"One Can't Occur without the Other": How Men Heal from Childhood Sexual Abuse in Addiction Recovery

Background: Substance misuse remains a serious public health problem in the United States (U.S.). Currently, over 22 million Americans are living in recovery from a substance use disorder (SUD). Experiencing trauma is a well-known risk factor for substance misuse. More specifically, evidence has supported a strong association between experiences of childhood sexual abuse (CSA) and SUD. Although girls experience CSA at higher rates, significant rates of boys are subjected to sexual violence in childhood. Community samples suggest that up to 25% of male clients in treatment for SUD have histories of CSA. However, the role that healing from CSA plays in the context of SUD recovery is not well understood, particularly in male survivors. To fill this gap and guided by the Self-Medication-Hypothesis and Recovery-Informed-Theory, this study explored the connection between healing from CSA and SUD recovery among male survivors.

Methods: In-depth interviews were conducted with English-speaking male survivors of CSA who have been in SUD recovery for at least one year. Purposive and snowball sampling were utilized to recruit a total of 25 adult cisgender men (mean age 45.2 years), most of them certified peer-recovery-supporters (PRS) from the midwestern U.S. Interviews were conducted in the Fall of 2023 via phone or Zoom calls. Audio recordings were transcribed using Otter.ai. Guided by aspects of grounded theory, data were analyzed using three rounds of coding. A variety of strategies were employed to build rigor, including member checking and peer debriefing.

Results: Themes emerged from the data that depict a close connection between healing from CSA and SUD recovery. Participants shared that substance use was a coping skill to self-medicate adverse effects of CSA. Two main themes emerged from the data pertaining to the role of healing in SUD recovery. First, healing and recovery are interconnected processes. Participants described SUD recovery as an individualized lifelong journey towards holistic well-being that should address sexual trauma. Survivors also explained that healing from CSA and recovery are interconnected processes of cyclical nature where sobriety is needed to start healing, and healing is essential to maintain long-term recovery. Second, SUD recovery creates unique conditions that are conducive to the processing of and healing from sexual trauma. Participants discussed that processes such as belonging to a community, improving relationship with self, learning adaptive coping skills, and engaging in mutual help facilitated healing.

Conclusion: The findings underline the important role that healing from sexual trauma plays for long-term SUD recovery in men. The results from this study have important implications for social work research and practice. Future research should develop effective interventions that are feasible and specifically tailored towards men with histories of CSA who are undergoing SUD treatment. Practitioners serving men with histories of SUD should be knowledgeable about the prevalence and effects of CSA in male clients. Interventions targeting SUD should offer a space for men to have conversations about sexual trauma and connect with other survivors. More advocacy and awareness building are needed to decrease the stigma surrounding CSA in men.