Using a structured interview on an ethnically diverse sample of 394 adolescents from 2 outpatient settings, the authors tested the relationship between reported histories of childhood maltreatment, symptoms of drug (mainly alcohol) abuse and dependence, and risky sexual behavior. They found symptoms of alcohol abuse and dependence mediated relations between scores of (1) emotional neglect (2) sex with co-occurring alcohol use and (3) sexual abuse with sex with co-occurring alcohol abuse. Addressing client histories of maltreatment may be necessary to effectively treat adolescents with substance abuse problems and prevent STD transmission.
Risky sexual behaviors are of a great public health concern as they account for a significant percentage of sexually transmitted infections (i.e., HIV). Patients being treated for substance abuse report having sex earlier and with more partners with less consistent condom use than those without drug abuse problems. There is also a significant association between alcohol use and sexual risk behaviors. Environmental risk factors such as childhood abuse and neglect influence both alcohol abuse and sexual risk behaviors. Childhood maltreatment is multidimensional and has well-documented short- and long-term consequences (i.e., developing internalizing disorders). Adolescent patients being treated for alcohol abuse show extensive histories of childhood abuse and neglect. Childhood abuse tends to happen before alcohol abuse, so seeing if alcohol use mediates its relationship with sexual risk behavior has important implications for treatment and prevention programs.
Methods & Analysis
Data were collected from an ethnically diverse sample of sexually active adolescents receiving substance abuse treatment from 2 outpatients facilities. The 38-item Childhood Abuse and Trauma Scale (CATS) was used to assess experiences of childhood and adolescent maltreatment. A modified version of the Timeline Follow Back instrument was used to measure sexual risk behaviors. Psychiatric symptoms and disorders were diagnosed using DSM-IV criteria. Path analyses were used to assess the constructs of interest.
Older participants reported higher levels of alcohol abuse, unprotected sex, and sex with co-occurring drug use. On average, male participants reported more sex with co-occurring alcohol use. There were no significant associations in relation to ethnicity.
Past-year drug abuse or dependence was suggested to mediate the influence of specific kinds of childhood maltreatment (i.e., sexual or emotional) on certain risky sexual behaviors. Childhood sexual abuse was positively related to past-year alcohol abuse and sex with co-occurring alcohol use. However, sexual abuse experiences were found to be negatively related to alcohol abuse and dependence.
Findings are consistent with previous research demonstrating significant associations between childhood maltreatment and sexual risk behaviors and the development of disorders including substance use disorders. This also reinforces associations between substance abuse with risky sexual behaviors. Different kinds of substance use could be coping strategies (i.e., emotional regulation) in reaction to specific types of childhood maltreatment, mediating risky sexual behaviors. Substance abuse during sex could be motivated by anxiety reduction from past sexual trauma. Sexual abuse is more likely to be associated with alcohol abuse than other drug abuse.
Patients with severe patterns of substance abuse and histories of childhood maltreatment appear to be at a higher risk for engaging in risky sexual behaviors (i.e., unprotected sex). The mechanisms underlying the relations between childhood maltreatment, alcohol abuse, and risky sexual behaviors needs further investigation. Particular attention to sexual risk behaviors and histories of childhood maltreatment are supported when treating adolescents with substance use problems.