Childhood adversity and the presence and persistence of substance use disorders over the life course among a nationally representative sample of adult women.

摘要

I examined relationships between experiences of childhood adversity (defined as abuse, neglect, household dysfunction), sociodemographic characteristics, and the presence and persistence of different types of substance use disorders (defined as no disorder, alcohol only, drug only, poly-substance).;Findings indicated that more than half of women and men in the United States have experienced some type of childhood adversity. More women than men have experienced three or more types of childhood adversity. Also, women and men have experienced different types of childhood adversity. Specifically, more women than men have experienced childhood sexual and emotional abuse, and certain types of childhood household dysfunction, specifically parental problematic substance use, having a battered mom, parental mental illness, and parental suicide attempt. In contrast, fewer women than men have experienced childhood physical abuse, childhood physical and emotional neglect, and having a parent who committed suicide. For women only, exploratory factor analysis indicated that type of childhood adversity may be best reduced to two concepts, i.e., childhood household dysfunction and childhood maltreatment (abuse and neglect).;For both women and men, there was a dose-response relationship between number of types of childhood adversity experienced and likelihood for each type of substance use disorder. However, with more experiences of different types of childhood adversity, the gap between women and men in predicted probability for a disorder narrowed in relation to an alcohol use disorder, it converged in relation to a drug use disorder, and it widened in relation to a poly-substance use disorder. These findings suggest that greater exposure to childhood adversity may act as a force that elevates women's odds for an alcohol and drug use disorder to levels that approximate or mirror those that are evident among men, and it increases the odds for a poly-substance use disorder more sharply among men than among women.;Analyses focused on only women revealed complexities in the ways that socioeconomic status moderated the relationship between childhood adversity and the occurrence of each type of substance use disorder. For example, higher socioeconomic status heightened women's odds for an alcohol use disorder in the context of exposure to 1 to 2 types of childhood adversity; but it dampened those odds in the context of exposure to 3 or more types of childhood adversity. In relation to drug use disorders, higher income heightened women's odds for a disorder in the context of childhood adversity; but those odds were dampened by higher educational attainment and certain employment statuses.;Finally, there were differences by race/ethnicity in the relationship between type of substance use disorder and disorder persistence. White and Black women were each more likely to have a persistent alcohol use disorder than Hispanic women. Black women were more likely to have a persistent drug use disorder than both White women and Hispanic women. Among both Black women and Hispanic women, having a drug use disorder elevated the risk for disorder persistence more than having only an alcohol use disorder; among White women the presence of a drug use disorder did not elevate the risk for disorder persistence more than having only an alcohol use disorder. For White, Black, and Hispanic women, the presence of a poly-substance use disorder was associated with disorder persistence. More research is needed to understand why there are differences by race/ethnicity in the relationship between having an alcohol or drug use disorder and disorder persistence. (Abstract shortened by UMI.).