Childhood Sexual Abuse and Addiction Among Men: What Are the Pathways?

Background and purpose: Addiction continues to be a pervasive problem in the United States. Each year, around 20 million Americans meet the criteria for a substance use disorder (SUD) diagnosis. Addiction is not only associated with premature death, but also costs American society around 740 billion dollars annually. Understanding the mechanisms driving SUDs is crucial in order to effectively prevent and treat substance use issues. Although childhood sexual abuse (CSA) has been identified as a contributing factor to substance use problems in both men and women, there is a lack of consensus on how exactly experiences of sexual abuse during childhood lead to the development of addiction. Self-medicating trauma has been identified as a factor for substance use among those struggling with trauma symptoms. Furthermore, little is known about the link between CSA and SUDs among men because prior studies have primarily focused on female survivors of CSA. To fill this gap, this scoping review was conducted to locate and synthesize existing peer-reviewed literature that examines the mechanisms connecting experiences of childhood sexual abuse and onset of substance use disorders in men.

Methods: Five databases were searched in November of 2020 to find studies published between 1980 and 2020 on the connection between CSA and subsequent substance use problems. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the review. Studies were included if they focused on pathways linking CSA and any type of substance use among males and were published in peer reviewed journals. Hand-searching or pearling was not performed.

Results: Initially, the search strategy identified 250 studies. The screening procedures, consisting of title-, abstract-, and full-text-review, led to eight articles, published between 2014 and 2020, that were included in the final analysis. The identified pathways linking CSA and SUD in male minors and adults included anger, trauma-related intrusions, negative post-traumatic cognitions, avoidance behaviors, tendency to dissociate, and general PTSD symptoms. The majority of the studies referred to self-medication as a possible explanation. The located studies revealed that CSA is common among men dealing with SUD.

Conclusion: The identified articles revealed that history of CSA among men struggling with SUDs is common and that CSA has adverse long-term effects on the afflicted individual. Consistent with Khantzian’s self-medication hypothesis, problematic substance use seems to be a way to cope with the psychological reactions that developed as a response to the trauma. While the pathways differ in their specific characteristics, male survivors of CSA appear to use drugs or alcohol to deal with anger, manage intrusive thoughts, or distance themselves from the trauma. The function of self-medication deserves more attention in the addiction treatment field, especially among men sexually abused as children. Future research could utilize these pathways to develop interventions to effectively treat substance use disorders.