Bucholz, Kathleen K

Heath, Andrew C

Lynskey, Michael T

Madden, Pamela A

Martin, N. G

Nelson, Elliot C

Statham, D. J

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Washington University School of MedicineDigital Commons@BeckerPosters 2003: Drinking and the High School Student2003Self-reported childhood abuse and illicit drugabuse/dependenceElliot C. NelsonWashington University School of Medicine in St. LouisAndrew C. HeathWashington University School of Medicine in St. LouisKathleen K. BucholzWashington University School of Medicine in St. LouisPamela A. MaddenWashington University School of Medicine in St. LouisMichael T. LynskeyWashington University School of Medicine in St. LouisSee next page for additional authorsFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2003Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2003: Drinking and the High School Student at Digital Commons@Becker. It has beenaccepted for inclusion in Posters by an authorized administrator of Digital Commons@Becker. For more information, please contactengeszer@wustl.edu.Recommended CitationNelson, Elliot C.; Heath, Andrew C.; Bucholz, Kathleen K.; Madden, Pamela A.; Lynskey, Michael T.; Statham, D. J.; and Martin, N.G., "Self-reported childhood abuse and illicit drug abuse/dependence" (2003). Posters. Paper 18 Samuel B. Guze Symposium onAlcoholism.http://digitalcommons.wustl.edu/guzeposter2003/18AuthorsElliot C. Nelson, Andrew C. Heath, Kathleen K. Bucholz, Pamela A. Madden, Michael T. Lynskey, D. J.Statham, and N. G. MartinThis poster is available at Digital Commons@Becker: http://digitalcommons.wustl.edu/guzeposter2003/18Self -Repor t ed Childhood Abuse and Illicit  Drug Abuse/DependenceE.C. Nelson; A.C. Heath; K.K. Bucholz; P.A.F. Madden; M.T. Lynskey, D.J. Statham; and N.G. Martin.Missouri Alcoholism Research Center, Washington University School of MedicineThe association of childhood sexual abuse (CSA) and physical abuse (PA) withsubsequent substance abuse and dependence risk was initially recognized in treatmentsamples. More recently, epidemiologic studies have confirmed these findings.1-4 We havereported5 on the association between CSA and negative outcomes in data from a recentlycompleted diagnostic telephone assessment of a volunteer panel of young adult Australiantwins and confirmed the association between a history of CSA and alcohol dependence. Inthe current analyses, we attempted to extend these findings by examining the effects of ahistory of childhood abuse (CA), either CSA or PA, on the risks for the use andabuse/dependence of various drugs, and on the onset of drug-related outcomes.A history of CA was reported by 22.6% of women and 14.9% of men. A consistent pattern of elevated hazard ratios representing the risk of subsequently-occurring drug use and abuse/dependence was associated with a history of CA were observed in women and men. In analyses controlling for gender and respondents’ report of maternal and paternal alcohol problems, a history of CA was associated with a significantly earlier onset of drug use. In discordant pair analyses, the twin with a history of CA was noted to have significantly increased risk for opioid, sedative, and stimulant abuse/dependence versus their CA-negative co-twin. The highest Odds Ratios were seen for opioid (OR 5.00; 95% CI 1.45-17.27) and sedative abuse/dependence (OR 16.00; 95% CI 2.12-120.65). Our results offer strong support for an association between CA and drug-related outcomes and suggest one route of mediation may occur via an earlier use of substances. ABSTRACTInitially observed in samples ascertained via clinical presentation, theassociation of childhood sexual abuse (CSA) or physical abuse (PA) withincreased risk for subsequent substance dependence has more recently beenconfirmed in general population studies.1-4 We have reported5 on theassociation between CSA and negative outcomes (including alcoholdependence) in data from a recently completed diagnostic telephoneassessment of a volunteer panel of young adult Australian twins. We usedanalyses uniquely available within the twin study design (e.g. comparisons ofrisks for outcomes in pair members who are discordant for abuse history, butshare other aspects of the family environment) to disentangle the risks relatedto the abuse from other family background risk factors. In the discordant pairanalyses, we found an odds ratio of 1.56 (1.01-2.40) for the risk for alcoholdependence associated with a history of CSA. In the current analyses, weattempted to extend these findings by examining the effects of a history ofchildhood abuse (CA) defined as either CSA or PA, on the risks for the use andabuse/dependence of various drugs, and on the onset of drug-related outcomes.INTRODUCTIONThe young adult ‘1989’ cohort of the Australian Twin Register (born 1964-1971) is a volunteer twin panel registered as children by their parents, who wereapproached through Australian school systems, and via mass media appeals, between1980 and 1982. Twins were first contacted (as young adults) in 1989 by means of mailedquestionnaire. In a recently completed investigation (AA10249; Heath, PI) (1996-2000),a standardized psychiatric diagnostic assessment was administered via telephone. Datapresented here are from this standardized interview, designed both to make DSM-IVdiagnoses and to provide a preliminary characterization of various aspects of the subjects’childhood and adolescence (including their home environment).Interviewed subjects (N=6265) had a mean age of 29.94 years (SD 2.47).55.3% were female. A broad range of socioeconomic levels was represented in thesample. The median level of education was 11-12 years of school with an apprenticeshipor diploma. At least an undergraduate university degree had been completed by 25.8% ofrespondents and another 8.6% had completed technical or teacher’s college. The medianyearly household income was $US 20,000-$US 24,500.ParticipantsMETHODSAssessm ent  A standardized psychiatric diagnostic assessment, an adaptation of theSemi-Structured Assessment for the Genetics of Alcoholism (SSAGA-OZ)was administered via telephone. The interview enabled lifetime DSM-IVdiagnoses to be made including, among other diagnoses, alcohol dependence,major depressive disorder, conduct disorder, and nicotine dependence. Inseparate non-diagnostic sections, subjects were asked about their early homeenvironment, their history of drug use, whether their mother or father hadproblems with alcohol, and whether they had experienced various traumaticevents.All interviews were conducted by lay interviewers who had completedan extensive training course, including supervised telephone diagnosticinterviews with community volunteers. Twins from the same pair were neverassessed by the same interviewer, and interviewers were blind to the results ofthe interviews of other family members.Assessm ent  of  Childhood Sexual Abuse (CSA)Self-report of CSA was determined from five questions from three separate sections of thediagnostic interview: conduct disorder, early home environment, and traumatic life events: 1) Before age 18, were you ever forced into sexual intercourse or any other form of sexualactivity? 2) Before you were 16 years old, were there any sexual contacts between you and anyoneother than a family member who was 5 or more years older than you were? By sexual contactI mean their touching your sexual parts, you touching their sexual parts, or sexual intercourse. 3) Before you were 16 years old, were there any sexual contacts between you and anyfamily members, like a parent, grandparent, uncle, aunt, brother or sister, or cousin (withsexual contact defined as in the previous question)?(Respondents directed to a list of traumatic events) 4) How about event #5 [You were raped (someone had sexual intercourse with you whenyou did not want to, by threatening you or using some degree of force).]? 5) Apart from event #5, did event #6 [You were sexually molested (someone touched orfelt your genitals when you did not want them to).] ever happen to you?A composite CSA variable was coded positively for an affirmative response to any of theabove unless: 1) the age of first contact was reported to be age 18 years or older, or 2) thesexual activity was consensual and involved a family member described as another child.Assessm ent  of  Physical Abuse (PA)Self-report of physical abuse (PA) was based on responses to:1) How often did your mother physically punish you so hard thatyou hurt the next day?2) How often did your father physically punish you so hard thatyou hurt the next day?(counted as PA if subject’s response was “often or “sometimes” foreither parent)?3) Were you ever physically injured or hurt on purpose as a childby an adult? Examples of such injuries would include: brokenbones, being hit so hard you developed bruises, punishments thatincluded scalding water, or any other physical injuries?4) Did event #8 (You were physically abused as a child) everhappen to you? (Respondent referred to traumatic event list)A composite variable for PA representing the endorsement ofany of these items was similarly created.Assessm ent  of  Drug Abuse/DependenceThe interview’s drug section was non-diagnostic, assessing only 4 of 7 the DSM-IV dependence criteria and only 2 of the abuse criteria. In the analyses below, drug use refers to report of any lifetime use. Drug abuse refers to drug use that was either in hazardous circumstances or interfered with work, school, or household responsibilities. Drug dependence refers to endorsement of at least two of the four symptoms assessed (i.e. use in larger amounts or for longer periods than intended, tolerance, persistent desire or failed attempts to decrease use, and continued use despite knowledge of problems related to the substance). Our report of drug abuse or dependence (ab/dep) thus must be considered at best presumptive. Dat a AnalysisPrimary statistical analyses were performed using either SAS Version 6.126 orSTATA.7 All estimates of 95% confidence intervals (95%CI) were adjusted for the non-independence of observations on twin pairs via the use of robust variance estimators.In Cox Regression analyses, the age of first use was chosen as a conservativeestimate for the onset of drug ab/dep. As most of the questions contributing to the PAcomposite failed to ask for age at first occurrence, PA onset was missing in more thanhalf of PA-positive subjects. Thus, in those individuals reporting a history of both CSAand PA, age at first occurrence of CSA was used when PA onset was missing. For themultivariate regression analysis results, all beta values represent the impact in years ofthat variable on the onset of the dependent variable and the intercept reflects the meanvalue for the dependent variable in the absence of endorsement of any of theindependent variables. Because twins were not asked use about parental drug use (thiswas also rare in the parental generation due to secular trends), these analyses insteadcontrol for parental alcohol problems.The discordant pair analyses were restricted to same-sex pairs. Separate tests forheterogeneity were performed to determine whether data could be combined on thebasis of gender and zygosity.Childhood Sexual AbuseCronbach’s alpha for the 5 CSA items was 0.79.Abuse components and compositeTotal (N=6265)Women (N=3462)Men (N=2803)Forced sex 10.0% 14.5% 4.4%Sexual contact (non-family) 3.8% 4.5% 3.0%Sexual contact (family) 4.4% 7.0% 1.1%Rape before age 18 years 3.5% 5.2% 1.4%Molested 9.2% 13.0% 4.4%CSA composite 12.3% 17.3% 6.0%Endorsement of Childhood Sexual Abuse (CSA) Components and CompositeRESULTSRESULTSEndorsement of Physical Abuse (PA) Components and CompositeAbuse components and compositeTotal (N=6265)Women(N=3462)Men(N=2803)Mother hit - hurt next day 4.6% 5.1% 3.9%Father hit - hurt next day 5.1% 5.5% 4.6%Purposely hurt by adult 8.0% 7.7% 8.4%Physical abuse 3.6% 4.2% 2.9%PA composite 10.7% 10.3% 11.1%Childhood Physical AbuseCronbach’s alpha for the 5 PA items was 0.80.The mean age at first occurrence of CA was age 9.9 years (SD 4.2).RESULTSOverlap of Composite Variables, CSA and PATotal (N=6265)Women(N=3462)Men(N=2803)CA (either CSA or PA) 19.2% 22.6% 14.9%Both CSA and PA 3.6% 4.8% 2.1%CSA only 8.7% 12.5% 3.9%PA only 7.0% 5.5% 8.9%Childhood Abuse (CA)Illicit  drug use associat ed w it h CASubstance-related outcomeRisk associated with CA history in:Women MenHR 95% CI HR 95% CICannabis use 1.77 1.58 -1.99 1.61 1.36 - 1.91Opioid use 2.97 2.17 - 4.08 3.41 2.41 - 4.83Sedative use 2.75 2.16 - 3.52 4.26 3.07 - 5.90Stimulant use 2.43 2.02 - 2.91 2.56 2.05 -3.21Cocaine use 2.28 1.63 - 3.19 3.61 2.61- 4.98Cannabis ab/dep 2.72 2.20 -3.37 2.47 1.94 - 3.15Opioid ab/dep 4.99 2.79 - 8.94 9.77 4.44 -21.53Sedative ab/dep 5.16 2.29 -11.63 14.30 5.87 -34.83Stimulant ab/dep 3.32 2.20 - 5.01 3.99 2.66 -5.99Cocaine ab/dep 3.26 1.14 - 9.33 4.23 1.67 -10.73Discordant  Pair  Analyses Substance (abuse/dependence)OR 95% CICannabis^ 1.35 0.87-2.11Opioid 5.00 1.45 - 17.27Sedative 16.00 2.12 - 120.65Stimulant 2.15 1.12 - 4.16Cocaine 3.00 0.61 - 14.86Non-cannabis illicit drug 2.64 1.43 - 4.89Any illicit drug* 2.03 1.32 - 3.12^MZ OR 0.65 (95%CI 0.32-1.31); DZ OR 2.36 (95%CI 1.26-4.40)*MZ OR 1.06 (95%CI 0.55-2.05); DZ OR 3.21 (95%CI 1.76-5.86)Drug Use(in years)Regression results (betas and 95%CI’s)CA Motheralcohol probsFatheralcohol probsMalegenderInterceptCannabis -1.18(-1.48 - -0.89) -0.59(-1.12 - -0.05) -0.14(-0.42- 0.13)-0.77 (-1.01- -0.52)19.63 (19.42-19.84)Opioid -1.21 (-2.24 - -0.19) -1.27(-3.17 - 0.64) -0.46 (-1.59- 0.68)0.01(-0.92- 0.94)22.92(22.11-23.73)Sedative -1.23 (-2.12 - -0.34) -1.01(-2.50 - 0.48) 0.18(-0.79- 1.15)-0.67(-1.53- 0.18)22.07(21.42-22.73)Stimulant -0.55(-1.03 - -0.07) -0.41(-1.23 - 0.41) -0.20 (-0.68- 0.27)0.08 (-0.36- 0.52)21.49(21.10-21.88)Cocaine -0.44(-1.31 - 0.43) -0.20(-1.59 - 1.19) -0.59(-1.53- 0.34)0.94 (0.15 - 1.73)23.11(22.41-23.81)Ef f ect  of  CA st at us on t he onset  of  drug use 22.6% of women and 14.9% of men reported a history of CA A history of CA was associated with significant risk forsubsequently-occurring drug use and ab/dep in men and womenwith the strongest effects were seen for opioids and sedatives. In discordant pair analyses, significantly greater risk for ab/dep ofopioids, sedatives, and stimulants was found in CA-positiveindividuals compared to their CA-negative co-twins. In analyses controlling for gender and respondents’ report ofmaternal and paternal alcohol problems, a history of CA wasassociated with a significantly earlier onset of use across drugs These results offer strong support for an association between CAand drug-related outcomes and suggest one route of possiblemediation may occur via an earlier use of substances (perhaps inan attempt to regulate negative affect).CONCLUSIONSREFERENCES1. Fergusson DM, Horwood LJ, and Lynskey MT. Childhood sexual abuse andpsychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexualabuse. Journal of American Academy of Child and Adolescent Psychiatry. 34:1365-74, 1996.2. Mullen PE, Martin JL, Anderson JC, Romans SE and Herbison GP. Childhood sexualabuse and mental health in adult life. British Journal of Psychiatry. 163:721-32,1993.3. Fergusson DM and Lynskey MT. Physical punishment/maltreatment duringchildhood and adjustment in young adulthood. Child Abuse & Neglect. 21:614-630,1997.4. Mullen PE, Martin JL, Anderson JC, Romans SE and Herbison GP. The long-termimpact of the physical, emotional, and sexual abuse of children: a community study.Child Abuse & Neglect. 20:7-21,1996.5. Nelson EC, Heath AC, Madden PAF, Cooper ML, et al. Association betweenchildhood sexual abuse and adverse psychosocial outcomes-results from a twin study.Archives of General Psychiatry. 59:139-145,2002.6. SAS Institute Inc. SAS/STAT Software: Changes and Enhancements for Release 6.12.Cary, NC: SAS Institute, Inc; 1996.7. StataCorp. Stata Statistical Software: Release 3.0. College Station, TX: StataCorporation, 1999.ACKNOWLEDGEMENTSSupported by NIH grants AA07728,AA11998, and AA10249 (to ACH) and byNIH grants AA 00277 and AA13446 (toECN).

Self-reported childhood abuse and illicit drug abuse/dependence

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Self-reported childhood abuse and illicit drug abuse/dependence

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