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Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders

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Abstract

Purpose

To examine gender differences in the associations between childhood adversity and different types of substance use disorders and whether gender moderates these relationships.

Methods

We analyzed data from 19,209 women and 13,898 men as provided by Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender moderates the associations between childhood adversity and DSM-IV defined lifetime occurrence of alcohol, drug, and polysubstance-related disorders. We used multinomial logistic regression, weighted to be representative of the US adult civilian, noninstitutionalized population, and we calculated predicted probabilities by gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pair-wise comparisons corrected for multiple comparisons using Bonferroni’s method.

Results

For each type of substance use disorder, risk was increased by more exposure to childhood adversity, and women had a lower risk than men. However, moderation effects revealed that with more experiences of childhood adversity, the gender gap in predicted probability for a disorder narrowed in relation to alcohol, it converged in relation to drugs such that risk among women surpassed that among men, and it widened in relation to polysubstances.

Conclusions

Knowledge regarding substance-specific gender differences associated with childhood adversity exposure can inform evidence-based treatments. It may also be useful for shaping other types of gender-sensitive public health initiatives to ameliorate or prevent different types of substance use disorders.

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Author information

Authors and Affiliations

  1. Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), 11075 Santa Monica Blvd., 200, Los Angeles, CA, 90025, USA

    Elizabeth A. Evans & Christine E. Grella

  2. Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, 36-071 CHS, 951772, Los Angeles, CA, 90095-1772, USA

    Elizabeth A. Evans & Dawn M. Upchurch

  3. Department of Veterans Affairs (VA) Health Service Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Bldg 206, Rm 250, Los Angeles, CA, 90073, USA

    Elizabeth A. Evans

  4. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, 325 Arnold House, 715 North Pleasant St., Amherst, MA, 01003-9304, USA

    Elizabeth A. Evans

Authors
  1. Elizabeth A. Evans
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  2. Christine E. Grella
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  3. Dawn M. Upchurch
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Corresponding author

Correspondence to Elizabeth A. Evans.

Appendices

Appendix 1: NESARC criteria for diagnosis of alcohol and drug abuse and dependence

The following information is provided by the NESARC Data Reference Manual (NIAAA, 2010).

Alcohol A diagnosis of DSM-IV alcohol abuse requires that a person show a maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as demonstrated by meeting at least one of the four abuse criteria. A diagnosis of alcohol dependence requires that a person meet at least three of the seven dependence criteria. Because the DSM-IV considers alcohol dependence a syndrome, symptoms comprising three or more dependence criteria have to cluster within any 12-month period. The withdrawal criterion of the alcohol dependence diagnosis was measured as a syndrome, requiring at least two positive symptoms of withdrawal as defined in the DSM-IV, or one positive symptom of withdrawal relief/avoidance (i.e., taking a drink or medicine or drug to avoid or get over bad aftereffects of drinking). A person who meets criteria for both abuse and dependence is classified in the dependence category.

Drugs NESARC contains questions that allow for a diagnosis of drug use disorders according to the DSM-IV. The drug use disorder diagnoses assessed in the NESARC include DSM-IV diagnoses of abuse and dependence for each of 10 separate categories of medicine and illicit drugs. These categories include: sedatives, tranquilizers, opiates (other than heroin or methadone), stimulants, hallucinogens, cannabis, cocaine (including crack cocaine), inhalants/solvents, heroin, and other drugs. Sedatives, tranquilizers, opiates, and stimulants were counted only if used without or beyond the bounds of a prescription.

The DSM-IV criteria for drug-specific abuse and dependence are similar to those for alcohol abuse and dependence, but vary slightly across drugs. At least one of the four abuse criteria is required for a drug-specific abuse diagnosis, and in general, at least three of the seven dependence criteria are required for a drug-specific dependence diagnosis. The withdrawal criterion is not used for cannabis, hallucinogen, or inhalant dependence diagnosis. For data tables presented in this manual, a diagnosis of any drug abuse or dependence results from drug-specific diagnoses made for any of the 10 separate medicine/drug categories in a 12-month period.

Appendix 2: Operationalization of childhood adversity

NESARC assessed adverse childhood events occurring before age 18 using questions that were a subset of items from the Conflict Tactics Scale [41] and the Childhood Trauma Questionnaire [5]. Respondents were asked to respond to all questions pertaining to abuse or neglect (except emotional neglect) on a five-point scale (never, almost never, sometimes, fairly often, or very often). Emotional neglect questions employed an alternative five-point scale of never true, rarely true, sometimes true, often true, or very often true. All questions pertaining to general household dysfunction required yes/no responding (except questions regarding having a battered mother, which used the same scale as for the items on abuse or neglect above) (Table 3).

We considered 11 types of childhood adversity, which we defined to be consistent with definitions employed in the Adverse Childhood Experiences study [10, 12] and epidemiological research on childhood adversity [1].

  1. 1.

    Physical abuse was defined as a response of “sometimes” or greater to either question when asked how often a parent or other adult living in the respondent’s home (1) pushed, grabbed, shoved, slapped, or hit the respondent; or (2) hit the respondent so hard it left marks or bruises, or caused an injury.

  2. 2.

    Emotional abuse was identified as a response of “fairly often” or “very often” to any question when asked how often a parent or other adult living in the respondent’s home (1) swore at, insulted, or said hurtful things to the respondent; (2) threatened to hit or throw something at the respondent (but did not do it); or (3) acted in any other way that made the respondent afraid he/she would be physically hurt or injured.

  3. 3.

    Sexual abuse was examined using four questions that examined the occurrence of sexual touching or fondling, attempted intercourse, or actual intercourse by any adult or other person when the respondent did not want the act to occur or was too young to understand what was happening. Any response other than “never” on any of the questions was coded as sexual abuse.

  4. 4.

    Physical neglect was defined as any response other than “never” to five questions that asked about experiences of being made to do difficult or dangerous chores, being left unsupervised when too young to care for self or going without needed clothing, school supplies, food, or medical treatment.

  5. 5.

    Emotional neglect was defined by five questions asking whether respondents felt a part of a close-knit family or whether anyone in the family of origin made the respondent feel special, wanted the respondent to succeed, believed in the respondent, or provided strength and support. Following prior research, the five items were reverse-scored and summed; scores of 15 or greater were coded as emotional neglect [1, 10, 12].

  6. 6.

    Parental substance abuse was a form of household dysfunction that was assessed with two questions asking whether a parent or other adult living in the home had a problem with alcohol or drugs. A response of “yes” to either question was defined as parental substance abuse.

  7. 7.

    To characterize the history of having a battered mother, respondents were asked whether the respondent’s father, stepfather, foster/adoptive father, or mother’s boyfriend had ever done any of the following to the respondent’s mother, stepmother, foster/adoptive mother, or father’s girlfriend: (1) pushed, grabbed, slapped, or threw something at her; (2) kicked, bit, hit with a fist, or hit her with something hard; (3) repeatedly hit her for at least a few minutes; or (4) threatened to use or actually used a knife or gun on her. Any response of “sometimes” or greater for questions 1 or 2, or any response except “never” for questions 3 or 4, was defined as having a battered mother.

  8. 8.

    For the other measures of household dysfunction, respondents were asked to answer with either “yes” or “no” whether a parent or other adult in the home (1) went to jail or prison; (2) was treated or hospitalized for mental illness; (3–4) attempted or actually committed suicide. A response of “yes” to any of these questions was coded as household dysfunction.

Appendix 2 Table 4 shows gender differences in experiences with different types of childhood adversity.

Table 3 Operationalization of childhood adversity
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Table 4 Type of childhood adversity reported by White, Black, and Hispanic women and men, NESARC weighted data (n = 33,107)
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Evans, E.A., Grella, C.E. & Upchurch, D.M. Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders. Soc Psychiatry Psychiatr Epidemiol 52, 901–912 (2017). https://doi.org/10.1007/s00127-017-1355-3

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