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Childhood Trauma and Later Substance Use: The Differential Role of Re-victimization and Emotion Dysregulation

October 7, 2016

Exposure to childhood abuse puts individuals at risk for many negative mental health outcomes in adulthood, including substance abuse. Identifying factors that may increase individuals risk for substance use problems following child abuse exposure is important as we work to improve both prevention and treatment of substance use disorders. Both problems with emotion regulation and later exposure to trauma may be particularly important factors to consider, and so the goal of our study was to examine the differential effects of child abuse exposure, other trauma exposure, and emotion dysregulation on substance use among a group of individuals with high rates of trauma exposure.   

We interviewed 2014 individuals in primary care, pharmacy, and gynecology clinics in Grady Memorial Hospital, located in downtown Atlanta, which serves a predominantly African American, low socioeconomic status, urban population. The interview consisted of questionnaires regarding childhood trauma, later trauma exposure, problems with emotion regulation, and alcohol and illicit drug use. Individuals in this sample reported a very high rate of trauma exposure, with greater than 90% experiencing a traumatic event and most reporting exposure to more than one trauma type (e.g., sexual assault, domestic violence, witnessing loved one killed or seriously injured). Approximately 40% also reported exposure to significant child physical, sexual, or emotional abuse.
 
In this sample, we found that all categories of child abuse were significantly associated with alcohol and substance use, although emotional abuse showed the strongest effect. We also found that emotion dysregulation and other trauma exposure indirectly impacted the relationship between childhood emotional abuse and adult substance use; suggesting that these two risk factors may independently help to explain the link between child abuse exposure and later substance use. Trauma exposure was a particularly strong predictor of substance use, suggesting that individuals may resort to substance use as a means of alleviating the long-term effects of trauma.  
 
Reducing re-traumatization following exposure to child abuse may be a particularly critical step toward reducing vulnerability for substance use disorders. Additionally, teaching adaptive emotion regulation strategies and emotional awareness can reduce the need for the use of substance use as a maladaptive coping strategy for symptoms. Incorporating such emotion regulation techniques into substance use interventions may help to enhance efficacy of these treatments. Ultimately, early intervention following childhood exposure to trauma and emotion regulation training among at risk youth could help to reduce risk for re-traumatization and subsequent risk for substance use disorders.

Reference Article

Mandavia, A., Robinson, G. G. N., Bradley, B., Ressler, K. J. and Powers, A. (2016), Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma. Journal of Traumatic Stress. doi:10.1002/jts.22131

Discussion Questions

  1. What are some subtopics that can be addressed in the individualized treatment of comorbid trauma and substance use disorders?
  2. What are some the environmental factors in this population that may exacerbate trauma exposure and increase risk?

Author Bios

Mandavia-(1).jpgAmar Mandavia, M.A. is currently a first year doctoral student pursuing clinical psychology at Teachers College, Columbia University. His current research examines the intersection of bio-psycho-social factors among individuals who are homeless and its impact upon their risk for suicide and psychosis.

Robinson.jpgGabriella G. N. Robinson, B.S., is a psychology graduate student with a concentration in substance use. Her interests are in psychophysiology, emotion regulation, and culturally sensitive treatments for underserved populations in regards to trauma and substance use disorders.

Bradley.jpgBekh Bradley, PhD Director of the Trauma Recovery Program at the Atlanta VA Medical Center. Assistant Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine.

Ressler.jpgKerry J. Ressler, MD, PhD Chief Scientific Officer and Chair in Psychiatry at McLean Hospital. Professor in psychiatry at Harvard Medical School.

Powers.jpgAbigail Powers, PhD is a licensed clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Emory University in Atlanta, GA.