Positive or negative history of childhood sexual abuse among problem drinkers : relationship to substance use disorders and psychiatric co-morbidity

Background. Victims of childhood sexual abuse (CSA) show higher rates of several psychiatric and substance abuse disorders in adulthood. High rates of CSA have been reported in alcohol- or drug-dependent patients presenting to treatment. However, there is a paucity of European research with regard to in-patient alcohol-dependent populations.

Aims. The aim was to describe the prevalence of CSA in a UK sample of alcohol-dependent in-patients admitted over a 3-year period to a specialist alcohol unit; also to identify socio-demographic, alcohol and other substance use-related variables, and co-morbid psychiatric disorders associated with CSA.

Method. Clinical and socio-demographic data and information on childhood sexual abuse (CSA) were collected from 414 admissions, between September 1995 and September 1998, to the Specialist Alcohol Inpatient Unit.

Results. In the total sample of 414 subjects, 52 had experienced CSA. Of the 311 male subjects included in the study, 20 (6.4%) had experienced CSA. Of the 103 female subjects in the study sample, 32 (31.1%) disclosed having a history of CSA (CSA-females). Women victims of CSA were more likely to be non-white, to have a positive family history of alcoholism and to have fewer years of excessive drinking prior to admission. They were also significantly more likely to a have a lifetime diagnosis of depressive, anxiety and eating disorders, as well as being more likely to have a co-morbid post-traumatic stress disorder and a borderline personality disorder. Male victims had significantly higher Alcohol Problems Questionnaire (APQ) scores, were more likely to live alone, to be single, separate, divorced or widowed and to have a posttraumatic stress disorder and a borderline personality disorder.

Conclusions. Very few alcohol and drug abuse treatment units have developed programmes specifically designed to meet the needs of patients, and particularly women, who have experienced sexual abuse during childhood. However, as reflected by the relationship between CSA and dual diagnosis shown in this study, victims of CSA may represent an important subgroup of alcohol-dependent patients with specific needs. They may require the combination of various forms of pharmacological and psychological treatments to match their clinical characteristics. Declaration of interest. None.