Interrelationships between victimization experiences and women's alcohol use

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Traumatic Stress-Induced Vulnerability to Addiction: Critical Role of the Dynorphin/Kappa Opioid Receptor System

Substance use disorders (SUD) may emerge from an individual’s attempt to limit negative affective states and symptoms linked to stress. Indeed, SUD is highly comorbid with chronic stress, traumatic stress, or post-traumatic stress disorder (PTSD), and treatments approved for each pathology individually often failed to have a therapeutic efficiency in such comorbid patients. The kappa-opioid receptor (KOR) and its endogenous ligand dynorphin (DYN), seem to play a key role in the occurrence of this comorbidity. The DYN/KOR function is increased either in traumatic stress or during drug use, dependence acquisition and DYN is released during stress. The behavioural effects of stress related to the DYN/KOR system include anxiety, dissociative and depressive symptoms, as well as increased conditioned fear response. Furthermore, the DYN/KOR system is implicated in negative reinforcement after the euphoric effects of a drug of abuse ends. During chronic drug consumption DYN/KOR functions increase and facilitate tolerance and dependence. The drug-seeking behaviour induced by KOR activation can be retrieved either during the development of an addictive behaviour, or during relapse after withdrawal. DYN is known to be one of the most powerful negative modulators of dopamine signalling, notably in brain structures implicated in both reward and fear circuitries. KOR are also acting as inhibitory heteroreceptors on serotonin neurons. Moreover, the DYN/KOR system cross-regulate with corticotropin-releasing factor in the brain. The sexual dimorphism of the DYN/KOR system could be the cause of the gender differences observed in patients with SUD or/and traumatic stress-related pathologies. This review underlies experimental and clinical results emphasizing the DYN/KOR system as common mechanisms shared by SUD or/and traumatic stress-related pathologies, and suggests KOR antagonist as a new pharmacological strategy to treat this comorbidity.

Rape Acknowledgment and Sexual Minority Women's Mental Health and Drinking Behaviors

Adult sexual assault (ASA) has been linked to numerous negative psychological and behavioral outcomes. Recent research suggests that postassault adaptation may differ based on how the victim conceptualizes their ASA. For instance, women who label their rape experiences as such (i.e., acknowledged rape victims) report worse mental health symptoms than women who do not (i.e., unacknowledged rape victims). To date, this literature has focused exclusively on heterosexual women. Relative to heterosexuals, sexual minority women (SMW) are at greater risk for sexual assault and report worse postassault outcomes, yet little is known about rape acknowledgment in this at-risk population. Moreover, it is unclear how distal factors, such as childhood sexual abuse (CSA), may influence SMW's rape acknowledgment following ASA. A total of 205 self-identified lesbian and bisexual women were categorized into four groups (no ASA, ASA that did not involve rape, rape acknowledged, rape unacknowledged) and compared across mental health and drinking outcomes. Roughly, 42% of the sample experienced rape, and of those, 60% were acknowledged rape victims. Results revealed no statistical differences between acknowledged and unacknowledged rape victims in terms of mental health or alcohol use. However, relative to comparison groups, SMW who were acknowledged rape victims reported greater mental health symptoms, and both acknowledged and unacknowledged rape victims reported greater hazardous drinking. Among SMW with rape histories, greater CSA severity increased the probability of acknowledging rape. These findings provide valuable information regarding SMW's postassault adaptation and can contribute to interventions to assist SMW who experience sexual assault.

Quality of life improvement in Latinas receiving combined substance use disorders and trauma-specific treatment: a cohort evaluation report

BACKGROUND

This study evaluates the benefits of integrating behavioral health and trauma services for Latinas with a history drug use. Changes in quality of life (QOL) domains were documented after participation in a manualized intervention in a cohort of Latinas.

METHODS

Participants were part of a prospective cohort study of 136 Latinas with co-occurring disorders (COD) who may have experienced trauma and receiving services in our outpatient treatment facility in Bayamón, Puerto Rico. The WHOQOL-BREF Spanish version was used to score physical, psychological, social, and environmental QOL domains, at intake and after six months. Sociodemographic variables, alcohol, drug use, mental health disorders, and severity of substance use disorders (as defined by the DSM-5) were also tabulated. Descriptive statistics and paired t test or the Wilcoxon signed-rank test were computed for comparison.

RESULTS

A median age of 39 years was seen and with 76% high school education or higher degree. The majority were unemployed (95.9%). A diagnosis of severe cocaine use (51.4%) was present and almost half (49.5%) had three or more DSM-5 diagnoses. Mean QOL scores were higher at six months with statistically significant differences in each domain. Women with neurodevelopmental disorders and schizophrenia yielded higher mean QOL scores for each domain at six months except for the social domain. Women with polydrug use and women who reported exposure to trauma and depressive disorder experienced statistically significant increments in the physical, psychological and social domains in comparison to counterpart women.

CONCLUSIONS

Significant and positive changes in QOL were found in each domain. Latinas who reported traumatic events had lower scores in the physical and psychological QOL domains. There was a high prevalence of diminished physical and mental functioning in Latinas with COD. The exposure to trauma and the lack of social support negatively affect treatment access and retention for Latinas.

Parental divorce and initiation of alcohol use in early adolescence

Parental divorce/separation is among the most commonly endorsed adverse childhood events. It has been shown to increase subsequent risk of alcohol dependence and problems across adolescence and early adulthood, but its influence on early stages of alcohol involvement has only recently been explored. In the present study, we examined whether time to first full drink was accelerated among youth who experienced parental divorce/separation. To determine specificity of risk, models controlled for perceived stress as well as family history of alcoholism, current parental drinking, and internalizing and externalizing problems. Developmental specificity in terms of timing of both parental divorce and first drink was also examined. Participants were 931 middle-school students (488 girls, 443 boys) who were enrolled in a prospective study on drinking initiation and progression (52% female; 23% non-White, 11% Hispanic). Students indicated whether and at what age they had consumed a full drink of alcohol. Parental divorce/separation was coded from a parent-reported life-events inventory and was grouped based on age experienced (ages 0-5, ages 6-9, age 10+). Cox proportional hazard models showed increased risk for onset of drinking as a function of divorce/separation, even controlling for stress, parental alcohol involvement, and psychopathology. There was no evidence for developmental specificity of the divorce/separation effect based on when it occurred nor in timing of first drink. However, the effect of parental divorce/separation on initiation was magnified at higher levels of parental drinking. Given the rates of parental divorce/separation and its association with increased risk of early drinking, investigation of the mechanisms underlying this link is clearly warranted. (PsycINFO Database Record

The Relationship Between Parents' Violence Against Daughters and Violence by Other Perpetrators

This article examines the links between violence perpetrated by parents and subsequent victimization in a sample of 510 Italian women attending different health and social services, using both quantitative and qualitative data. Almost one quarter of the respondents reported some kind of abuse by one or both parents, fathers' violence being more common than mothers'; 9.6% had suffered subsequent sexual violence, and 18.2% had experienced partner violence. Violence by one or both parents during childhood—especially mothers' violence—was associated with an increased risk of suffering from sexual violence and from partner violence.

Trauma Exposure and Alcohol Use in Battered Women

The purpose of the present study was to examine the relationship between battering severity and alcohol use among battered women. The study used multiple regression analyses to examine predictive relationships between three forms of trauma exposure—childhood physical and sexual abuse and domestic violence—and alcohol use. This study is among the first to investigate these relationships, using a sample of 78 battered women drawn from both shelter and nonresidential community agencies. Both battering severity and childhood sexual abuse were positively correlated with alcohol use. Multiple regression analysis showed that childhood sexual abuse was the stronger predictor when collinearity was controlled.

Correlates of Poverty and Partner Abuse Among Women on Methadone

This study explores the association between poverty and experiences of partner abuse among 204 women recruited from methadone maintenance treatment programs. Logistic regressions were used to examine the associations between extreme poverty and indicators of partner abuse. The findings show that extreme poverty was prevalent and associated with partner abuse. The study findings suggest that providers of methadone maintenance programs need to incorporate poverty indicators in their assessment because extreme poverty seems to correlate with all forms of partner abuse. The impact of welfare reform on partner violence should be on the agendas of policy makers and researchers.

Bar Victimization of Women

Little is known about the types and specific circumstances that surround the victimization of women who drink in the public context of bars. This study provides a preliminary description of the types of violence experienced by women bar drinkers and the roles of exposure and impairment as risk factors for encountering bar-related aggression. Both quantitative and qualitative data were collected from 52 women bar drinkers through self-administered questionnaires and focus-group discussions about their lifestyles, alcohol and drug use, and patterns of bar drinking. Nearly half of the women (48.1%) had experienced physical violence (e.g., assault) and one third (32.6%) had experienced either attempted or completed rape associated with drinking in a bar. Our findings indicate that women who regularly drink in bars experience a substantial amount of physical and sexual aggression associated with these settings.

Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study

Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RR Total Effect = 2.75, 95% CI: 2.19-3.10), an 89% increased risk of being unhealthy (RR Total Effect = 1.89, 95% CI: 1.47-1.99), and a 42% increased risk of having a low level of well-being in adulthood (RR Total Effect = 1.42, 95% CI: 1.29-1.52). Social support and behavioral factors mediate 11-18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.

Examining the Role of Antisocial Personality Disorder in Intimate Partner Violence Among Substance Use Disorder Treatment Seekers With Clinically Significant Trauma Histories

This study examined the associations among posttraumatic stress disorder (PTSD) symptom severity, antisocial personality disorder (ASPD) diagnosis, and intimate partner violence (IPV) in a sample of 145 substance abuse treatment-seeking men and women with positive trauma histories; sex was examined as a moderator. ASPD diagnosis significantly predicted both verbal and physical aggression; sex moderated the association between ASPD diagnosis and physical violence. PTSD symptom severity significantly predicted engaging in verbal, but not physical, aggression. Overall, these results suggest that an ASPD diagnosis may be an important risk factor for engaging in IPV among women seeking treatment for a substance use disorder.

Longitudinal Associations among Discordant Sexual Orientation Dimensions and Hazardous Drinking in a Cohort of Sexual Minority Women

We examined differences between sexual minority women's (SMW's) sexual identity and sexual behavior or sexual attraction as potential contributors to hazardous drinking across a 10-year period. Data are from a longitudinal study examining drinking and drinking-related problems in a diverse, community-based sample of self-identified SMW (Wave 1: n = 447; Wave 2: n = 384; Wave 3: n = 354). Longitudinal cross-lagged models showed that SMW who report higher levels of identity-behavior or identity-attraction discordance may be at greater risk of concurrent and subsequent hazardous drinking. Results of multigroup models suggest that sexual orientation discordance is a more potent risk factor for risky drinking outcomes among SMW in older adulthood than in younger adulthood. Findings support that discordance between sexual orientation dimensions may contribute to hazardous drinking among SMW and provide evidence that cognitive-behavioral consistency is important for individuals expressing diverse and fluid sexual identities, attraction, and behavior.

A longitudinal analysis of drinking and victimization in college women: is there a reciprocal relationship?

The purpose of the current study was to assess the relationship between drinking and severe physical and sexual victimization in a sample of 989 college women over 5 years. Participants completed a Web-based survey each fall semester, beginning as first-time incoming freshman, and continuing each year for 5 years. The survey was comprehensive in assessing drinking, victimization, and relevant covariates. Women were followed whether they remained at university or not. Prior year same type of severe victimization predicted current year victimization, both severe physical and sexual. However, prior year drinking did not predict current year severe victimization. Prior year severe sexual victimization predicted current year drinking. Our findings of a longitudinal relationship between severe sexual victimization and subsequent increases in drinking suggests that college women may be drinking to cope with negative sequelae that they experience as a result of the victimization. We did not find the same longitudinal relationship between drinking and severe physical or sexual victimization, suggesting that a reciprocal relationship does not exist between drinking and victimization among college women. We did find that severe sexual victimization decreased across college, suggesting that the year prior to and the first year of college may be a critical period for intervening to reduce risk for severe victimization.

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

OBJECTIVES: The aim of the study is to determine the relationship between of the problem of alcohol abuse and child maltreatment. METHOD: The ACE study was administered by the University Clinic of Psychiatry, Department for Child and Adolescent Psychiatry. The ACE study used a representative sample of students in year four of secondary school (aged 18 and above) and first- and second-year university students. The sample consisted of 664 secondary school students (258 males and 406 females.The university student sample consisted of 613 (343 female and 270 male) students from four universities. The data were obtaining by applying ACE Study Questionnaires.RESULTS: Individuals who experience psychological abuse are more prone to develop alcoholism. One of the most serious risk factors for abuse and neglect of children was alcoholism, as a form of household dysfunction. Overall, 13.4% of students lived with someone who misused alcohol. Overall, 10.7% lived with someone who was alcoholic. The association to each ACE was highest among respondents who grew up with two alcohol-abusing parents compared with persons with no alcohol-abusing parents. The health-risk behaviours of most concern included among the others alcohol use (by 82.2% of students). Alcohol use is widespread among students and its prevalence rate is almost 28% by both sexes, and they start drinking at the age of 14–15.CONCLUSION: Among the most frequent household dysfunctions was alcohol use by a family member and about 82% of respondents had ever used alcohol.

Sexual assault risks among gay and bisexual men

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men-and the potential benefits of focusing on alcohol consumption in risk reduction efforts.

The role of alcohol use during sexual situations in the relationship between sexual revictimization and women's intentions to engage in unprotected sex

Research has demonstrated relationships among childhood sexual abuse, adult sexual assault, and sexual risk taking. This study proposes that one mechanism through which the victimization-sexual risk-taking relationship works is through an increased likelihood of drinking during sexual situations. Using path analysis, this study explores this hypothesis in a sample of 230 women. The model illustrates that women with a history of child and adult sexual victimization reported greater intentions to engage in unprotected sex and that this relationship is in part accounted for by an increased likelihood of drinking in sexual situations. The results suggest that sexual risk reduction programs and sexual assault treatment programs should educate women about the alcohol-involved sexual risk taking that often follows sexual assault victimization.

Childhood abuse and neglect and transitions in stages of alcohol involvement among women: a latent transition analysis approach

BACKGROUND

Childhood abuse and neglect have been linked with alcohol disorders in adulthood yet less is known about the potential of early trauma to influence transitions in stages of alcohol involvement among women. Study aims were to (1) identify stages of women's alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions.

METHODS

The sample consisted of 11,750 adult female current drinkers identified in Wave 1 (2001-2002) and re-interviewed in Wave 2 (2004-2005) of the National Epidemiological Survey on Alcohol and Related Conditions.

RESULTS

Three stages of alcohol involvement emerged from latent class analysis of 11 DSM-IV abuse/dependence criteria: severe (1.5% at Wave 1, 1.9% at Wave 2), hazardous (13.6% at Wave 1, 16.0% at Wave 2), and non-problem drinking (82.1% at Wave 1, 84.5% at Wave 2). Adjusted latent transition analyses determined transition probabilities between stages across waves. Women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe (AOR=3.90, 95% CI=1.78-8.53) and hazardous (AOR=1.56, 95% CI=1.22-2.01) drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage.

CONCLUSIONS

Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in women's alcohol involvement.

Intimate partner violence outcomes in women with PTSD and substance use: a secondary analysis of NIDA Clinical Trials Network "Women and Trauma" Multi-site Study

Studies have shown strong associations between intimate partner violence (IPV) and both posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Despite these linkages, research on the dual diagnosis of PTSD-SUD and its relationship to IPV is in an early stage, and little is known about how PTSD-SUD treatment might influence IPV outcomes. The current study is a secondary analysis of a larger NIDA Clinical Trials Network study exploring the effectiveness of two behavioral interventions for women with comorbid PTSD-SUD. Participants (n=288) were randomly assigned to Seeking Safety (SS), a cognitive-behavioral treatment that focuses on trauma and substance abuse symptoms, or to Women's Health Education, a psychoeducational group. Logistic regressions were used to examine how treatment condition, identified risk factors and their interactions were related to IPV. Results showed that participants who were abstinent at baseline were significantly less likely to experience IPV over the 12-month follow-up period, whereas participants living with someone with an alcohol problem were significantly more likely to experience IPV over follow-up. Findings also showed that at a trend level participants with recent interpersonal trauma at baseline and higher total of lifetime trauma exposures were more likely to report IPV during follow-up. Although there was no main effect for treatment condition, a significant interaction between treatment condition and baseline abstinence was found. Participants who were abstinent at baseline and in the SS condition were significantly less likely to report IPV over follow-up. These findings indicate that an integrated treatment for PTSD and SUD was associated with significantly better IPV outcomes for a subset of individuals. The possibility that women with PTSD-SUD may differentially benefit from SS has important clinical implications. Further research examining the intersection of PTSD, SUD and IPV, and the impact of treatment on a range of outcomes is needed.

Sexual victimization and associated risks among lesbian and bisexual women

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.

Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment

Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.

The role of alcohol consumption in female victimization: findings from a French representative sample

Alcohol is frequently related to interpersonal aggression, but information regarding the role of alcohol consumption by victims of severe aggression is however lacking. In order to better understand the dynamic of victimization, we investigated contextual, facilitator, and psychological impact variables related to victimization in a French sample composed of 1,033 females aged 18-74 years. The participants were recruited using quota sampling methodology, and responses were measured using Computer-Assisted Self-Interviewer. A logistic regression was conducted using a backward elimination procedure to identify the significant predictors of blows and wounds suffered in the past 24 months. The results indicated that victims, relative to nonvictims, did binge drink significantly more often, had a higher aggression trait, and had experienced more social hardships in the past. The study's limitations are noted.

Cumulative abuse: do things add up? An evaluation of the conceptualization, operationalization, and methodological approaches in the study of the phenomenon of cumulative abuse

For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.

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.

Sexual victimization and health-related indicators among sexual minority men

This study reports rates of childhood and adult sexual victimization among a community sample of 634 gay and bisexual-identified men, and examines how men with differing sexual victimization histories compare on a number of health-related outcomes. Results indicate that men with histories of childhood and adult sexual victimization are more likely to report substance use, more lifetime STIs, higher sexual compulsivity scores, and greater gay-related stigma scores than men with no histories of sexual victimization. Few differences are found in comparisons of health outcomes based on age at first sexual victimization (childhood vs. adulthood). Furthermore, men with histories of sexual victimization report healthier coping skills than men with no histories of sexual victimization, but no significant group differences are found in social support or stress-related growth. Findings underscore the importance of assessing lifetime sexual victimization among sexual minority men during counseling, with special attention given to the enhancement of protective factors among those at risk for harmful behaviors and subsequent poor health outcomes.

Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Child physical and sexual abuse: a comprehensive look at alcohol consumption patterns, consequences, and dependence from the National Alcohol Survey

BACKGROUND

Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample.

METHODS

This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures.

RESULTS

Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (OR(adj) = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (OR(adj) = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (OR(adj) = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (OR(adj) = 3.5; 95% CI 2.6 to 4.8) and dependence (OR(adj) = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse.

CONCLUSION

Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting.

Sexual victimization in female and male college students: examining the roles of alcohol use, alcohol expectancies, and sexual sensation seeking

Alcohol and alcohol expectancies relate to sexual victimization. The present study examined these links in a sample of 407 predominantly Hispanic male and female college students, along the Mexico-US border. The study also examined the independent contribution of sexual sensation seeking to the prediction of victimization. Results showed that victimization was associated with alcohol risk, alcohol consumption-related problems, and positive alcohol expectancies. Importantly, sexual sensation seeking independently predicted victimization and did so after controlling for alcohol risk and expectancies. Our results suggest that associations among victimization, alcohol risk, and expectancies generalize to Hispanic women and men. The study's limitations are noted.

Trauma and substance use disorders in rural and urban veterans

CONTEXT

Disparities in the prevalence, morbidity, and mortality of multiple mental health conditions have been described between rural and urban populations. However, there is limited information regarding differences in exposure to trauma and trauma-related mental health conditions in these populations. Given the number of veterans who are returning to rural communities after serving in Operation Enduring Freedom and Operation Iraqi Freedom, differences in trauma exposure are of particular relevance. Trauma exposure is related to a variety of mental health disorders including substance use disorders (SUD).

PURPOSE

The objectives of this preliminary study were to describe lifetime military and nonmilitary trauma and to compare trauma history between rural and urban veterans in SUD treatment.

METHODS

Sixty adults in SUD treatment were enrolled at 3 Veterans Health Administration sites in Nebraska over a 3-month period in 2008. Subjects completed an interview with study staff, which assessed SUD diagnoses and childhood, lifetime, and military trauma. Rural or urban status was determined by self-report of childhood residence. Childhood trauma, lifetime trauma, and response to military trauma were compared between rural and urban veterans.

FINDINGS

Although there were no significant differences in trauma exposure between rural and urban groups, there was an association between specific types of trauma and measures typically associated with increased substance abuse severity and poorer SUD treatment outcome.

CONCLUSION

This is the first study, to our knowledge, which compared trauma exposure between rural and urban veterans and identified an association between childhood trauma exposure and multiple SUD treatment attempts.

Impact of adolescent exposure to intimate partner violence on substance use in early adulthood

OBJECTIVE

Youth exposure to intimate partner violence has been theorized to increase the risk of adverse outcomes in adulthood including substance-use problems. However, the limited research on the association between early exposure to intimate partner violence and later alcohol- or drug-use problems is inconclusive. Using a prospective design, this study investigates whether adolescent exposure to intimate partner violence increases the risk for problem substance use in early adulthood and whether this relationship differs by gender.

METHOD

The study uses a subsample (n = 508) of participants from the Rochester Youth Development Study, a longitudinal study of urban, largely minority adolescents that oversampled youth at high risk for antisocial behavior and drug use. Logistic regression analyses were conducted to assess whether adolescent exposure to intimate partner violence predicted increased odds of four indicators of problem substance use in early adulthood, controlling for parental substance use, adolescent maltreatment, and sociodemographic risk factors.

RESULTS

Exposure to severe intimate partner violence as an adolescent significantly increased the odds of alcohol-use problems in early adulthood for young women (odds ratio = 5.63, p < .05) but not for young men. Exposure to intimate partner violence did not increase the odds of other substance-use indicators for either gender.

CONCLUSIONS

Girls exposed to intimate partner violence may be at increased risk for problems with alcohol use in adulthood and should be a target for prevention and intervention efforts. Overall, however, the association between exposure to intimate partner violence and later substance-use problems is less than anticipated in this high-risk community sample.

Barriers and facilitators for alcohol treatment for women: are there more or less for rural women?

Among women at-risk for problems drinking, treatment seeking can be hindered by a complex array of issues such as a lack of transportation, social stigma, denial, fear of losing children, and reluctance of primary care physicians to refer women. This study describes the barriers/facilitators and need for treatment among a community sample of rural and urban women at-risk drinkers. Data for this study were assembled from the baseline sample of individuals who participated in a large probability sample of rural and urban at-risk drinkers (N = 733) from six Southern states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, and Tennessee. Men and women differed on perceived barriers/facilitators and need for alcohol treatment. Women differed from men on measures of treatment affordability, accessibility, acceptability and report of social support, illness severity, comorbidities, and demographic characteristics. Rural women differed from urban women on measures of treatment affordability and accessibility and report of illness severity and comorbidities.

Childhood trauma in substance use disorder and depression: an analysis by gender among a Brazilian clinical sample

OBJECTIVE

In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses.

METHODS

The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the "Childhood Trauma Questionnaire."

RESULTS

A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men.

CONCLUSION

Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment.

Childhood sexual abuse, post-traumatic stress disorder, and use of heroin among female clients in Israeli methadone maintenance treatment programs (MMTPS)

This study investigated association between post-traumatic stress disorder (PTSD) and a 1-year follow-up heroin use among female clients in methadone clinics in Israel. Participants were 104 Israeli female clients from four methadone clinics (Mean age = 39.09, SD = 8.61) who reported victimization to childhood sexual abuse. We tested traces in urine of these female clients for heroin a year preceding and a year following the assessment of their PTSD. Results show that 54.2% reported symptoms that accedes the DSM-IV criteria for PTSD. We found that among childhood victimized women PTSD is associated with more frequent use of heroin at a 1-year follow-up even after controlling for duration of the stay at the clinic, background, other traumatic experiences and heroin use a year prior the assessment of their PTSD. This study shows the potential long-run negative consequences of childhood sexual abuse. Not only are these sexually abused women trapped into drug dependence and addiction, they cannot break the vicious cycle of continuing the use of illicit drugs even when treated for their addiction. One major practice implication is that treatment for PTSD proven efficacious will be provided in the methadone and other drug treatment services.

Predictors of alcohol and drug problems in rural African American women

African American women report less alcohol and other drug (AOD) use than Caucasian women. However, health care professionals cannot afford to dismiss AOD use as significant problems for some African-American women. Although we know much more about AOD problems in women in general, we still lack information about AOD disorders and associated factors among rural African American women. Stepwise multiple regression was used to identify the best predictors of alcohol and drug problems among 142 rural African American women who took part in a study of risk factors for AOD disorders in rural women.

Intimate partner violence among Asian immigrant communities: health/mental health consequences, help-seeking behaviors, and service utilization

Intimate partner violence (IPV) is a serious epidemic among Asian immigrant communities. Yet little is known about the scope, nature, and related contextual, cultural, and social factors of IPV among this population. In particular, the lack of research has been evident in examining health and mental health outcomes of IPV and service utilization, revealing notable gaps in health disparities which result in a failure to provide relevant services and law enforcement protection for battered Asian immigrant women. This article examines critically the growing body of literature on IPV among Asian immigrant populations in several areas: (a) the context of IPV: cultural, social, and individual/familial, (b) prevalence of IPV, (c) physical health and increased risk for sexually transmitted disease and HIV/AIDS, (d) mental health consequences and substance use, (e) social support and help-seeking behaviors, and (f) barriers to service utilization. Future directions for practice, policy, and research are discussed.

Disentangling the complex association between childhood sexual abuse and alcohol-related problems: a review of methodological issues and approaches

This review describes and evaluates methodological approaches aimed at unraveling the association between childhood sexual abuse (CSA) and later misuse of alcohol, which is complicated by the significant overlap between factors that elevate risk for CSA exposure and those that increase risk for problem alcohol use. We critique methods used to distinguish direct effects of CSA events on alcohol-related outcomes from the effects of risk factors frequently present in families in which CSA exposure occurs (e.g., parental alcohol-related problems). These methods include measurement and adjustment for potentially confounding factors and the use of co-twin designs. The findings across methodological approaches provide support for a CSA-specific risk for alcohol misuse, despite the significant contribution of family background factors to overall risk, but much work remains to be done before a comprehensive model for this association can be proposed. Additional directions for research, including the incorporation of measured genes and the use of longitudinal designs, are proposed to further efforts to model the pathways from CSA to alcohol-related problems.

Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies.