We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsychINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption. Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. While many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stressrelated motivation to use/abuse cannabis and is associated with decision making deficits and alterations in brain-stress pathways that may exacerbate compulsive drug-seeking and sensitize individuals to stress-related drug use. Overall, stress-coping interventions and harm reduction focused on reducing the amount ingested may facilitate prevention and recovery efforts.

The CCQ-Brief was found to be a reliable and valid measure in a mixed gender sample, and both the CCQ-Now and CCQ-Brief were predictive of cocaine relapse risk. Craving assessments that go beyond desire and take into account intent and planning to use cocaine and the patient's anticipation of a positive outcome from using cocaine are likely to provide a sensitive index of cocaine relapse susceptibility. However, fear of social and clinical consequences could impact accurate reporting of cocaine craving and intent to use cocaine.

We prospectively examined the gender-specific effects of childhood trauma on cocaine relapse outcomes in an inpatient sample of treatment engaged cocaine dependent adults. Cocaine dependent men (n = 70) and women (n = 54) participating in inpatient treatment for cocaine dependence were assessed on severity of childhood trauma and followed for 90 days after discharge from treatment. Greater severity of childhood emotional abuse was associated with an increased risk of relapse in women. Severity of emotional abuse, sexual abuse, and overall childhood trauma was associated with the number of days cocaine was used during follow-up in women, as was the association of severity of physical abuse and overall childhood trauma with the average amount of cocaine used per occasion. No associations between childhood trauma and cocaine relapse outcomes were found in men. These findings demonstrate that childhood trauma increases the likelihood of cocaine relapse and drug use escalation after initial relapse in women but not in men. Comprehensive assessments of childhood trauma and specialized treatments that address trauma-related pathophysiology could be of benefit in improving cocaine treatment outcomes in women.

Naltrexone-treated opioid abusers demonstrate vulnerability to stress and drug-cue-induced craving and arousal responses that may contribute to the high rates of noncompliance and relapse among opioid-dependent individuals undergoing naltrexone treatment. Pharmacological and behavioral interventions that specifically target the negative affectivity that co-occurs with drug-cue and stress-induced craving could be of benefit in improving naltrexone treatment outcomes in opioid dependence.

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction. KeywordsChildhood maltreatment; gender differences; substance use Childhood maltreatment is associated with the use and misuse of a variety of substances (1-4). However, the child maltreatment literature is limited by its historically disproportionate focus on sexual and physical abuse and its placement of emotional abuse and neglect to the periphery of investigations (5). Given that child neglect is most prevalent form of maltreatment, it is striking that it is not understood as well as other forms of maltreatment (6). Additionally, because emotional abuse was deemed less damaging than physical forms of maltreatment and because it was difficult to identify and define, until recently many researchers have not explicitly included this form of abuse in their studies (7,8). This critique is not meant to imply that the continued study of sexual and physical abuse is unwarranted. Rather, this research trend suggests that there is a greater need for investigation of the impact of all types of maltreatment on substance use development.The manner by which childhood maltreatment influences substance use may be best explained by stress-coping models of addiction. According to Wills and Hirky (9), living in an environment with few models of adaptive coping and experiencing negative life events may place individuals at risk for substance use by elevating stress, reducing reinforcement from the social environment, and making the coping functions of substance use appear more attractive. Childhood maltreatment fits into this model as an aversive early life experience that can increase an individual"s risk for experimental drug use and later addiction. Therefore, an important avenue of investigation would be to examine the influence of all types of childhood maltreatment on the age at which individuals first use various substances and the age at which they escalate to regular use of substances. Understanding these relationships is important from a prevention standpoint because certain types of childhood maltreatment may differentially place individuals at risk for initiating use of diffe...