Consistent with previous findings (Medrano et al., 2002
), all types of childhood maltreatment were highly prevalent in our cocaine dependent sample. Most cocaine dependent inpatients reported multiple types of childhood maltreatment, and only 15% reported no maltreatment at all. In addition, the prevalence of childhood maltreatment was higher than that found in a normative undergraduate sample (Paivio & Cramer, 2004
), and severity scores for overall childhood maltreatment were higher than those reported by a racially mixed community sample of men and women (see Scher et al., 2001
Our findings suggest that the severity of overall childhood maltreatment experienced by recently abstinent cocaine dependent adults has a significant relationship with perceived stress and avoidance coping in adulthood. Specifically, childhood maltreatment explained 11% of the variance in perceived stress and 7% of the variance in avoidance coping. Considering that greater levels of acute stress increases cocaine craving (Sinha et al., 1999
) and risk of cocaine relapse (McMahon, 2001
; Sinha, 2001
; Sinha et al., 2006
; Wallace, 1989
), those with the most severe childhood maltreatment histories may be more susceptible to stress-related problems including cocaine relapse.
Our findings suggest that having a more severe childhood maltreatment history may result in a greater sensitivity to stress that could make cocaine use more negatively reinforcing and result in a potentially treatment-resistant group of patients. Although effective cognitive-behavioral coping skills treatments for cocaine addiction are available (e.g., Carroll, 1998
), the current findings suggest that for this group of patients, basic coping skills training may not be adequate in decreasing distress and avoidant coping in order to decrease substance use and relapse. Additional interventions that focus on stress tolerance, altering appraisals of stress, stress desensitization, and affect and emotion regulation skills may be of particular benefit to patients with childhood maltreatment histories.
The fact that childhood maltreatment is a preventable phenomenon that occurs early in life and affects psychological functioning well into adulthood makes our findings relevant to clinical practice with children as well. Early identification and treatment of maltreated children may help prevent stress sensitivity or the development of a less adaptive style of coping. Assessment of coping ability and the implementation of coping skills and stress tolerance training may also be indicated for maltreated children in an effort to increase their coping efficacy and decrease their vulnerability to stress later in life.
It is important to note the following limitations. First, the amount of variance captured by childhood maltreatment is minimal, and the findings are based on a relatively small sample size. Furthermore, these findings may not generalize to other drug dependent samples or nonclinical samples of cocaine dependent adults. Also, the reports of childhood maltreatment relied on retrospective self-report data, and it is unclear whether self-reports represent true histories. However, confidentiality was ensured, and participants had no study-related reason to misrepresent their childhood maltreatment histories. We also want to note that retrospective findings in child maltreatment research, while limited, should not be disregarded because prospective designs require maltreatment survivors to be identified and followed and some sort of intervention is ethically required (Kendall-Tackett & Becker-Blease, 2004
). In effect, identified children may be very different from children who are not identified, and retrospective studies may measure a segment of the population that is missed by prospective studies (Kendall-Tackett & Becker-Blease, 2004
). Another limitation of our study is that the correlational analysis precludes speculation about causality. Many factors in addition to child maltreatment, such as genetics, biological responses to stress, and such social factors as parental modeling, may have contributed to our findings. Future studies may benefit by examining the relative contribution of these other factors to the development of substance use disorders. Finally, because we excluded individuals who were taking medications for psychiatric or medical conditions, the results may not generalize to a more severe, dually diagnosed population, a population that may have evidenced an even stronger relationship between childhood maltreatment and perceived stress and stress-coping.
Although the specific relationships found in this study were moderate, it is important to note that the experience of childhood maltreatment is a distal factor. There may be more proximal factors, such as altered stress reactivity as a result of early trauma or repeated experiencing of trauma in adulthood that may contribute to, or account for, a larger amount of variance in the way cocaine dependent individuals perceive and cope with stress. Nevertheless, the relationships found may have direct implications for addiction prevention and treatment. Ultimately, recently abstinent cocaine dependent individuals who sustained the most severe childhood maltreatment may be most susceptible to stress-related problems, including cocaine relapse.