Exploring the nature of the relationship between child sexual abuse and substance use among women

AIMS: This study investigated whether child abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. DESIGN: The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. SETTINGS: Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. PARTICIPANTS: Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counseling services and medial advertising. MEASUREMENTS: The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. FINDINGS: There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among abused CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. CONCLUSIONS: The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.     

Morphology and cytochemistry of acute lymphoblastic leukaemia

A total of 88 consecutive new women patients were surveyed on an adult psychiatric inpatient unit which did not have a specific program for the treatment of alcoholics. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the Michigan Alcoholism Screening Test (MAST) than those with no such history. Former drinkers and teetotalers were more likely to have been both physically and sexually abused than the others. Thirty-three patients (38%) reported a history of alcohol problems measured by scores of seven or more on the MAST, but only 20 had a diagnosis of alcohol abuse or alcohol dependence made by a psychiatrist.     

Personality profiles, dissociations, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse.

Women reporting either repressed, recovered, or continuous memories of childhood sexual abuse or no abuse history completed questionnaires tapping personality traits, absorption (fantasy proneness), dissociation, depression, and posttraumatic stress. Planned contrasts indicated that recovered memory participants scored higher on absorption and dissociation than did those reporting either continuous memories or no abuse history; repressed memory participants scored nonsignificantly higher than did recovered memory participants. On measures of distress, continuous memory participants were indistinguishable from nonabused participants, repressed memory participants scored highest, and recovered memory participants scored midway between continuous and repressed memory participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trail making test performance in Vietnam combat veterans with and without posttraumatic stress disorder

The present study investigated variables associated with performance on the Trail Making Test from the Halstead-Reitan neuropsychological test battery in Vietnam combat veterans. There was a significant difference in performance between veterans with and without PTSD on both parts of the Trail Making Test. In subgroup analyses excluding participants on medications (antianxiety, antidepressant, and cardiac), comorbid diagnoses (history of alcohol or substance abuse, history of major depression and comorbid anxiety disorder) and compensation-seeking status, the group difference on Trails B remained significant. However, subgroup analyses suggested that poorer performance on Trails A was influenced by antianxiety and cardiac medications, as well as heavy combat exposure status.     

Intercessory prayer in the treatment of alcohol abuse and dependence: a pilot investigation

OBJECTIVE: To conduct a pilot study of the effect of intercessory prayer on patients entering treatment for alcohol abuse or dependence. DESIGN: In addition to standard treatment, 40 patients admitted to a public substance abuse treatment facility for treatment of alcohol problems who consented to participate were randomized to receive or not receive intercessory prayer (double-blind) by outside volunteers. Assessments were conducted at baseline, 3 months, and 6 months. RESULTS: No differences were found between prayer intervention and nonintervention groups on alcohol consumption. Compared with a normative group of patients treated at the same facility participants in the prayer study experienced a delay in drinking reduction. Those who reported at baseline that a family member or friend was already praying for them were found to be drinking significantly more at 6 months than were those who reported being unaware of anyone praying for them. Greater frequency of prayer by the participants themselves was associated with less drinking, but only at months 2 and 3. CONCLUSION: Intercessory prayer did not demonstrate clinical benefit in the treatment of alcohol abuse and dependence under these study conditions. Prayer may be a complex phenomenon with many interacting variables.     

Clinically Abusive Relationships in an Unselected Birth Cohort: Men's and Women's Participation and Developmental Antecedents.

In an unselected birth cohort (N=980, age 24-26 years), individuals in abusive relationships causing injury and/or official intervention (9% prevalence) were compared with participants reporting physical abuse without clinical consequences and with control participants who reported no abuse, on current characteristics and prospective developmental risks. In nonclinically abusive relationships, perpetrators were primarily women. In clinically abusive relationships, men and women used physical abuse, although more women needed medical treatment for injury. Women in clinically abusive relationships had childhood family adversity, adolescent conduct problems, and aggressive personality; men had disinhibitory psychopathology since childhood and extensive personality deviance. These findings counter the hibitory assumption that if clinical abuse was ascertained in epidemiological samples, it would be primarily man-to-woman, explained by patriarchy rather than psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholism and drug abuse in three groups--bipolar I, unipolars and their acquaintances

OBJECTIVE: Previous work has shown that manic-depressive illness and alcohol abuse are linked. This study further explores the relationship of alcohol and drug abuse in bipolar I patients and unipolar depressives and a comparison group obtained through the acquaintance method. METHOD: Diagnosis was accomplished according to Research Diagnostic Criteria (RDC): controls = 469; bipolars = 277; unipolar depressives = 678. Systematic data were gathered using the SADS on lifetime and current drug abuse and alcoholism. Both patients and comparison subjects were then followed prospectively for 10 years. First degree family members were interviewed using the RDC family history method. RESULTS: The group of bipolar patients and the group of unipolar patients had higher rates of drug and alcohol abuse than the comparison group when primary and secondary affective disorder patients were combined. However, primary unipolar patients did not have higher rates of alcohol or drug abuse than the comparison group. In contrast, primary bipolar patients had higher rates of alcoholism, stimulant abuse, and ever having abused a drug than the primary unipolar group and the control group. In an evaluation of the bipolar patients, drug abusers were significantly younger at intake and had a significantly younger age of onset of bipolar disorder. There was a significant increase in family history of mania or schizoaffective mania in the drug-abusing bipolar patients as compared to the non-abusing bipolar patients. LIMITATION: As in all adult samples of patients with affective illness, the chronology of alcohol and substance problems vis-à-vis the onset of illness was determined retrospectively. CONCLUSIONS: (1) Alcoholism and drug abuse are more frequent in bipolar than unipolar patients. (2) The drug abuse of bipolar patients tends toward the abuse of stimulant drugs. (3) In a bipolar patient, familial diathesis for mania is significantly associated with the abuse of alcohol and drugs. (4) More provocatively, these findings suggest the hypothesis of a common familial-genetic diathesis for a subtype of bipolar I, alcohol and stimulant abuse. CLINICAL IMPLICATIONS: The present analyses, coupled with two previous ones from the CDS, suggest that drug abuse may precipitate an earlier onset of bipolar I disorder in those who already have a familial predisposition for mania. Furthermore, in dually diagnosed patients with manic-depressive and alcohol/stimulant abuse history, mood stabilization of the bipolar disorder represents a rational approach to control concurrent alcohol and drug problems, and should be studied in systematic controlled trials.     

Alcohol use and type of life events experienced during adolescence.

Measured the incidence of stressful life events among 119 adolescents who had an alcohol abusing parent, were in treatment for alcohol/drug abuse, or had no personal or family history of alcohol abuse. Group scores were compared for 7 types of life events based on the Life Event Checklist (LEC) of M. D. Newcomb et al (see record 1982-20103-001). Adolescents in treatment experienced more deviance and emotional distress events whereas adolescents with an alcoholic parent reported significantly more family-related problems. Results provide evidence for the usefulness of the LEC in clinical populations of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with sexual behavior problems in young sexually abused children

OBJECTIVE: To identify variables associated with the presence of sexual behavior problems in young sexually abused children. METHOD: Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3-7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family's history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally "expected"; (2) "sexualized/self-focused"; and (3) problematic "interpersonal" sexual behavior. RESULTS: Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator's use of sadism, and a history of physical and emotional abuse differentiated between those children with and without "interpersonal" sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively "self-focused" (sexualized) versus "interpersonal." CONCLUSIONS: The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.     

Low-cost contingency management in community clinics: Delivering incentives partially in group therapy.

This study examined the feasibility and effectiveness of prize-based contingency management (CM) when incentives for attendance were administered in group therapy and incentives for abstinence were administered in individual meetings. Three community substance abuse treatment programs participated in this two-phase, crossover design study. Outpatients (N = 103) entering treatment who met diagnostic criteria for cocaine, opiate, and alcohol abuse or dependence were recruited. During the standard condition, participants received standard treatment and submitted breath and urine samples that were tested for alcohol, cocaine, and opiates twice weekly during Weeks 1-6 and once weekly during Weeks 7-12. During the CM condition, participants received the same standard treatment and sample and attendance monitoring, plus the opportunity to win prizes for negative samples and treatment attendance. Demographic information and substance abuse history were evaluated at intake, and posttreatment substance use (toxicology results and self-report) was evaluated at Month 6 and Month 9 follow-up interviews. Primary outcomes were weeks retained in treatment and longest duration of sustained abstinence (LDA). LDA was significantly greater in CM-condition participants, but weeks retained did not differ between groups. Rates of substance use were lower in CM participants at Month 9 but not at Month 6. This study suggests that it is feasible to deliver incentives for attendance in group therapy, but that further research is needed to understand the modest effects on attendance. Strengths and limitations of this study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Understanding adverse experiences in the psychiatric institution: The importance of child abuse histories in iatrogenic trauma.

Psychiatric institutions are intended to be places of treatment and sanctuary. However, iatrogenic events in the hospital may interfere with treatment delivery and adherence (Shaw, McFarlane, & Bookless, 1997); additionally, a history of childhood abuse may increase vulnerability to negative emotional reactions to later adverse or threatening events (Chisholm, Freeman, & Cooke, 2006). The present study extends previous research on the frequency and impact of negative hospital events using the Psychiatric Experiences Questionnaire (Cusack et al., 2003), specifically considering the rate of negative events and consumers' perceptions of their treatment experiences. Questionnaires were administered to 43 participants with a history of at least one inpatient psychiatric hospitalization. Results indicated that 98% of participants had experienced at least one negative event in the psychiatric hospital. Child abuse history was significantly related to number of reported negative hospital events, so that those with a history of child abuse reported experiencing a greater number of negative hospital events and a higher level of subjective distress. Implications for research, clinical practice, and policy to improve trauma-sensitive assessments and treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex dfferences in the relation of mood to weight gain after quitting smoking.

Weight gain with smoking cessation is well documented. In this study the authors explored the impact of mood state on weight gain after quitting. Data of 350 participants enrolled in 2 smoking cessation trials were analyzed; primary analyses assessed the relation of affective factors to weight gain in abstinent participants only. Weight gain was predicted by abstinence status. Depression history, gender, and mood change from pre- to postcessation assessments were included in a model predicting weight gain in abstinent participants at the end of smoking cessation treatment (N?=?201) and at 1-year follow-up (N?=?87). At posttreatment, depression history positive women gained more than depression negative women, whereas depression history positive men gained less than depression history negative men. At 1-year follow-up, weight gain was predicted by improved mood in "normal" men and by worsened mood in both depression history positive and negative women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on empirical underpinnings of the ethics of alcohol administration in research settings.

This article introduces the special section of Psychology of Addictive Behaviors that focuses on the ethics of administering alcohol to human research participants, particularly those with a history of alcohol abuse or dependence. It is argued that many assumptions underlying ethical decision making can be put to an empirical test. These assumptions involve the degree to which participants can understand and give informed consent as well as the types and magnitude of possible risks associated with consuming alcohol in a research setting. The research literature relevant to these assumptions is reviewed in this series. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Controlled Study of a Cigarette Smoking Cessation Intervention for Adolescents in Substance Abuse Treatment.

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has received limited research and clinical attention. This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse, ages 13-18 (22% female). Participants were assessed at 4 time points. A greater proportion of participants in the treatment condition (n = 26) reported cessation attempts and point abstinence than did control participants (n = 28) at all time points. However, significant differences were found only for point abstinence at a 3-month follow-up. These findings provide initial support for the efficacy of a smoking cessation intervention delivered in the context of adolescent substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relations among personality, symptoms of alcohol and marijuana abuse, and symptoms of comorbid psychopathology: Results from a community sample.

This study examined the relation of the Five-Factor Model (FFM) of personality to symptoms of alcohol and marijuana abuse before and after controlling for symptoms of antisocial personality disorder (APD) and internalizing psychopathology. The 481 participants completed a well-validated measure of the FFM and a structured diagnostic interview at age 21 years. Hierarchical regression analyses indicated that unique constellations of personality characteristics were associated with symptoms of alcohol abuse, marijuana abuse, APD, and internalizing disorders. For example, symptoms of alcohol abuse were associated with high Extraversion and low Conscientiousness, whereas symptoms of marijuana abuse were characterized by low Extraversion and high Openness to Experience. Findings have implications for models of the etiology and treatment of substance use and abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence.

Empirically-supported treatments for alcohol dependence exist, yet understanding of influences contributing to the intended behavior change is limited. The current study, a secondary analysis of the recent multisite COMBINE trial (The COMBINE Study Research Group, 2003), tested a mediational model wherein change in client self-efficacy for abstinence was examined as a potential mediator of associations between client report of the therapeutic bond and one-year outcomes of drinking frequency, drinking consequences, and psychiatric functioning. For analyses, the 1383 COMBINE trial participants were grouped as follows: 1) those receiving study medications (naltrexone, acamprosate, naltrexone + acamprosate, placebo) and enrolled in medication management (MM) only (n = 607), 2) those receiving study medications/MM and also enrolled in a combination behavioral intervention (CBI) as well (n = 619), and 3) those enrolled in CBI only (n = 157). Mediation analyses using the product-of-coefficients approach indicated self-efficacy change during treatment significantly mediated associations between the therapeutic bond with the CBI therapist and each of the three one-year outcomes among those exclusively receiving CBI, but failed to do so among those receiving pills/MM (with or without CBI). Effect sizes were small, but indicated that variance in bond-outcome associations was partially mediated by self-efficacy change for trial participants. Findings advance understanding of proximal client change processes during delivery of treatments for alcohol dependence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Reasons for drinking among psychiatric outpatients: Relationship to drinking patterns.

Alcohol is the most commonly used drug among people with mental disorders; however, few studies have addressed subjective reasons for drinking among the mentally ill. The purpose of this study was to evaluate the relationship between drinking motives and drinking patterns in 67 psychiatric outpatients. Results indicated that both positive and negative reinforcement motives differentiated drinkers from nondrinkers, with both types of motives correlated significantly with maximum quantity consumed in the last year. Enhanced negative (but not positive) reinforcement motives were associated with a history of treatment for alcohol or drug abuse. This study, which yielded findings similar to those found in previous research with nonclinical participants, represents the first psychometric investigation of motives underlying alcohol use among people with mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Digital replantation in children: a long-term follow-up study

Symptoms of conduct disorder (CD), antisocial personality disorder (ASP), alcohol abuse, drug abuse, and somatization were tabulated for the families of 35 delinquent, substance-abusing (multiple-problem) adolescent male probands and 35 age-matched control males. Alcohol abuse, CD/ASP, and somatization were assessed with either the Diagnostic Interview Schedule (DIS) (for participants aged 18 and up) or the Diagnostic Interview for Children and Adolescents (DICA) (for participants aged 12 to 17). Drug abuse for all participants was assessed with the Substance Abuse Module (SAM) of the Comprehensive Interview for Diagnostic Evaluation (CIDE). As expected, proband groups had significantly more (p < .0001) CD/ASP, alcohol abuse, and drug abuse symptoms than control groups. A significant (p < .01) positive correlation among CD/ASP, alcohol abuse, and drug abuse was found for each group. Somatization was not differentially associated with proband status. It was concluded that identifying male multiple-problem youths also identifies families with a high incidence of similar problems.