Re-examining the link between childhood maltreatment and substance use disorder: a prospective, genetically informative study

Abstract

Childhood maltreatment is considered a risk factor for substance use disorders (SUD), but this is largely based on retrospective self-reports that are subject to recall bias, designs that do not control for familial confounding, or both. The specific contribution of childhood maltreatment to SUD risk thus remains unclear. Here, we evaluated this contribution in a prospective cohort with objectively recorded childhood maltreatment, using a design that allows controlling for familial confounding. We used medical records and registers to study 525 young adults (20-37 years) with prospectively and objectively documented severe maltreatment exposure, 1,979 clinical controls (unexposed former child and adolescent psychiatry patients), 1,388 matched healthy controls; and their siblings and cousins. We examined the association between maltreatment and SUD using Cox regression models in the population, as well as stratified within siblings in the same family.SUD risk was significantly increased with childhood maltreatment exposure (crude HR: 6.61, 95%CI: 5.81-7.53; HR adjusted for sex, birthyear, externalizing problems, parents ' SUD and socioeconomic factors: 3.50, 95%CI 2.95, 4.16). An approximately 3-fold elevated SUD risk remained when comparing exposed individuals with their unexposed siblings (adjusted HR: 3.12, 95%CI 2.21, 4.42). We provide estimates of the association between childhood maltreatment and SUD accounting for possible confounds of both recall bias and familial factors. When familial confounding is controlled for, SUD risk attributable to severe childhood maltreatment is decreased, but nevertheless considerable. These findings establish a specific contribution of childhood maltreatment to SUD, underscoring the need for SUD prevention in young people exposed to maltreatment.

Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies

“…Internalising problems includes internalising symptoms, internalising behavior, emotional symptoms, and trauma symptoms; conduct problems includes conduct disorder, conduct problems, antisocial, oppositional, or aggressive behavior, arrest or incarceration; externalising problems includes externalising symptoms or behavior; personality disorder includes borderline, paranoid, schizoid, schizotypal, histrionic, narcissistic, antisocial, avoidant, obsessive-compulsive and dependent personality disorders; psychopathology broad includes total psychopathology symptoms, the p-factor, any psychopathology disorder, and total behaviour problems (on the Strengths and Difficulties Questionnaire). Outcomes assessed in only one study (bulimia ( 37 ) and substance use disorder ( 54 )) were not included in the moderator analysis.…”

Neurodevelopmental origins of substance use disorders: Evidence from animal models of early‐life adversity and addiction

“…For example, in women, a history of neglect or maltreatment predicts a higher probability of opioid dependence, while dependence in men is instead better predicted by acute traumatic experiences and concomitant post‐traumatic stress symptoms (Shand et al., 2011). In fact, women with a history of ELA appear to be particularly predisposed to substance use disorders relative to men and to individuals with no history of ELA (Capusan et al, 2021; Gershon et al., 2008; Hyman et al., 2006, 2008; Lansford et al., 2010; Marsh et al., 2018; Najavits et al., 1997; Peltier et al., 2019; Shand et al., 2011; Widom et al., 1995). Notably, this sex‐dependent relationship may be partially explained by the fact that girls and boys tend to be exposed to different types of adversities (Haahr‐Pedersen et al., 2020; Short & Baram, 2019).…”

Risk Pathways Contributing to the Alcohol Harm Paradox: Socioeconomic Deprivation Confers Susceptibility to Alcohol Dependence via Greater Exposure to Aversive Experience, Internalizing Symptoms and Drinking to Cope

“…Specifically, socioeconomic deprivation prospectively predicts aversive environmental experiences ( Frioux et al, 2014 ; Imran et al, 2019 ), internalizing symptom severity ( Ribeiro et al, 2017 ; Boyle, 2020 ), drinking to cope ( Martin et al, 2019 ), and alcohol dependence ( Gauffin et al, 2013 ). In turn, aversive experience (specifically, abuse, and bullying) predicts internalizing symptoms ( Norman et al, 2012 ), drinking to cope ( Topper et al, 2011 ), and substance dependence ( Capusan et al, 2021 ). Internalizing symptom severity prospectively predicts drinking to cope ( Windle and Windle, 2012 ; Young et al, 2015 ; Collins et al, 2018 ; Corcoran et al, 2021 ) and alcohol dependence ( Anker and Kushner, 2019 ).…”