This study examined the association between childhood physical and sexual abuse and later harmful substance use among criminal offenders. Rates of childhood abuse in our sample are broadly consistent with prior studies of offenders (e.g., Messina & Grella, 2006
; Weeks & Widom, 1998
), with 58.6% of men and 64.9% of women reporting childhood physical abuse and 15.4% of men and 49.1% of women reporting childhood sexual abuse. As expected, these rates are higher than those found in community samples. For example, MacMillan et al. (1997)
found that 31% of males and 21% of females in a large community sample reported childhood physical abuse, while 13% of females and 4% of males in this sample reported sexual abuse. In the present study, results corroborated our hypothesis that childhood abuse would be related to harmful substance use among offenders. Specifically, we found that childhood physical abuse was positively associated with symptoms of alcohol use disorder and childhood sexual abuse is positively associated with symptoms of drug use disorder after controlling for gender, age and ethnicity. Our second hypothesis, that both forms of childhood abuse would be associated with later substance use consequences, even after controlling for gender, age, ethnicity, and frequency of use of several classes of substances, was also corroborated. These data indicate that factors beyond the frequency and type of substance used contribute to the apparent negative impact of substance use among individuals with histories of child abuse. Exploratory analyses indicated that the childhood physical abuse-alcohol use disorder relationship was partially mediated by symptoms of MDD and GAD. Moreover, symptoms of MDD and GAD partially mediated the relationships between both forms of childhood abuse and substance use consequences. These findings replicate, in a sample of offenders, Douglas et al.'s (2010)
findings in a community sample, and indicate the importance of treating mood and anxiety disorders in criminal offenders with histories of abuse.
Our findings suggest that rates of use do not account for the relationships between childhood abuse and substance use consequences. The identification of factors, beyond depression and anxiety, that underlie this relationship represents an important area for further research, and prior research suggests a number of promising candidates. Consistent with findings regarding childhood abuse and subsequent violent and criminal behavior (Lansford et al., 2007
; Widom & Maxfield, 2001)
, poor impulse control is one potential mediator of the childhood abuse-substance use consequences relationship (Liebschutz et al., 2002
). There is evidence that impulsivity is a consequence of childhood trauma, potentially due to an acquired inability to inhibit actions (Kendall-Tacket, 2002
). It has also been suggested that trait impulsivity may increase the risk for experiencing negative emotional consequences of traumatic experiences (Braquehais, Oquendo, Baca-Garcia, & Sher, 2010
). Emotional dysregulation is another potential candidate for explaining the link between childhood abuse and harmful substance use. Specifically, childhood abuse may interfere with the development of emotional self-regulation (Masten and Coatsworth, 1998
), and emotional dysregulation in adulthood may lead to difficulties managing responsibilities and maintaining healthy relationships. Such difficulties may exacerbate the consequences of substance use, and there is evidence that childhood abuse contributes to disturbances in intimate relationships in adulthood (Colman & Widom, 2004). Notably, impulsivity, emotional dysregulation, and problems in close relationships are often seen in individuals with PTSD. Whereas we did not find that PTSD mediated any of the observed relationships, these problems are also seen in several Axis II disorders (e.g., borderline personality disorder; Linehan, 1993
) that we did not assess in this study. Personality disorders are common in offender populations (Cooke, 2010
), and the inclusion of measures of Axis II pathology in future studies of childhood abuse and substance use consequences among offenders may enhance our understanding of the mechanisms by which childhood abuse leads to substance use consequences.
Whereas both forms of abuse were associated with substance use consequences, we found that childhood physical abuse was associated with symptoms of alcohol use disorder and childhood sexual abuse was associated with symptoms of drug use disorder. The reasons for this are unclear, given that we rigorously controlled for gender, age, and ethnicity; factors that might help to account for the pattern of relationships. There is some evidence, from non-offender samples, that childhood sexual abuse represents a nonspecific risk factor for negative outcomes that are more severe than those associated with childhood physical abuse (Fergusson, Boden, & Horwood, 2008
; Schneider, Cronkite, & Timko, 2008
). Thus, while victims of childhood physical abuse may overuse alcohol, victims of childhood sexual abuse may be more likely to be involved with severe, high-risk behaviors (e.g., prostitution) that are associated with illicit drug use. This post-hoc explanation is offered tentatively, however, and requires further study.
Contrary to our hypothesis that childhood abuse and harmful substance use are more highly related among females than males, we found no evidence of a childhood abuse by gender interaction for CPA or CSA across any measure of harmful substance use, and the effect sizes for the abuse by gender interaction terms were very small across all analyses. Our findings warrant further study and suggest that childhood trauma is linked to problematic substance use among males and females. The current findings highlight the importance of carefully assessing history of child abuse among all offenders.
Several limitations of our study are worthy of note. First, the retrospective assessment of childhood abuse is not optimal given the potential for underreporting due to memory or social desirability biases (Fang & Corso, 2008
). Although there is evidence that childhood abuse can be assessed retrospectively by self-report with reasonable accuracy (Widom & Shepard, 1996
), longitudinal studies would enable greater confidence with regard to the assessment of abuse. Second, our use of a relatively small number of questions to assess childhood abuse may have contributed to low sensitivity that reduced statistical power (Cohen, Brown, & Smailes, 2001
). Nonetheless, the use of a small number of questions rather than a large protocol to define child maltreatment is widespread and has been recommended to maximize specificity in childhood abuse research (Fang & Corso, 2008
). Finally, we urge caution when generalizing many of our findings to non-offender groups.
In summary, among criminal offenders we found a relationship between both childhood physical and sexual abuse and harmful substance use, including substance use consequences. The relationship between childhood abuse and substance use consequences was not accounted for by substance use type and frequency. Symptoms of MDD and GAD, however, were found to partially mediate several of the relationships between childhood abuse and harmful substance use. There was no evidence that relationships between childhood abuse and any of the substance use outcomes differed for males and females. Current findings highlight the importance of careful assessment and treatment of substance use problems and mood and anxiety problems among offenders with histories of childhood abuse.
- Among criminal offenders, childhood physical abuse was related to symptoms of alcohol use disorder, childhood sexual abuse was related to symptoms of drug use disorder, and both forms of childhood abuse were related to adult substance use consequences.
- There was no evidence that gender moderates any of the observed relationships, suggesting the importance of assessing childhood abuse among both male and female offenders with substance use problems.
- Consistent with prior work in non-offenders, symptoms of depression and generalized anxiety were found to partially mediate several childhood abuse-harmful substance use relationships, underscoring the importance of treating mood and anxiety disorders among offenders with substance use problems.