Mechanisms of Risk Transmission Across the Lifespan: Development of Alcohol Use Behavior in Adult Survivors of Child Physical & Sexual Abuse

Purpose: Two of social work practice's most prevalent clinical issues include addiction (Straussner, 2001) and child maltreatment(Barth, et al., 2008). While existing literature shows connections between child maltreatment (e.g., physical and sexual child abuse) and later alcohol use (Widom, et al., 2007) the mechanisms that link these adverse experiences are unclear and poorly understood. Review of the research literature shows an evident need for more prospective research on these issues.

Analyses used data from a 30-year prospective, longitudinal study to investigate mechanisms that link physical and sexual abuse to outcomes of alcohol use during adolescence and adulthood. Hypothesized mediators of child abuse include individual beliefs about alcohol use and peer influences during adolescence. Analyses also account for family substance use in childhood, as a covariate of abuse and stand-alone predictor of later substance use. The following research questions guided the study: 1. Is there a direct effect of physical and sexual child abuse on later alcohol use after accounting for family substance use in childhood, 2. Do individual beliefs and peer influences mediate the effect of abuse experiences on later alcohol use during adolescence and adulthood?

Methods and Results: Hypotheses were examined using Structural Equation Modeling. A first step Confirmatory Factor Analysis (CFA) showed the proposed measurement model fit the data well (chi-square (46)=187.255, p<.01, CFI=.98, TLI: .95 RMSEA=.04). Structural tests of the full mediation model also showed an adequate fit to the data (chi-square(46)=68.664, p=.0168, CFI=.98, TLI: .96 RMSEA=.039). Physical abuse significantly predicted peer influences (Beta=.14, p<.05), as did family substance use (Beta=.22, p<.001). Peer influences, in turn, predicted frequency of adolescent alcohol use (Beta=.38, p<.001). Individual beliefs was unrelated to earlier forms of child abuse and family substance use , although it was predictive of adolescent alcohol use (Beta=.37, p<.001). Interestingly, adulthood alcohol use frequency was related only to individual beliefs about alcohol in adolescence (Beta=.28, p<.01)not peer influences. Sexual abuse, modeled as a childhood predictor, was unrelated to the hypothesized mediators and tested alcohol use outcomes.

Conclusion and Implications: This study focused on predictors and pathways to adolescent and adulthood alcohol use frequency from childhood abuse. Particularly noteworthy is the importance of peer influences as a driver of adolescent alcohol use, and of individual beliefs about alcohol as a predictor of both adolescent and adult alcohol use. The study offers important insights about the mechanisms leading to these outcomes and, thus, can help guide the development of prevention programs focused on reducing the misuse of alcohol and, possibly, other drugs. Further research should investigate the importance of additional mediators of child abuse, including those related to social context and environmental influences.