarding comorbid phobic anxiety disorders, PTSD, and suicidality. These findings underline the importance of routine assessment of childhood trauma and possible trauma-related disorders in individuals presenting to alcohol treatment services. More studies with bigger samples sizes of female alcohol-dependent patients are needed.

Alcohol misuse by women

Alcohol misuse among women is an important and growing problem. There is epidemiological and metabolic evidence that risk factors for and consequences of alcohol misuse are significantly different for women than for men. Understanding these differences is imperative if effective preventative and treatment interventions are to be undertaken. This article reviews the epidemiology of alcohol misuse by women, effects of alcohol misuse on women, fetuses, and relationships, and assessment and treatment strategies. We then suggest directions for future research in this field.

Self-Perceived Effects of SEXUAL TRAUMA Among Women Who Smoke Crack

This descriptive study examined how Black women who smoke crack cocaine spoke about their experiences of sexual trauma, drug use, and the implications of these experiences for their lives. The authors also explored whether the women's perceptions of the effects of sexual abuse were related to objective indicators of mental health and drug use. The most commonly reported effects of sexual trauma were feeling dirty or ashamed or blaming self, having negative feelings toward the perpetrator, experiencing a general dislike of men or sex, and reporting a conscious reluctance to cope with the incident. In addition, conscious or unconscious denial of the effects of sexual trauma was associated with use of drugs to cope with intrapersonal and interpersonal feelings, inwardly directed responses to the trauma (e.g., self-blaming, feeling ashamed) were positively related to depression, and outwardly directed responses to the trauma (e.g., anger at the perpetrator) were positively related to self-esteem. These findings are discussed in terms of their implications for the self-medication model of substance use, treatment implications for women who have been sexually abused, and the role of self-perception in the relationship between sexual trauma and long-term outcomes.

History of abuse and drinking outcomes following inpatient alcohol treatment: a prospective study

Little is known about the impact of sexual or physical abuse history on response to alcohol treatment. This prospective study investigated the relationships between sexual and physical abuse histories, participants' characteristics, and response to inpatient alcohol treatment. Forty-one women and 59 men were assessed monthly for 1 year following hospitalization for alcohol dependence. Survival analyses showed that sexual abuse history was associated with shorter times to first drink and relapse. Physical abuse history was not associated with poorer drinking outcomes. Although women were more likely than men to have a history of sexual abuse, no gender differences were found in drinking outcomes. Poorer drinking outcomes were found among participants who at baseline were not married, had less than a college education, were not employed full time, or carried a diagnosis of depression or other psychiatric disorder. When adjusted for these characteristics, the associations between sexual abuse history and times to first drink and relapse were no longer statistically significant. While sexual abuse history is a clinically meaningful predictor of return to drinking we note the importance of considering patients' background and clinical characteristics in examining the impact of sexual abuse history on drinking outcomes following treatment.

Correlates of received and expressed violence persistence following substance abuse treatment

This study examined different types of violence (i.e. 'expressed' towards others and 'received' from others) across different relationship types (i.e. 'partners' and 'non-partners') among men and women in substance abuse treatment, and during a 2-year follow-up period. For received violence, participants were divided into three groups: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Similarly, participants also were divided into three groups based on expressed violence: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Both expressed and received violence (either before or after treatment) was associated with younger age. Unique demographic markers of received violence included being female, reporting less income and greater unemployment. For both received and expressed violence, several problem severity indicators (e.g. drug consequences, psychological distress) and psychosocial relapse risk indicators (e.g. resource needs, substance-using leisure activities) differentiated those who reported violence (either before or after treatment) and those who did not report violence. In addition, received violence was related to greater exposure to substances whereas expressed violence was related to greater cocaine use and craving. Continued received and expressed violence post-treatment was related to substance use during the follow-up, recruitment from inpatient treatment, and baseline psychological distress (expressed violence only). The results are consistent with contemporary models of violence specifying the impact of substance use, social/contextual and individual difference factors, and highlight risk factors that could be targeted during treatment to potentially reduce post-treatment substance use and violence.