Childhood sexual abuse and substance use problems: Disentangling a complex association

Evidence for the association between childhood sexual abuse (CSA) and later misuse of substances covers a wide range of licit and illicit drugs and spans multiple stages of involvement, including increased likelihood of use, higher probability of early initiation, and elevated risk for onset of substance use disorders (SUDs). Contributions to this literature represent a variety of approaches to addressing the association of CSA to alcohol and drug-related problems, which is complicated by the fact that many of the same factors that elevate risk for CSA exposure also increase risk for substance use problems. Methods for disentangling direct effects of CSA events on substance use outcomes from the effects of risk factors that are frequently present in families in which CSA exposures occurs (e.g., parental drug or alcohol problems) include measurement and adjustment for potentially confounding factors and the use of co-twin designs. Findings across methodological approaches provide support for CSA-specific risk for substance use outcomes, despite the significant contribution of family background factors to overall risk. In combination with the critical information about treatment presentation and response provided by clinical population-based studies, these investigations represent important steps for modeling the pathways from CSA to substance use outcomes and for informing intervention efforts with this high-risk population.