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Experiencing maltreatment during childhood increases the likelihood of lifetime alcohol dependence
  1. Abby L Goldstein
  1. Applied Psychology and Human Development, OISE, University of Toronto, Toronto, Ontario, Canada

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Question

Question: What is the relationship between childhood maltreatment and adult lifetime alcohol dependency, and is there an influence of parental history?

Population: A total of 27 712 civilian, non-institutionalised adults (over the age of 18 years in 2001–2002) participating in Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiological Survey on Alcohol and Related Conditions. Eligible Wave 1 respondents were reinterviewed at Wave 2; individuals were deemed ineligible at Wave 2 if they were deceased, deported, mentally or physically impaired or on active duty throughout the follow-up period. Interviews were through face-to-face surveys.

Setting: USA; 2001–2005.

Risk factors: Childhood maltreatment (before the age of 18 years) at the hands of a parent or other adult in the individual's home, as assessed during Wave 2 interviews using the National Institute on Alcohol Abuse and Alcoholism's Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version (AUDADIS-IV). Five maltreatment subtypes were assessed: physical, emotional or sexual abuse, physical or emotional neglect.

Outcomes: Lifetime alcohol dependence, as assessed at Waves 1 and 2 using the AUDADIS-IV. Dependence was defined as reporting at least three of seven DSM-IV alcohol dependence criteria within a 12-month period, in at least one of four time frames (prior to the past year at Wave 1, in the past year at Wave 1, since Wave 1 but prior to the past year at Wave 2 or in the past year at Wave 2). The association between childhood maltreatment and adult alcohol dependence was assessed, controlling for covariates including demographic variables (gender, race, education, age at Wave 1), other adverse childhood experiences (incarceration of a caregiver, attempted or completed suicide of a caregiver, living in a foster home or institution, parental divorce or death, witnessing of serious fights at home) and parental alcohol disorders (alcohol problems among biological parents).

Methods

Design: Cross-sectional survey.

Follow-up period: Not applicable.

Main results

Overall, 17.1% of the participants were classified as experiencing alcohol dependence during their adult lives. The prevalence of childhood maltreatment was 15.8% for physical neglect, 14.9% for physical abuse, 12% for emotional abuse, 10.1% for sexual abuse and 7.9% for emotional neglect. All five categories of maltreatment except for emotional neglect were significant predictors of adult alcohol dependence. When controlling for demographic characteristics, any other maltreatment and other adverse childhood experiences, logistic regression analysis revealed that individuals with a history of childhood sexual abuse were 79% more likely to experience alcohol dependency as an adult compared with individuals with no such abuse history (OR 1.79, 95% CI 1.55 to 2.06). ORs for alcohol dependence among individuals who had experienced other assessed types of childhood maltreatment were: physical abuse OR 1.74, 95% CI 1.53 to 1.98; emotional abuse OR 1.62, 95% CI 1.42 to 1.84; physical neglect OR 1.40, 95% CI 1.24 to 1.59; emotional neglect OR 1.05, 95% CI 0.90 to 1.23.

Conclusions

Experiencing physical, emotional or sexual abuse, or physical neglect during childhood is associated with increased risk of adult alcohol dependency, independent of other adverse childhood experiences and parental alcohol disorders.

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Commentary

Childhood maltreatment is a well-established risk factor for the development of alcohol problems, but research to date suggests moderate effects.1 The study by Fenton and colleagues addresses several of the methodological limitations in the extant literature and provides important evidence to strengthen conclusions regarding the link between multiple forms of childhood maltreatment and adult alcohol dependence. The authors utilised a large, nationally representative sample of adults and included multiple dimensions of child maltreatment, while also controlling for the effects of other forms of maltreatment and childhood adversity.

This study makes an important contribution to the evidence linking child maltreatment to multiple negative outcomes throughout the lifespan. The need for effective interventions to prevent maltreatment and its consequences cannot be denied, but additional work is needed.2 Fenton and colleagues made several important points in this regard. First, their study provides evidence that the effects of maltreatment extend beyond sexual and physical abuse, and include forms of maltreatment that are often overlooked, including emotional abuse. Second, they highlight the need to better understand the conditions under which the negative effects of maltreatment are most likely to emerge. They found effects for gender and parental alcohol problems, but other moderators require further study, including contextual and individual difference factors. Third, they discuss the importance of understanding the mechanisms that underlie the relationship between child maltreatment and alcohol dependence. In particular, longitudinal research is needed to identify causal relationships between maltreatment, mediating mechanisms and negative outcomes. Finally, they note that alcohol dependence was not an inevitable outcome for those who experienced maltreatment. Although they suggest the need to identify other risk factors, these findings also point to the importance of research on resilience, which provides a much-needed strength-based approach to prevention in the maltreatment field.

References

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Footnotes

  • Sources of funding National Institute of Drug Abuse, National Institute on Alcohol Abuse and Alcoholism.

Footnotes

  • Competing interests None.

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