Childhood Maltreatment

Experiences among Adult Men

and Women with Substance Use
Disorders
Sheeba Shamsudeen
M Phil Clinical Psychology Trainee,
Central Institute of Psychiatry (CIP) Ranchi
Dr Lakshmi Sankaran
Assistant Professor, Dept. of Clinical Psychology, Christ University
“It may be unfair, but what happens in a few days,
sometimes even a single day… can change the
course of a whole lifetime.”

The Kite Runner, Khaled Hosseini

 INTRODUCTION
– “Child maltreatment is defined as all forms of physical and/or emotional ill
treatment, sexual abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child’s health, survival,
development or dignity in the context of a relationship of responsibility, trust or
power.” (WHO Consultation on Child Abuse Prevention, 1999)

– The World Report on Violence and Health and the 1999 WHO Consultation on Child
Abuse Prevention distinguish the following types of child maltreatment:

– Physical Abuse
– Sexual Abuse
– Emotional Abuse
– Physical Neglect
– Emotional Neglect
– The devastating effects of childhood maltreatment on adult mental health morbidity
has been well documented in literature.
– Substance use often emerges as a maladaptive strategy used to manage the negative
results of trauma exposure, including posttraumatic stress disorder (PTSD) and
depression (Dembo et al, 1990) and significantly increases the risk for a number of
other psychiatric disorders in adulthood (Costello et al, 2002).
– Empirical and clinical literature demonstrates that victims childhood abuse may
suffer a wide array of psychological, behavioral, and interpersonal difficulties as a
result of their victimization including anxiety, depression, dissociation, sleep and
sexual disturbances (Beitchman et al, 1992).
– In India, the epidemic of substance abuse among the young generation has assumed
alarming dimensions. Although women abused lesser substances as compared to
men although this difference is becoming convergent with increasing rates of women
abusers. (World Drug Report, United Nations, 2010).
– The Child Abuse India Study (2007) by the Department of Women and Child
Welfare, Government of India reports the alarming prevalence and equally
alarming deficiency of effective studies in the area of childhood maltreatment in
India.
– Gender may also play an important role in behavioral and psychiatric outcomes of
different types of childhood abuse. However, the potential differential role of type of
childhood maltreatment on substance abuse in a high-risk population remains
unclear.
AIM OF THE STUDY

The aim of the present study was to assess the relationship

between substance abuse, childhood maltreatment and trauma
symptoms and to assess the gender differences.
METHODS
– Cross-sectional study

– Sampling Technique: Purposive Random Sampling

– Sample:
– 40 adult males and 40 adult females who met the inclusion
and exclusion criteria for the study were included in the
final sample.

– The study was conducted from samples taken from two

deaddiction centres in Bangalore.
 INCLUSION CRITERIA EXCLUSION CRITERIA
Self report of substance abuse for the past–
12 months with moderate to high risk Individuals with significant head
scores on the ASSIST screening tool injury or other organic mental
A residential stay in the deaddiction disorders
centers for a period of minimum 1 month Individuals with comorbid
and undergone detoxification psychiatric disorders, after
Self report of any type of childhood reviewing the case record file of
maltreatment with moderate or severethe patient
scores on the CTQ
Participants aged between 18 to 45 years
TOOLS USED
– The Alcohol, Smoking and Substance Involvement
Screening Test (ASSIST) (WHO, 1997)

– The Childhood Trauma Questionnaire (CTQ) (Bernstein

& Fink, 1998)

– The Trauma Symptom Checklist (TSC-40) (Briere &

Runtz, 1989)
 PROCEDURE
– Initial contact was made with two addiction treatment centres and permission was
obtained.
– Case record file was reviewed for the selection of the sample.
– Participants matching with the inclusion criteria were selected.
– Participants were briefed about the study and informed consent was taken.
– Demographic details and clinical data sheet were filled.
– Screening for substance abuse done using the ASSIST tool and CTQ was administered to
assess presence and severity of retrospective reports of childhood maltreatment.
– Trauma Symptom Checklist 40 was administered.
– A brief intervention and debriefing session was conducted for the individual participants
with the assigned case supervisor after completing of data collection.
STATISTICAL ANALYSIS
– The data obtained was subjected to statistical treatment using
Statistical Package for Social Sciences, Version 19.

– Pearson’s correlation was used to find significant relationships

between the types of substances abuse, the types of childhood
maltreatment and the trauma symptoms.

– A multivariate analysis of variance (MANOVA) was used to

analyze the gender differences on the types of substances abused,
the forms of childhood maltreatment and the trauma symptoms.
RESULTS
RESULTS
 DISCUSSION

– Retrospective reports of childhood maltreatment experiences by both males

and females with substance abuse had associated trauma symptoms.

– Maltreatment during childhood was commonly experienced in the form physical,

sexual and emotional abuse along with current trauma symptoms of anxiety,
sexual problems and sleep disturbance.

– Gender differences existed between males and females on the various types of
substances abused; the types of childhood maltreatment and the different trauma
symptoms in adulthood.
– Tobacco and alcohol were abused more by males whereas inhalants and
sedatives were abused more by females.

– Physical abuse was the most common type of maltreatment found among males
in contrast to sexual abuse which was more prevalent among females.

– With regard to trauma symptoms during adulthood, higher levels of depression

and anxiety were reported among males compared to sleep disturbances among
females.
 CONCLUSION
– The current study found that exposure to adverse maltreatment
experiences in childhood was associated with substance abuse
accompanying higher levels of trauma symptoms during adulthood.
– Tobacco, alcohol and cannabis are the most commonly abused
substances. Maltreatment during childhood was experienced in the form
physical, sexual and emotional abuse along with current trauma
symptoms like anxiety, sexual problems and sleep disturbance.
– The study shows that there is a significant gender difference on
different types of childhood maltreatment and adult trauma symptoms
which may have implications for treatment among adults with substance
abuse problems.
– This findings of the study has implications for mental health
professional to render effective treatment interventions among
adults with substance use disorders.

– There may be a need to routinely address and elicit childhood

maltreatment experiences among adults with substance abuse
to facilitate effective relapse prevention and better therapeutic
engagement.
LIMITATIONS
– As the sample size was small, the findings of this study cannot be
generalized to a larger population.
– The sampling used was purposive in nature, which might have
increased the error variance.
– Sample was only collected from two deaddiction centres, therefore, only
a particular strata was represented in the study.
– The Childhood Trauma Questionnaire used in this study may not be
entirely culture sensitive as it was originally designed for a western
population.
 REFERENCES
– Costello EJ, Erkanli A, Fairbank JA, Angold A. J (2002). The prevalence of potentially traumatic events in childhood
and adolescence. Trauma Stress. Apr; 15(2):99-112.
– Dembo R., Williams L., la Voie L., & Berry E. (1990). Physical abuse, sexual victimization and marijuana/hashish and
cocaine use over time: A structural analysis among a cohort of high risk youths. Journal of Prison & Jail Health, 9,
13–43.
– World Health Organization (1999). Report of the Consultation on Child Abuse and Neglect Prevention, 29-31 March,
Geneva. Geneva, Switzerland: World Health Organization. Document WHO/HSC/PVI/99.1.
– World Health Organization (2002) Krug E.G, Mercy JA, Dahlberg LL, & Zwi A. B. The world report on violence and
health. Geneva. Lancet; 360 (9339):1083–1088.
– Spatz Widom C., Marmorstein N. R., & Raskin White H. (2006). Childhood victimization and illicit drug use in middle
adulthood. Psychology of Addictive Behaviors, 20, 394–403.
– United Nations Office on Drugs, & Crime. (2010). World drug report 2010. United Nations Publications.
– Ministry for Women and Child Development, Child Abuse India (2007) Government of India.
– Beitchman, J. H., Zucker, K. J., Hood, J. E., DaCosta, C, Akman, D., & Cassavia, E. (1992). A review of the long-term
effects of child sexual abuse. Child Abuse & Neglect, 16, 101-118
THANK YOU

Sheeba Shamsudeen

sheeba.dr@gmail.com