Gender Specific Associations Between Types of Childhood Maltreatment and the Onset, Escalation and Severity of Substance Use in Cocaine Dependent Adults

Abstract

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...

Exposição a trauma e transtorno de estresse pós-traumático em usuárias de crack

“…Nesse sentido, a experiência traumática na infân-cia pode ser considerada um fator de risco para a experimentação de drogas e subsequentemente ao desenvolvimento da dependência, à medida que a substância poderia ser utilizada como uma tentativa de automedicação para atenuar os sintomas de humor associados ao trauma 52 . Embora não se tenha observado tal associação na idade de início de uso de cocaína e maconha, sugere-se que o impacto do trauma na infância contribua diretamente para a experimentação de álcool, uma vez que estudos apontam para ele como a porta de entrada para o uso e abuso de substâncias e, consequentemente, uma busca por uma droga potente e economicamente mais viável, como o crack, mais precocemente 4,30 . Além disso, o próprio abuso de substâncias em idade precoce tornaria o indivíduo mais vulnerável a uma resposta exacerbada associada a uma vivência potencialmente traumática 27 .…”

“…Ainda, considerando os pressupostos de conhecimento referente a trauma e dependência, alguns autores sugeriram que o TEPT possivelmente seja um fator de risco para a adição a drogas de abuso, embora nenhum dos estudos associativos evidencie que a dependência possa ser considerada fator de risco ao diagnóstico pós-traumático 15,27 . Mesmo que não se possa afirmar que não ocorra uso ou abuso de substâncias antecedentes ao desenvolvimento do TEPT 28,29 , alguns estudos buscaram pesquisar o impacto da experiência traumática na busca e consumo de drogas de abuso, investigando possíveis diferenças quanto à idade de ocorrência do trauma e às implicações posteriores 27,30 . Nesse sentido, constataram que um número significativo de sujeitos com dependência de substâncias vivenciou algum evento traumático nos primeiros anos de vida e que esses sujeitos apresentaram alterações referentes à idade do primeiro uso de substâncias, experimentando diversas drogas prematuramente em relação a sujeitos que vivenciaram uma experiên-cia traumática somente na idade adulta 11,31 .…”

“…Nesse sentido, constataram que um número significativo de sujeitos com dependência de substâncias vivenciou algum evento traumático nos primeiros anos de vida e que esses sujeitos apresentaram alterações referentes à idade do primeiro uso de substâncias, experimentando diversas drogas prematuramente em relação a sujeitos que vivenciaram uma experiên-cia traumática somente na idade adulta 11,31 . Segundo esses estudos, quanto mais precoce o trauma vivenciado, mais prematuro poderia ser o primeiro contato com as substân-cias de abuso consideradas "porta de entrada" como álcool e maconha, ainda que esse efeito possa estar associado igualmente à experimentação de cocaína tipo crack 30 . A importância de estudos relacionando a dependência de substâncias psicoativas em pacientes com TEPT está fundamentada na literatura.…”

Severity of childhood trauma is predictive of cocaine relapse outcomes in women but not men

“…Posttraumatic Stress Disorder (PTSD), which is frequently diagnosed in childhood trauma survivors (Rodriguez et al, 1996;Widom, 1999), is more likely to develop following childhood sexual abuse in females as compared to males (Walker et al, 2004). Moreover, while substance use disorders are more prevalent in men, the association between childhood trauma and the development of substance use disorders is generally stronger in women (Hyman et al, 2006;MacMillan et al, 2001;Simpson and Miller, 2002;Sinha and Rounsaville, 2002).…”

Childhood Maltreatment and Substance Use Disorders among Men and Women in a Nationally Representative Sample

“…10,[15][16][17][18][19][20][21] In addition to earlier age of onset for substance use, many types of childhood maltreatment have been linked to binge drinking and regular alcohol use in adolescent samples. 15,16,22 With an increased likelihood of earlier and excessive use of alcohol and drugs, it may not be surprising that childhood maltreatment is also related to SUDs in adolescence and adulthood.…”