Elliott Jennifer C, Stohl Malka, Wall Melanie M, Keyes Katherine M, Goodwin Renee D, Skodol Andrew E, Krueger Robert F, Grant Bridget F, Hasin Deborah S
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Addiction. 2014 May;109(5):842-50. doi: 10.1111/add.12477. Epub 2014 Feb 16.
Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study.
Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities.
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence (n = 1172) and nicotine dependence (n = 4017).
Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce).
Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio (AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence (AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence (AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence (AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk (AOR = 1.19-1.36; 95% CI = 1.11-1.56).
A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence.
酒精和尼古丁依赖与相当高的发病率和死亡率相关，尤其是当病情持续时。童年期受虐待会增加酒精和尼古丁依赖的风险。然而，童年期受虐待对依赖病程的影响尚不清楚，本研究对此进行了评估。
将身体虐待、性虐待、情感虐待以及身体忽视和情感忽视作为随访3年期间持续性酒精和尼古丁依赖的预测因素，同时控制和不控制其他童年期逆境因素。
全国酒精及相关状况流行病学调查（NESARC）。
NESARC中完成基线和随访的参与者，这些参与者在基线时符合过去一年酒精依赖（n = 1172）和尼古丁依赖（n = 4017）的标准。
使用酒精使用障碍及相关残疾访谈表（AUDADIS）测量酒精/尼古丁依赖、童年期受虐待情况以及其他童年期不良经历（如父母离异）。
仅控制人口统计学因素时，身体虐待、性虐待、情感虐待和身体忽视可预测3年的酒精依赖持续性[调整优势比（AOR）= 1.50 - 2.99；95%置信区间（CI）= 1.04 - 4.68]和尼古丁依赖持续性（AOR = 1.37 - 1.74；95% CI = 1.13 - 2.11）。在控制了其他童年期逆境因素后，虐待类型仍然可以预测酒精依赖持续性（AOR = 1.53 - 3.02；95% CI = 1.07 - 4.71）和尼古丁依赖持续性（AOR = 1.35 - 1.72；95% CI = 1.11 - 2.09）。此外，更多类型的虐待会逐步增加依赖持续性风险（AOR = 1.19 - 1.36；95% CI = 1.11 - 1.56）。
童年期受虐待史可预测成年后持续性酒精和尼古丁依赖。这种关联在控制了其他童年期逆境因素后依然稳固，表明虐待（而非普遍艰难的童年）会影响依赖病程。
