Breaking The Chains of Childhood Abuse: Resilience & Reduced Substance Use

Resilience is the ability to cope adaptively with adversity or trauma. Childhood abuse or trauma can contribute to substance use disorders.

This study explored if resilience can mitigate the deleterious effects of childhood abuse on alcohol and illicit drug use.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Substance use disorders are associated with the experience of childhood abuse.

Resilience: abilities to cope adaptively with adversity or trauma, including but not limited to childhood abuse.

Regarding risk for substance use specifically, someone experiencing childhood trauma but with high resilience might be able to rely on adaptive or flexible thinking to reduce the risk of alcohol or other drug use. Resilience characteristics may therefore mitigate the risk of developing substance use disorders, however, studies on the interaction between resilience and the experience of childhood abuse on substance use problems are very limited.

Therefore, to address knowledge gaps in research on resilience and substance use disorders, this study examined associations between resilience traits and lifetime alcohol and illicit drug use problems in a population of inner-city adults with high rates of childhood abuse and other trauma exposure.

If resilience characteristics are associated with less alcohol and illicit drug use after experience of childhood trauma, it may help explain how to support victims of childhood violence to reduce negative outcomes.

HOW WAS THIS STUDY CONDUCTED?

This was a cross-sectional study (e.g., assessed at one point in time) of 2,024 participants from inner-city areas. Participants were recruited from healthcare facilities based on having a low income, and high stress and trauma experience.

Statistical associations were examined between resilience and two separate outcomes:

lifetime alcohol use
lifetime illicit drug use

Authors adjusted for the severity of childhood abuse (emotional, sexual, and physical), other trauma experience (natural disaster, life-threatening illness, military combat, serious accident/injury, etc.), sex, and age. The sample was comprised of mostly female (70.4%) and African American (93.4%) individuals.

Additionally, they decomposed childhood abuse into subcategories of sexual, physical, and emotional abuse to test for their specific associations with alcohol and illicit drug use. Lastly, they examined associations between resilience and substance use disorders vs. substance use (separately for alcohol and other drugs).

The researchers hypothesized that greater resilience would be associated with fewer substance use problems.

WHAT DID THIS STUDY FIND?

For both lifetime hazardous alcohol and illicit drug use, resilience was associated with a reduction in use, whereas childhood abuse and other trauma experience was associated with an increase use. Notably, resilience buffered against childhood abuse to decrease hazardous alcohol use.

In addition, being a woman was also associated with less alcohol use.

Individuals with high resiliency have lower alcohol scores, even after childhood abuse.

Participants in the high resilience group had the lowest hazardous alcohol use scores compared to those of the medium and low resilience groups as displayed, even when they reported more childhood abuse.

In other words, individuals with high resilience are less affected by childhood abuse in terms of its effect on alcohol.

Individuals with medium and low resilience are more affected by having childhood trauma. The same association was found for illicit drug use. Regarding alcohol use disorder vs. alcohol use, they found that higher resilience scores were associated with lower odds of having alcohol use disorder and that greater childhood abuse or other trauma was associated with greater odds for having alcohol use disorder. These reduced odds of about 5%, however, were small in magnitude (e.g., for those with high resilience, their odds of alcohol or other drug use disorder were 1.05 times lower than for those without high resilience).

Notably, when childhood abuse was decomposed, emotional and physical abuse were associated with more problematic alcohol use, sexual abuse was only weakly associated with it. When predicting harmful drug use, emotional abuse was associated with more harmful drug use while physical and sexual abuse were not.

WHY IS THIS STUDY IMPORTANT?

This study highlights the importance of resilience and its association with less alcohol and illicit drug use in individuals with childhood abuse or trauma.

More direct experience with individuals with substance use disorder, and greater belief that treatment can be successful, was related to higher regard.

In doing so, this study helps to fill knowledge gaps on the association between resilience and substance use disorders in vulnerable treatment seeking (e.g., for healthcare) populations.

Screening individuals with substance use disorder and childhood emotional or physical abuse to assess their level of resilience (e.g., high, intermediate, or low) may offer a tool to identify individuals who could be targeted for resiliency improvement to potentially enhance treatment outcomes (e.g, those with less resilience).

LIMITATIONS

This study is limited in its generalizability due to its recruitment from healthcare facilities. Although healthcare utilization is common among many individuals in the U.S., healthcare utilization may not be evenly distributed among subgroups (e.g., insured vs. uninsured patients). Therefore, the degree to which resilience can mitigate the deleterious effects of childhood abuse on substance use disorders in other vulnerable populations is unknown.
In addition, the cross-sectional design does not allow us know the direction of the relationship between resilience and substance use. Meaning, it is also possible that using more substances creates lower resilience.
Because the study design was cross-sectional (assessed at a single one point in time), more longitudinal work would be needed to establish the value in screening.
Last, the primarily African American sample is a strength of the study but it also limits generalizability.

NEXT STEPS

More studies are needed to uncover the psychological mechanisms underlying the protective effects of resilience characteristics on substance use disorders.

For example, resilience characteristics may mitigate the risk of developing substance use disorders, perhaps through effective emotional regulation, tolerance of negative affect, or active seeking of supportive or nurturing relationships. Elucidating the mechanisms by which resilience buffers against hazardous alcohol or illicit drug use may provide clues on how to build resilience in patients with a history of childhood abuse and other traumas.

BOTTOM LINE

For individuals & families seeking recovery: If you or a family member have experienced childhood emotional or physical abuse in the past, it may relate to your substance use disorder. Consider learning about resiliency (e.g., from your treatment provider or otherwise), and the degree to which you practice it. Learning adaptability and flexibility in general may help you cope with the biopsychosocial stressors of transitioning into a sober lifestyle.
For Scientists: Resilience has received a lot attention in the scientific literature and holds promise as a way to reduce or potentially prevent alcohol and illicit drug use in individuals with childhood abuse. However, our empirical understanding of the associations between resilience, childhood abuse, and alcohol and illicit drug use is limited and this cross-sectional study is a start at exploring these associations. Longitudinal research should be tested before strong inferences can be drawn.
For Policy makers: Resilience offers a promising tool to reduce or prevent alcohol and illicit drug use among individuals with childhood abuse (see here for policy implications of resilience). This study should be replicated in longitudinal study designs to determine the if there is a relationship between resilience, alcohol and illicit drug use, and childhood abuse and how large the effect size is. Additional research could enhance understanding regarding how we may foster recovery among individuals with childhood abuse and other traumas.
For Treatment professionals and treatment systems: It is not uncommon to have patients with substance use disorder and a history of childhood abuse or trauma. Consider paying clinical attention to the resilience construct to learn about its association with alcohol or other drug use. However, more work is needed to determine if resilience should be a clinically targeted mechanism to reduce alcohol and other drug use.

CITATIONS

Wingo, A. P., Ressler, K. J., & Bradley, B. (2014). Resilience characteristics mitigate tendency for harmful alcohol and illicit drug usein adults with ahistory of childhood abuse: A cross-sectional study of 2024 inner-city men and women. Journal of Psychiatric Research, 51, 93-99.