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Mental Health Business Week
April 17, 2004
SECTION: EXPANDED REPORTING; Pg. 45
LENGTH: 1123 words
HEADLINE: UNIVERSITY OF AMSTERDAM: Childhood abuse may predict social phobia
and PTSD among adult alcoholics
BODY:
Both researchers and clinicians can attest to the high co-occurrence of alcoholism
and other psychiatric disorders, although the exact contribution of genetic
and environmental factors to coexisting psychopathologies remains unclear.
Findings published in Alcoholism: Clinical & Experimental Research have
uncovered the important role that an environment of childhood abuse - sexual,
physical or both - appears to play in the development of psychiatric comorbidity
among alcoholic patients.
"Our findings clearly indicate that childhood abuse – more specifically,
sexual abuse and combinations of sexual and physical abuse - is an important
factor for the presence of comorbid anxiety disorders in treated alcoholics,
particularly regarding social phobia, agoraphobia, and posttraumatic stress
disorder," said Willemien Langeland, a freelance trauma researcher at the
University of Amsterdam and the Vrije Universiteit in Amsterdam, as well as
first author of the study.
Langeland added that, compared with other environmental risk factors, childhood
sexual and "dual" abuse contribute independently
to a more severe clinical profile, that is, more comorbid diagnoses, in abused
vs. nonabused alcoholic patients. "This has not been previously demonstrated
in treated alcoholics," she said. "In addition, more severe and intrusive
forms of early sexual abuse as well as early multiple traumas are associated
with a more complex symptom constellation that includes dysthymia (a chronic
mood disorder) and suicidality."
"This study and a few others clearly show that seeing alcoholics only as
people having an alcohol problem should be a thing of the past," said Onno
van der Hart, professor of psychopathology of chronic traumatization in the
department of clinical psychology at Utrecht University in The Netherlands.
"Very often the alcohol dependency or abuse is an indissoluble part of
a history of childhood maltreatment or other adverse life events or conditions,
as well as a range of other mental health problems. Insight into such complex
patterns will lead to the realization that the simple treatment goal of 'stopping
drinking' makes sense only when the overall treatment is geared toward this
more complex system of problems."
Researchers collected data during 8 months (September 1994-May
1995) from 155 alcoholics (122 males, 33 females) applying for treatment in
a center for substance-use disorders. All study participants were assessed for
demographics and treatment history through use of the European Addiction Severity
Index; numerous childhood stressors were indexed by the Structured Trauma Interview;
and lifetime diagnoses of major depression, dysthymia, panic
disorder, social phobia, agoraphobia, generalized anxiety disorder and post-traumatic
stress disorder (PTSD) were assessed with the Composite International Diagnostic
Interview. Participants were also asked about lifetime suicide attempts.
Alcoholic patients who reported childhood abuse - sexual, or sexual and physical
- also reported social phobia, agoraphobia and PTSD more often than patients
with no history of abuse.
"Our study suggests a distinct pattern of psychiatric comorbidity associated
with childhood abuse in treatment-seeking alcoholics," said Langeland.
"These findings point to the need for greater clinical attention to the
role of childhood stressors in the evaluation and treatment of alcoholic patients.
They also underline the importance of routine assessment of childhood trauma
and possible trauma-related disorders in individuals presenting to alcohol-treatment
services. Usually, standard or routine screening procedures do not include possible
trauma-related symptoms such as PTSD, leading to under-diagnosis of this disorder."
Van der Hart concurred: "It should be/become standard procedure that
diagnostic evaluation of patients seeking treatment for alcohol or other substance
abuse or dependence includes the wide range of DSM-IV Axis I and Axis II diagnoses,"
he said. "Also, careful inquiries regarding lifetime trauma and other adverse
events seem mandatory."
Although this study's sample size of men was much greater than the sample size
of women, Langeland said it is likely that gender may influence the way that
alcohol problems and a co-occurring psychiatric disorder are related. "For
example," she said, "there is some evidence suggesting that women
may be at higher risk than men to the form of comorbidity in which the PTSD
develops first. There is also a growing body of literature, both clinical and
preclinical, that supports the notion of higher stress sensitivity in females
under both acute and chronic conditions."
In addition, said Van der Hart, "it may well be that many female patients
with alcohol dependence or abuse seek treatment in, or are referred to, more
general mental-health centers. Perhaps their comorbid disorders, such as depression
and anxiety disorders, as well as their trauma history (females report higher
degrees of sexual abuse history), are more in the foreground, with the alcohol
problems regarded as part of this overall clinical picture. Given this possibility,
in future, research patients should also be recruited from other mental-health
centers than these specialized substance-use treatment centers."
Both Langeland and Van der Hart noted that these findings raise Questions about
the use of alcohol as a form of self-medication to mitigate the negative psychological
consequences of earlier abuse.
"PTSD appears to be a particularly important factor for alcohol problems
in women who have experienced childhood sexual or physical abuse," said
Langeland.
"Given the fact that a considerable proportion of alcoholics report a history
of childhood trauma and adverse events that include childhood physical and/or
sexual abuse, as well as maternal dysfunction, which may point to neglect,"
added Van der Hart, "studies should investigate whether the use of alcohol
or other substances may be a form of coping or self-soothing. In addition, future
studies, like the current one, should not only focus on one type of trauma,
such as childhood sexual abuse, but should take the whole range of adverse life
events and conditions into account" (Langeland Willie. Draijer Nel, van
den Brink Wim. Psychiatric comorbidity in treatment-seeking alcoholics: the
role of childhood trauma and perceived parental dysfunction. Alcoholism: Clinical
& Experimental Research, 2004;28(3):441-447).
This article was prepared by Mental Health Business Week editors from staff
and other reports. Copyright 2004, Mental Health Business Week via IncRx.com.
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