We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.
KeywordsChildhood maltreatment; gender differences; substance use Childhood maltreatment is associated with the use and misuse of a variety of substances (1-4). However, the child maltreatment literature is limited by its historically disproportionate focus on sexual and physical abuse and its placement of emotional abuse and neglect to the periphery of investigations (5). Given that child neglect is most prevalent form of maltreatment, it is striking that it is not understood as well as other forms of maltreatment (6). Additionally, because emotional abuse was deemed less damaging than physical forms of maltreatment and because it was difficult to identify and define, until recently many researchers have not explicitly included this form of abuse in their studies (7,8). This critique is not meant to imply that the continued study of sexual and physical abuse is unwarranted. Rather, this research trend suggests that there is a greater need for investigation of the impact of all types of maltreatment on substance use development.The manner by which childhood maltreatment influences substance use may be best explained by stress-coping models of addiction. According to Wills and Hirky (9), living in an environment with few models of adaptive coping and experiencing negative life events may place individuals at risk for substance use by elevating stress, reducing reinforcement from the social environment, and making the coping functions of substance use appear more attractive. Childhood maltreatment fits into this model as an aversive early life experience that can increase an individual"s risk for experimental drug use and later addiction. Therefore, an important avenue of investigation would be to examine the influence of all types of childhood maltreatment on the age at which individuals first use various substances and the age at which they escalate to regular use of substances. Understanding these relationships is important from a prevention standpoint because certain types of childhood maltreatment may differentially place individuals at risk for initiating use of diffe...