Developmental Pathways from Child Physical, Emotional, and Sexual Abuse to Adolescent Substance Use

Background and Purpose:
Adolescent substance use is a significant public health concern that hinders healthy youth development. While previous research has identified a significant link between child abuse and adolescent substance use, the developmental pathways from maltreatment to adolescent substance use remain less clear. Moreover, little research has examined if those pathways differ by maltreatment type. This study seeks to fill these gaps by 1) examining caregiver-child relationships, posttraumatic stress (PTS), and externalizing behavior as the pathways through which child physical, sexual, and emotional abuse affect adolescent substance use; and 2) assessing the differences in the pathways by maltreatment type.

Methods:
Secondary data analysis was conducted using a sample of 883 adolescents drawn from Longitudinal Studies of Child Abuse and Neglect, a multi-site cohort study examining the long-term effects of child abuse and neglect on children’s development. Child abuse at age 11 was assessed, using a set of questions that asked adolescents about their victimization experience of physical abuse, emotional abuse, and sexual abuse in the past year. The caregiver-child relationship was measured at age 12, using a 6-item scale (e.g., level of closeness, understanding, trust) that assessed adolescents’ perceptions of the quality of the relationship with their caregivers. PTS at age 12 was measured using the posttraumatic stress symptoms scale of the Trauma Symptoms Checklist for Children. Externalizing behavior at age 14 was assessed using the Child Behavior Checklist. Substance use was assessed at age 16, using adolescent self-report of tobacco, alcohol and marijuana use in the last year. Substance use was specified as a latent variable with three indicators (alcohol, tobacco, and marijuana). Child race, gender, parental substance use, and household income were used as control variables. Structural equation modeling was conducted using Mplus v.7.31 to test the hypothesized pathways from child abuse to adolescent substance use.

Results:
All three (physical, sexual, emotional) types of abuse were associated with higher levels of posttraumatic stress symptoms which in turn led to adolescent substance use. Additional pathways were identified for emotional abuse and physical abuse. Child emotional abuse indirectly affected adolescent substance use via caregiver-child relationships and externalizing behavior; emotionally abused children had poorer caregiver-child relationships, which in turn, were associated with increased externalizing behavior that led to adolescent substance use. Child physical abuse indirectly affected adolescent substance use via increased externalizing behavior. Child abuse, regardless of the type of abuse, had no direct impact on adolescent substance use.

Conclusions and Implications:
This study adds to the existing literature by identifying multiple distinctive pathways through which different types of child abuse influence adolescent substance use. Findings suggest that providing selective interventions tailored to address the types of abuse experienced by adolescents may be effective in preventing adolescent substance use and promoting healthy youth development. While intervention and treatment programs that address PTS symptoms may be universally helpful in reducing the risk of substance use among victims of child abuse, adding the caregiver-child relationship enhancement factor may be especially beneficial for emotionally abused children and maximize intervention effects.