Childhood Trauma Linked to Substance Abuse Later in Life

Jim Kling

November 07, 2016

DENVER — There is an association between childhood trauma, especially sexual trauma, and the misuse of prescription pain pills and injectable drugs, according to a large nationwide sample that followed subjects from adolescence into adulthood.

The more types of trauma that subjects experienced during childhood, the greater the odds of pain pill misuse, and those odds increase with increasing age, said Kelly Quinn, PhD, assistant professor of population health at the NYU Langone Medical Center in New York City.

"That speaks to the fact that childhood trauma potentially has down-the-road consequences that may not manifest immediately, but could have implications for the later course of health," she told Medscape Medical News.

Dr Quinn presented the research here at the American Public Health Association 2016 Annual Meeting.

She and her colleagues analyzed a range of trauma types in a diverse nationwide population using data from the National Longitudinal Study of Adolescent to Adult Health.

Of the 12,288 participants, 54% were female, 66% white, 16% were black, and 12% were Hispanic.

The cohort was stratified into three waves: adolescence, which involved participants 12 to 21 years of age; emerging adulthood, which involved participants 18 to 28 years; and adulthood, which involved participants 24 to 34 years.

The researchers looked at the exposure to trauma before the age of 18, and assessed nine specific traumas: neglect; emotional, physical, and sexual abuse; parental incarceration and binge drinking; and witness to, being threatened with, or experiencing violence.

Overall, 16% of participants experienced emotional abuse during childhood and 5% experienced personal violence. In the cohort, 47% of participants reported no childhood trauma, 28% reported one, 13% reported two, 7% reported three, 3% reported four, and 2% reported at least five.

The risk for injectable drug use in adulthood was highest for people who had experienced sexual abuse (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.44 - 9.34) and for people who had witnessed violence (OR, 2.82; 95% CI, 1.24 - 6.44).

During emerging adulthood, 20.25% of the participants misused pain pills, and during adulthood, 10.46% did. After adjustment for sociodemographic factors, the more traumas experienced, the higher the probability of pain pill misuse during emerging adulthood and adulthood.

Table 1. Number of Childhood Traumas and Pain Pill Misuse During Emerging Adulthood and Adulthood

  Emerging Adulthood Adulthood
Number of Traumas Odds Ratio 95% Confidence Interval Odds Ratio 95% Confidence Interval
1 1.34 1.14–1.58 1.46 1.12–1.91
2 1.58 1.25–1.99 1.71 1.23–2.36
3 1.70 1.20–2.25 2.16 1.43–3.26
4 2.17 1.49–3.15 2.70 1.62–4.52
5 or more 1.97 1.05–3.07 3.09 1.52–6.30

 

The relation between the number of trauma types experienced and injectable drug use during emerging adulthood was particularly striking.

Table 2. Types of Childhood Traumas and Injectable Drug Use During Emerging Adulthood

Number of Trauma Types Odds Ratio 95% Confidence Interval
     
1 1.94 0.96–3.94
2 4.32 1.98–9.46
3 2.64 0.97–7.19
4 7.15 2.65–19.29
5 or more 4.67 1.22–17.87

 

Dr Quinn ascribed the drop-off in risk at five or more traumas to the infrequency of injectable drug use in the population, which was approximately 1%. But "regardless of the drop-off, those are compelling findings," she said.

These results are similar to those seen in the 2003 Adverse Childhood Experiences (ACE) study of an HMO population in California (Pediatrics. 2003;111:564-572).

The causative relation remains unclear, according to Laurens Holmes, MD, DrPH, director of health disparity research at the Nemours Alfred I. duPont Hospital for Children in Wilmington, Delaware.

He said he is impressed by the ability of Dr Quinn's team to control for a wide range of variables, but noted that causal relations are notoriously difficult to confirm. Before being completely convinced, a closer look at the data is required, he explained.

Still, "the fact they were able to control for other traumas that were not central or fundamental to the study makes the study a bit more reasonable and realistic," Dr Holmes told Medscape Medical News.

If the relation is causative, it could have implications for the treatment and prevention of drug use.

"If you can get a sense of trauma that may have happened in childhood and address it early on, maybe you can avoid the misuse of drugs altogether," Dr Quinn said. This has "implications for drug users later down the road. You wouldn't expect to successfully treat them and prevent relapse if you weren't addressing the constellation of issues that go on in their life. That's when trauma-informed treatment comes into play."

This study could also have implications for the dispensation of pain medication, according to session moderator Judith Weissman, PhD, JD, research manager in the division of general internal medicine and clinical innovation at the NYU Langone Medical Center.

The results could help identify patients who might be at high risk for addiction, she pointed out.

In the United States, the misuse of prescription pain pills quadrupled from 1999 to 2008 (J Safety Res. 2012;43:283-289).

"There has to be much more consideration and discretion in how opioids are passed out by physicians who are not pain experts. A prescription gets a person out of pain, but ultimately it can create a problem down the road," Dr Weissman said.

Dr Quinn, Dr Holmes, and Dr Weissman have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2016 Annual Meeting: Abstract 354983. Presented November 2, 2016.

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