Childhood maltreatment was associated with a younger age of first alcohol use which, in turn, was associated with a younger age of first cocaine use. Childhood maltreatment was also associated with a greater lifetime severity of substance use. There were gender differences with respect to the types of childhood maltreatment that were related to these outcomes and the strength of the associations. In men, there was a small but significant association between emotional abuse severity and age of first alcohol use. In women, severity of sexual abuse, emotional abuse, and overall childhood maltreatment were all more strongly related to the age at which cocaine dependent women had their first alcoholic beverage, suggesting a stronger association between childhood maltreatment and the age of first alcohol use in women.
Contrary to hypotheses, childhood maltreatment was not directly related to the age of onset of regular alcohol use nor was it directly related to the age of first use or age of onset of regular use of nicotine or cocaine in either men or women. However, follow-up analyses indicated that there may be indirect relationships between childhood maltreatment and progression toward cocaine use that is mediated by the age of first alcohol use. Thus, while childhood maltreatment may directly contribute to the age of initial alcohol use, it may be that the impact of early alcohol use on other aspects of adolescents” lives (e.g., increased affiliation with substance using peers) contributes to a faster progression toward cocaine use.
Of particular interest for males was the finding that emotional abuse, the only form of maltreatment that was related to the age of first alcohol use, was also the only type of maltreatment that was related to lifetime substance use severity. This finding suggests that emotional abuse may influence the course and severity of substance use in men, which may prove to be a promising avenue for future study. Of particular interest in women was that sexual abuse was not directly related to lifetime substance abuse severity, yet it had the strongest relationship with the age of first alcohol use. Thus, while sexual abuse may be related to an earlier age of first alcohol use, other forms of maltreatment may have a more direct impact on substance abuse severity over a woman”s lifetime. Overall, the findings indicate that early intervention for child victims, especially females, may help delay or prevent the early onset of alcohol consumption and reduce the risk for a more severe course of addiction.
These findings, while informative, must be interpreted in light of the following limitations. First, because we relied on a clinical sample of cocaine dependent men and women, it is unknown whether our findings will generalize to non-clinical samples. Second, retrospective self-report data were used, and it is unclear whether self-reports represent true histories. Another limitation of the study is that our design precludes speculation about causality. Many other factors in addition to child maltreatment, such as genetics, family, and social factors may have contributed to our findings. Finally, the relatively low psychometrics of the physical neglect subscale suggests that findings based on this scale may not be as reliable as findings derived from the other CTQ-SF scales.
Nevertheless, the study findings may have direct implications for gender-specific prevention and treatment development. Of course, given the limited focus on childhood maltreatment, it is unclear how genetics or other social and psychological factors may have additionally influenced the substance use of our sample. The addiction field will undoubtedly benefit from additional research that examines how childhood maltreatment, alone and in combination with other environmental and genetic factors, can influence the development of substance use disorders in men and women.