Childhood Sexual Abuse and Substance Use: A Meta-Analysis

Purpose:  Childhood sexual abuse is a major social problem that negatively affects society, ignoring racial, ethnic, or socioeconomic boundaries. Those who have experienced childhood sexual abuse face multiple obstacles in the path to a long and fruitful life, such as anxiety, post-traumatic stress, lower self-esteem, and behavioral problems. These issues can lead to maladaptive coping through licit and illicit substances, potentially creating additional problems for not only the individual who experienced childhood sexual abuse, but also for those around the individual and society as a whole. Many studies, varying in both size and scope, have looked at outcomes of childhood sexual abuse, with substance use being a commonly discovered negative outcome. Understanding how often substance use outcomes occur is an important discovery that could assist clinicians and researchers in prevention efforts and in treatment development and implementation. The purpose of this research was to conduct a thorough and systematic meta-analysis of existing literature to quantify and estimate how substantial the relationship is between childhood sexual abuse and substance use outcomes.  

Methods:  A lengthy and comprehensive literature search was orchestrated by reviewing multiple databases, relevant journals, and cross-referencing various sources. Inclusion criteria for this meta-analysis included any study that measured childhood sexual abuse as a key construct, while also measuring an outcome of substance use. From the 1644 articles that were found and reviewed, 66 were retained due to meeting the inclusion criteria. This resulted in 156 various effect sizes estimating the relationship between childhood sexual abuse and substance use outcomes, with the most common being Pearson’s r, standardized betas (β), and odds ratios (OR). The effect sizes were subsequently pooled, converted to a common metric (odds ratios), and subjected to a nested-design, multivariate meta-analysis to estimate the relationship between childhood sexual abuse and substance use outcomes.

Results:  Findings indicate that individuals that have experienced childhood sexual abuse are almost twice as likely to engage in substance use (OR = 1.94; 95% CI = 1.73-2.17, p < .0001) than individuals that have not experienced childhood sexual abuse. The percentage of males in each study was the only significant moderator variable (p = .017), while other moderators such as age, ethnicity, type of substance, and country of study were not significant.

Implications:  These findings suggest that substance use is a common maladaptive outcome of childhood sexual abuse. Such findings heighten the importance of screening for childhood sexual abuse in substance abuse treatment, and early substance abuse prevention measures. By utilizing comprehensive screening procedures for those who have suffered childhood sexual abuse, special attention can be paid to addressing the individualized and complex needs of clients that have experienced childhood sexual abuse. Similarly, early substance abuse prevention measures could help individuals that have experienced childhood sexual abuse understand the potentially damaging effects of substance abuse. By utilizing the biopsychosocial and client-centered focus that social work embraces, clinicians and researchers could help those who have experienced childhood sexual abuse avoid negative substance use outcomes and live a long and fruitful life.