Childhood abuse and harmful substance use among criminal offenders☆
Highlights
► We examined the relationship of childhood abuse to later harmful substance use among offenders. ► Physical abuse was related to alcohol use and sexual abuse was related to drug use. ► Both forms of abuse were related to substance use consequences. ► Mood and anxiety symptoms partially mediated several of these relationships.
Introduction
Childhood abuse is a serious public health problem that is associated with numerous negative mental health outcomes. It is related to internalizing disorders, such as depression and generalized anxiety disorder (GAD), trauma-related conditions, including posttraumatic stress disorder (PTSD; Binder et al., 2008, Malinosky-Rummell and Hansen, 1993), as well as externalizing problems, such as poor impulse control and aggression (Lansford et al., 2007, Liebschutz et al., 2002). Childhood abuse is also associated with harmful substance use, which may exacerbate other emotional, behavioral, and interpersonal problems. Indeed, a substantial literature has identified links between childhood physical and sexual abuse and later substance use problems (Dube et al., 2003, Langeland et al., 2004, Nelson et al., 2002, Schneider et al., 2008a, Schneider et al., 2008b). The prevalence of both childhood abuse and the harmful use of alcohol and other drugs is particularly high among criminal offenders, and both factors have been proposed to increase risk for criminality (Langan and Pelissier, 2001, Bureau of Justice Statistics, 2006).
Given the potential influence of alcohol and other drug use on criminal behavior, the determination of the extent to which findings based on studies of non-forensic samples generalize to forensic samples has important implications for forensic assessment and treatment. However, although a general link between childhood abuse and problematic substance use has been established in both clinical and nonclinical populations, this relationship has not been comprehensively examined among criminal offenders. This study's goal was to address this gap in the literature by examining the relationship between childhood abuse and harmful alcohol and other drug use in a sample of criminal offenders. The elucidation of these interrelationships in an offender sample is particularly important given that patterns of relationships established in settings with relatively lower rates of both childhood abuse and harmful substance use might not generalize to samples (e.g., offenders) in which childhood abuse and harmful substance use are more common and in which childhood abuse is potentially less strongly linked to substance use problems. The importance of establishing the parameters of generalizability is accentuated by the prominence of both substance use problems and consequences of childhood abuse among targets for interventions among criminal offenders.
Among individuals in the criminal justice system, even relatively low rates of substance use may have serious implications (Inciardi & Pottieger, 1994). For supervised offenders, any substance use may lead to re-incarceration, and a high number of offenders report being under the influence of alcohol or other substances when committing crimes (U.S. Department of Justice, Bureau of Justice Statistics, 2004). Thus, the degree to which individuals in the criminal justice system experience consequences of substance use, including exacerbations of impulse-control problems, interpersonal difficulties, negative emotional responses, failure to manage legal responsibilities, and physical problems, may be an important indication of harmful substance use. Although substance use consequences may be relatively independent of frequency of use (Liebschutz et al., 2002), studies of offenders have largely relied on measures of substance use severity, primarily based on consumption or symptoms of substance use disorder (e.g., Swogger et al., 2010, Walsh et al., 2007). Therefore, in this study we supplemented symptom-based indications of harmful substance use with a measure of substance use consequences.
The frequency and type of substances used might account for any observed relationships between childhood abuse and substance use consequences. That is, childhood abuse may be differentially associated with type and level of substance use. However, the wide range of problems associated with childhood abuse suggests an alternative explanation; childhood abuse may lead to an array of interpersonal, psychological, and other problems that decrease coping abilities and social support, thus increasing the likelihood that substance use will result in severe consequences, independent of substance use type and frequency. Thus, another aim of this study was to test whether frequency and type of substances used help to explain relationships between childhood abuse and substance use consequences.
Additionally, we were interested in obtaining preliminary information about potential mechanisms that may underlie relationships between childhood abuse and harmful substance use. Prior work with non-offender samples (Douglas et al., 2010, Simpson and Miller, 2002) found that the relationship between adverse childhood events and substance dependence was partially mediated by internalizing (i.e., depression and anxiety) disorders. Additionally, childhood abuse has been linked to posttraumatic stress disorder (PTSD; National Institute of Justice, 2003, Teicher, 2010). Thus, another aim of this study was to examine whether relationships between childhood abuse and harmful substance use in offenders are mediated by symptoms of depression, GAD, and PTSD.
Rates of childhood abuse and substance use disorders are particularly high among female offenders (Messina et al., 2006, Messina et al., 2003). In a study of female prisoners, Messina and Grella (2006) found that nearly 31% of participants reported having been physically abused prior to age 16, and 45% reported sexual abuse. These high rates of abuse among female prisoners are consistent with rates found in other studies and generally exceed rates of childhood abuse that incarcerated males report (Langan and Pelissier, 2001, Messina and Grella, 2006). However, rates of reported childhood abuse–especially physical abuse–are also substantial among male offenders (Cuomo et al., 2008, McClellan et al., 1997) and may also lead to emotional problems among men that contribute to substance use (Brems, Johnson, Neal, & Freeman, 2004). Relatively few studies have examined the relationship of childhood abuse to harmful substance use among male offenders. In a study that directly examined gender differences in male and female prisoners, McClellan et al. (1997) identified a positive relationship between childhood abuse and substance dependence. Though the authors concluded that this relationship was stronger for females (Cohen's d = .40), it was also substantial among males (Cohen's d = .31). Additional study of the relationship between childhood abuse and harmful substance use among male offenders will help to clarify treatment targets for substance using male offenders with histories of abuse. Thus, a final aim of our study was to determine whether our data could support McClellan et al.'s (1997) conclusion that, whereas childhood abuse is linked to substance use problems in both male and female offenders, the relationship is stronger among female offenders.
This study was designed to examine the relationship between childhood abuse and harmful substance use and consequences among male and female adult offenders in a pretrial jail diversion program. We tested the following hypotheses: 1) Experiencing childhood physical and sexual abuse is directly related to symptoms of substance use disorders, 2) Experiencing childhood physical and sexual abuse is directly related to substance use consequences, after accounting for substance use characteristics, 3) Gender moderates these relationships such that the association between experiencing childhood abuse and substance use problems is stronger among females. We also conducted a series of exploratory analyses to determine the extent to which relationships between childhood abuse and harmful substance use are statistically mediated by symptoms of 1) depression, 2) GAD, and 3) PTSD.
Section snippets
Participants and procedures
Participants were 162 males and 57 females (n = 219), ages 18–58, participating in a pretrial supervision program as a consequence of being charged with a crime. Sample characteristics and mean scores on study measures are presented in Table 1. All participants had to meet the following inclusion criteria: 1) had been at the pretrial program for a maximum of 2 weeks, 2) could read and speak English, as assessed by having them read aloud part of the consent form. Participants who were obviously
Data screening and preliminary analyses
Five outliers (>3 SDs from the mean) were detected on the childhood sexual abuse measure. These values were changed to one unit above the highest non-outlier value to reduce their influence on the analyses (Tibachnick & Fidell, 2001). Measures of childhood physical abuse, childhood sexual abuse, and alcohol use disorders all exhibited non-normal distributions, which were improved using either inverse or square-root transformations as appropriate. Pronounced multicollinearity was not observed,
Discussion
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 and Grella, 2006, Weeks and 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
Role of funding sources
Funding for this study was supported by the National Institute on Drug Abuse (NIDA Grant K23 DA027720 to Marc T. Swogger). NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Marc T. Swogger designed the study. Marc T. Swogger and Stephen A. Maisto conducted statistical analyses. All authors contributed substantially to interpretation of data and writing and editing of the discussion section.
Conflict of interest
All authors declare that they have no conflicts of interest.
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This work was supported by the National Institute on Drug Abuse (Grant K23 DA027720-01A1 to Marc T. Swogger). We would like to thank Sarah Cashman-Brown and Melissa Parkhurst for assistance with data collection. Thanks to Barbara Darby and Craig McNair for their ongoing support during the conduct of this research.