A literature review on the link between sexual trauma and substance abuse. How can this knowledge inform trauma based care?

1. Sexual
Trauma
Are survivors at a higher risk for substance
abuse?
A literature review by Ambrosia Isely
Walla Walla University

2. What is sexual abuse
and/or sexual assault?
• Sexual assault and sexual abuse would be
defined as anytime the victim was pressured to
do sexual things they didn’t want to do and/or
if the victim stated they were victims of sexual
rape of assault (Skinner, Kristman-Valente,
Todd & Herrenkohl, 2015) or invitations,
exposure and unwanted physical contact such
as fondling or intercourse (Downs, Gondoli, &
Keil, 1987).

3. What is substance
abuse?
• Substance abuse can be defined as any self-
disclosed level of impairment or
consequence from substance use.
Additionally, any current level of substance
abuse treatment involved or diagnosis of
substance use disorder is considered an
operational definition.

4. What is the relationship?
• The relationship between
sexual trauma and substance
abuse has been confirmed
through many different
types of research.
• The associations have been
confirmed through
longitudinal data, cross
sectional studies, qualitative
interviews and retrospective
case control studies.

5. Where does is happen?
• Sexual abuse and/or sexual assault has been reported in hospitals,
AIDS clinics, military institutions, colleges, prisons, and social service
agencies
• One such research study examined sexual trauma and substance with
two different settings: women who were incarcerated and women in
college. t (Asberg, & Renk, 2013)
• What were the findings?

6. The incarcerated women displayed worse
psychological symptoms than the college women.
• In fact, the incarcerated women
disclosed more severe forms of
(CSA) child sexual abuse
• Furthermore, these women
received negative reactions to the
disclosure of the abuse.
• Findings conclude that severity of
CSA elevates the severity of
substance abuse which in turn
increases the risk of
incarceration (Asberg, & Renk,
2013).
Severity of
CSA
Increased
Risk of
Substance
Abuse
Higher risk
of
incarceration

7. The
Who is affected by sexual trauma and
substance abuse?
• Men, women, children, female veterans, and minorities. Essentially
everyone!!!
• The research confirms the hypothesis among many different
demographics!
• One study used base line cross sectional data that was collected from a
sample of 296 men who reported risky sexual behavior and a history of CSA
The research concluded that these men were at higher risk for PTSD and
depression (Choi, Batchelder, Ehlinger, Safren., & O’Cleirigh, 2017).
• Another study drew from records from juvenile drug courts. Result
indicated that boys with a history of CSA were 10 times more likely to be
arrested. Moreover, the ratio of being arrested for at least one offense was
39 % greater for maltreated children than for the control group (Ireland, &
Spatz-Widom, 1994).

8. Are there gender
differences in coping?
• It appears so!
• In one study, 19 males and 59 females were asked to
complete a background questionnaire to assess
dispositional coping inventories, retrospective coping
styles, and assessment of current psychological
adjustment.
• Men displayed more acceptance of the abuse
whereas women used more emotion centered
strategies.
• Women showed more signs of distress, depression,
and trauma related symptoms than men. In fact,
other studies show worse outcomes for women than
men (Sigmon, Greene, Rohan, & Nichols, 1996).

9. What about race ?
1,106 women who self-
identified as lesbian and/or bisexual
were selected from the internet.
The women were administered
surveys and questionnaires on
history their history of sexual
trauma and peak drinking limits.
The representation of race
included (76%) White, (10%) African
American, (9%) Latina, and (4%)
Asian women aged 18 to 25 years.
Results showed very little
difference in outcomes of trauma
exposure, however minority
women of color were found to be
more resilient to the effects of
substance abuse, despite additional
stressors (Balsam, Molina, Blayney,
Dillworth, Zimmerman,
& Kaysen, 2015).

10. Childhood Sexual Abuse
• Much of the research found
in the literature review
examined the long-term
effects of childhood sexual
abuse (CSA) as it relates to
substance abuse.
• A study of illicit drugs in
middle adulthood and
childhood victimization was
conducted with a sample of
892 individuals identified in
cases drawn from records of
county juvenile and adult
criminal courts in a
longitudinal study (Spatz-
Widom, Marmorstein, &
Raskin-White, 2006).
• Results?

11. Childood victimization increases risk of illicit
drug use
• Results showed a strong association
between childhood victimization and
illicit drug use. Furthermore, victims
of abuse reported a higher use of
different drugs used in the past year
(i.e., marijuana, cocaine, heroin, and
psychedelics).
• Another interesting find was that
abused and neglected women
reported a far higher use of heroin
then men. The findings conclude that
survivors do not simply age out of the
substance abuse Spatz-
Widom, Marmorstein, & Raskin-
White, 2006).

12. Women Veterans
• The prevalence of sexual victimization and substance abuse
can also be seen in a military setting.
• One such study was conducted to examine this relationship
with a sample size of 1,004 veteran women who completed a
telephone survey assessing
rape history, substance abuse, dependence, depression, and
PTSD symptoms
• Results showed that one third of respondents met criteria for
lifetime substance use disorder, while half reported lifetime
completed rape, a third reported childhood rape, and one
quarter reported in-military rape.
The most recent occurrences of rape had the highest
association of substance use disorder
(Booth, Mengeling, Torner, & Sadler, 2011).

13. Reports of Rape
• A study that was conducted on the association between substance abuse
and rape included 3001 women from national sample between the ages of
18 to 86.
• Further defining criteria for the study included the respondent to have
experienced a forcible drug facilitated rape versus a non-drug facilitated
rape
• The respondents were administered a structured phone survey identifying
the details of substance abuse, rape history, and criteria for PTSD. Results
indicated that women who reported a drug facilitated rape
reported a higher incidence of substance abuse then did the women who
reported only forcible rape (Zinzow, Resnick, McCauley, Amstadter,
Ruggiero, & Kilpatrick, 2012).

14. A Recipricol relationship...
• a 3-wave longitudinal study in which a
sample of 3,006 women who were
studied for 2 years was constructed to
examine the relationship between
violent assault and substance abuse.
• Results: women who abuse substance
are at a higher risk of victimization,
and prior history of assault of women
increases the risk of substance
abuse.(Kilpatrick, & Acierno 1997).
• Given that lifestyle and behavior also
increase risk, the subculture of illicit
drug use increased interactions with
predatory assailants (Laub, 1990).
Revictimization
Substance
Abuse
Sexual Assault

15. Inconsistencies and Contradictions
• Not all studies confirmed the relationship between sexual trauma and
substance abuse.
• In fact, one study involving a sample of 239 homeless men were
drawn from four shelters in urban, rural and suburban locations, and
administered 7 questionnaires. The questionnaires contained
questions referring to both psychological trauma from childhood
physical and sexual abuse as well as severity of substance abuse to all
participants.
• Results reported an absence of association was found between the
variables of sexual trauma and substance abuse (Kim, Ford, Howard,
& Bradford, 2010).

16. How are researchers asking the question?
• One group of researchers examined multiple forms of data to measure just
how prevalent sexual assault is.
• Researchers examined studies that used large, representative samples of
female undergraduates with multiple behaviorally specific
questions. Results show empirical support towards the claims that one in
five women experience sexual assault while in college.
• Additionally researchers critique studies indicating a non-significant or
inverse relationship. According to the researchers, these studies do not
effectively address the point out misunderstandings about research
methods. In essence, the research itself is a representation of the values of
gender relations, power, and sexuality as it is perceived by mainstream
society (Muehlenhard, Peterson, Humphreys, & Jozkowski, 2017).

17. Limitations
• There were limitations and
weaknesses to all studies. For
instance, it became clear that most
of the research struggled with
disentangling other factors from
the outcomes. To elaborate, the
presence of child neglect, physical
abuse and exposure to parental
substance abuse all had a
confounding effect on the results,
even when researchers took
measures to control these
variables.
Child
Neglect
Physical
Abuse
Sexual
Abuse
Parent's
Drinking
Habits
Substance
Abuse

18. Other Limitations
• The effect of time on memory
• Attrition (participants dropping out of the study)
• Could offering something of benefit to ensure participation influence
the results?
• Mental health: An individual with prior trauma history experiences a
constant flow of interaction between environment, biology, and their
internal mental state. It is difficult to compartmentalize it.

19. Why is any of this
important?
• According to research, 1 in 5 women reported rape to police and half
reported satisfaction with the treatment they receive from the justice
system (Tjaden,& Thoennes,2006).
• Societal views influences the outcomes of disclosure. The culture of
"slut-shaming" blames the victim.(Muehlenhard, Peterson, Humphreys,
& Jozkowski, 2017).
• Other research identifies the following as disclosed barriers to seeking
substance abuse treatment: lack of transportation, fear of losing children,
denial of substance use, and acknowledgement of the difficulty involved
in completing the treatment as well as the stigmatization of receiving
treatment
• How would a survivor cope with this?
• Therefore it is important to screen!

20. Micro: understanding the trauma of the
individual provides a more holistic
approach. It also informs better
practice.
Meso: community-based prevention
and education can be an effective
intervention.
Macro: an informed society may shift
attitudes towards victim blaming that
prevents survivors from coming
forward. Empirical knowledge may
inspire social policies or programs that
assist individuals with cooccurring
disorders.

21. Conclusion
• The research confirms a
strong relationship between
sexual abuse/assault and
substance abuse. This
knowledge can inform
practitioners on how best to
develop a screening process
for sexual abuse/assault
survivors as well as offer
interventions based on
cooccurring disorders.

22. References
• Asberg, K., & Renk, K. (2013). Comparing incarcerated and college student women with histories of childhood sexual abuse: The roles of abuse severity, support, and substance
use. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 167–175.
• Balsam, K. F., Molina, Y., Blayney, J. A., Dillworth, T., Zimmerman, L., & Kaysen, D. (2015). Racial/ethnic differences in identity and mental health outcomes among young sexual
minority women. Cultural Diversity and Ethnic Minority Psychology, 21(3), 380–390.
• Booth, B. M., Mengeling, M., Torner, J., & Sadler, A. G. (2011). Rape, sex partnership, and substance use consequences in women veterans. Journal of Traumatic
Stress, 24(3), 287–294.
• Choi, K. W., Batchelder, A. W., Ehlinger, P. P., Safren, S. A., & O’Cleirigh, C. (2017). Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD,
and sexual risk in sexual minority men with trauma histories. Journal of Consulting and Clinical Psychology, 85(12), 1158–1170.
• Ireland, T., & Spatz-Widom, C. (1994) Childhood Victimization and Risk for Alcohol and Drug Arrests, International Journal of the Addictions, 29:2, 235-274.
• Kim, M. M., Ford, J. D., Howard, D. L., & Bradford, D. W. (2010). Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health & Social
Work, 35(1), 39–48.
• Laub, J. H. (1990). Patterns of criminal victimization in the United States. In A. J. Lurigion, W. G. Skogan, & R. C. Davis (Eds.), Victims of crime: Problems, policies, and programs
(pp. 23-46). Newbury Park, CA: Sage.
• Muehlenhard, C. L., Peterson, Z. D., Humphreys, T. P., & Jozkowski, K. N. (2017). Evaluating the one-in-five statistic: Women’s risk of sexual assault while in college. Journal of Sex
Research, 54(4–5), 549–576.
• Sigmon, S. T., Greene, M. P., Rohan, K. J., & Nichols, J. E. (1996). Coping and adjustment in male and female survivors in childhood sexual abuse. Journal of Child Sexual Abuse,
5(3), 57-75.
• Spatz Widom, C., Marmorstein, N. R., & Raskin White, H. (2006). Childhood victimization and illicit drug use in middleadulthood. Psychology of Addictive Behaviors, 20(4), 394–403
• Tjaden, P. G., & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey.
• Zinzow, H. M., Resnick, H. S., McCauley, J. L., Amstadter, A. B., Ruggiero, K. J., & Kilpatrick, D. G. (2012). Prevalence and risk of psychiatric disorders as a function of variant rape
histories: Results from a national survey of women. Social Psychiatry and Psychiatric Epidemiology, 47(6), 893–902.