The effects of physical and sexual abuse on treatment outcome among substance abusers

Previous literature has shown links between abuse experiences and substance use problems. Substance abuse is theorized as a form of self-medication for painful affects following traumatic abuse experiences. The paucity of prospective studies addressing treatment course for substance abusers who have abuse histories has necessitated research in this area. The purpose of this study was to explore whether substance abusers who report histories of physical and/or sexual abuse have more severe psychopathology and poorer treatment outcomes.;The design consisted of interviews and questionnaires administered to male and female patients entering substance abuse treatment at Roger Williams Hospital. Follow-up interviews and questionnaires were administered at one-, two- and three-month intervals. The interview instrument assessed levels of substance use and treatment utilization. Questionnaires assessed the presence of a reported physical and/or sexual abuse history and levels of psychiatric symptomatology.;The results replicate other studies which have shown that, among a substance abuse population, there is a high prevalence of patients reporting abuse histories. Statistical analyses revealed significant relationships between reported abuse histories during childhood and greater initial levels of psychopathology. Childhood physical abuse resulted in the greatest degree of elevated psychiatric symptomatology (depression, anxiety, PTSD symptoms, dissociation, and general psychiatric distress). Childhood sexual abuse also resulted in elevated levels of trauma symptomatology, dissociation, and psychiatric distress.;Tests of the relationship between the outcome variables (substance relapse and treatment utilization) and abuse history were not significant. No relationship was shown between the presence of an abuse history and greater likelihood of substance relapse within the first three months of treatment or lesser likelihood to engage in recommended treatment activities. Additional analyses were conducted to ascertain whether patients who discontinued participation in the study differed significantly from those who continued. Dropout/follow-up was not related to demographics or abuse history.;Whereas there were highly significant relationships between childhood abuse and almost every measure of psychopathology, there were no significant relationships found between childhood abuse and the two outcome measures. These findings and recent studies suggest the need for future research incorporating the independent variables of abuse history, psychopathology, and specific drug of choice in the prediction of treatment outcome.