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CHILD MALTREATMENTAND
ADOLESCENT PROBLEM
DRINKING AMONG CHILD
WELFARE-INVOLVED YOUTH
Sherry H. Stewart, PhD
Departments of...
Overview
• Study 1 – Sex-Specific Pathways from Childhood Sexual
Abuse to Problem Drinking Among Child Welfare Youth
• Stu...
SEX-SPECIFIC PATHWAYS
FROM CHILDHOOD SEXUAL
ABUSE TO PROBLEM
DRINKING AMONG CHILD
WELFARE YOUTH
Hudson, A., Wekerle, C., G...
Background
Childhood sexual abuse (CSA)  number of enduring
negative outcomes
 Substance use and misuse
• Early initiati...
Background
Links between CSA and alcohol use well-established
 Mechanisms?
• A large proportion of CSA victims experience...
Current Study
Objective: to understand links between CSA and
alcohol problems in a sample of youth involved in child
welfa...
Method – Participants &
Design
• Subset of participants from the Maltreatment and
Adolescent Pathways (MAP) project (Weker...
Childhood Experience of Violence
Questionnaire (CEVQ; Walsh et al., 2008)
Physical, emotional, and sexual abuse (six items...
Trauma Symptom Checklist for Children
(TSCC; Briere, 1996)
Emotion symptomology in children/ adolescents
Likert scale 0 (n...
Rutgers Alcohol Problem Index
(RAPI; White & Labouvie, 1989)
• Measure of problem drinking in adolescents
• 23 negative co...
Results
Males
Results
Females
Discussion
• Emotion symptoms pertinent for predicting problem
drinking in females
• Anxiety + Anger had explanatory roles...
FROM CHILDHOOD
MALTREATMENT TO
ADOLESCENT
PROBLEM DRINKING:
MEDIATION THROUGH PTSD
SYMPTOMS AND DRINKING TO COPE
Stewart, ...
Background
Childhood maltreatment (abuse and neglect)  myriad
negative consequences
 School drop out
 Violence perpetra...
Background
Links between childhood maltreatment and alcohol misuse
well-established
 Mechanisms?
• PTSD is a possible neg...
Motives
CopingEnhancement
Social Conformity
Source
Valence
Positive Negative
External
Internal
Cooper, 1994
Motives: Links to Problems
CopingEnhancement
Social Conformity
Source
Valence
Positive Negative
External
Internal
Cooper, ...
Current Study
Objective: to understand links between childhood
maltreatment and alcohol problems in a vulnerable
sample of...
Method – Participants &
Design
• Subset of participants from the MAP project (Wekerle
et al., 2009)
• N = 568; 54% female
...
Childhood Trauma Questionnaire (CTQ; Bernstein
& Fink, 1998) – wave 1
When you were growing up….
Physical abuse
Emotional ...
Trauma Symptom Checklist for Children
(TSCC; Briere, 1996) – waves 1 and 2
PTSD scale
Hyperarousal
Reexperiencing
Avoidanc...
The Drinking Motives Questionnaire-Revised
(DMQ-R, Cooper, 1994) – waves 1 and 2
• Four motives for drinking:
• Social “To...
Rutgers Alcohol Problem Index
(RAPI; White & Labouvie, 1989) – waves 1 and 2
• Measure of problem drinking in adolescents
...
Results
Discussion
• PTSD symptoms pertinent for explaining relation of
maltreatment in childhood to problem drinking in
adolescen...
Limitations
• Issues with retrospective self-reports of CSA (e.g.,
unwillingness to disclose, memory distortions) and self...
Implications
Study 1
• Screening for CSA
• Emotion symptoms as
targets for tailored
interventions
• ‘Gendered’ approach
St...
Motivation-matched Interventions
• Motivation-matched treatments
― Individualized coping skills
― Target at-risk youth wit...
Acknowledgements
MAP Collaborators, advisory board, and research staff
Ontario Association of Children's Aid Societies
Chi...
Acknowledgements
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Wekerle CIHR Team - Child Maltreatment and Adolescent Problem Drinking Among Child Welfare-Involved Youth

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Child Maltreatment and Adolescent Problem Drinking Among Child Welfare-Involved Youth

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Wekerle CIHR Team - Child Maltreatment and Adolescent Problem Drinking Among Child Welfare-Involved Youth

  1. 1. CHILD MALTREATMENTAND ADOLESCENT PROBLEM DRINKING AMONG CHILD WELFARE-INVOLVED YOUTH Sherry H. Stewart, PhD Departments of Psychiatry and Psychology & Neuroscience Dalhousie University sstewart@dal.ca CAPHC Webinar, March 30, 2016
  2. 2. Overview • Study 1 – Sex-Specific Pathways from Childhood Sexual Abuse to Problem Drinking Among Child Welfare Youth • Study 2 -- From Childhood Maltreatment to Adolescent Problem Drinking: Mediation through PTSD Symptoms and Drinking to Cope • Conclusion – Clinical Implications; Tailored Treatments
  3. 3. SEX-SPECIFIC PATHWAYS FROM CHILDHOOD SEXUAL ABUSE TO PROBLEM DRINKING AMONG CHILD WELFARE YOUTH Hudson, A., Wekerle, C., Goldstein, A., Ellenbogen, S., Waechter, R., Thompson, K., Stewart, S. H.
  4. 4. Background Childhood sexual abuse (CSA)  number of enduring negative outcomes  Substance use and misuse • Early initiation of illicit drug use • Polysubstance use • Risk of fatal overdose • Increased alcohol use • Alcohol use disorders Dube et al 2003; Harrison et al., 1997; Brems et al., 2004
  5. 5. Background Links between CSA and alcohol use well-established  Mechanisms? • A large proportion of CSA victims experience emotion symptoms: depression, anxiety, and anger • Research suggests: Briere & Runtz, 1988; Faulkner et al., 2014; Hannan et al., 2015; Trautmann et al., 2015 Emotion Symptoms Maltreatment/ Violence Alcohol Problems
  6. 6. Current Study Objective: to understand links between CSA and alcohol problems in a sample of youth involved in child welfare services • Emotion symptoms as mediators of CSA-alcohol problems relation • Gender as potential moderator • Dep; Anx - Females • Anger - Males Briere & Elliott, 2003; Goldstein et al., 2010
  7. 7. Method – Participants & Design • Subset of participants from the Maltreatment and Adolescent Pathways (MAP) project (Wekerle et al., 2009) • Participants randomly selected through child welfare services (Children’s Aid Societies; CAS) • N = 301; 56% female • Mage =15.9 years (SD = 1.1) • Cross-sectional design • Data from single wave of MAP study
  8. 8. Childhood Experience of Violence Questionnaire (CEVQ; Walsh et al., 2008) Physical, emotional, and sexual abuse (six items) 0 = never 1 = 1–2 times 2 = 3–5 times 3 = 6–10 times 4 = more than 10 times Females Mean = 1.68 (SD 2.62)* Males Mean = 0.41 (SD 1.13) *Females significantly higher
  9. 9. Trauma Symptom Checklist for Children (TSCC; Briere, 1996) Emotion symptomology in children/ adolescents Likert scale 0 (never) to 3 (almost all of the time) Females Males Anxiety M = 5.9 (6.31)* M = 3.27 (3.78) Depression M = 6.85 (6.82)* M = 3.8 (4.58) Anger M = 7.42 (7.57) M = 6.24 (6.06) *Females significantly higher
  10. 10. Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989) • Measure of problem drinking in adolescents • 23 negative consequences of drinking • Frequency in past 12 mths 0 (never), 1 (1-2 times), 2 (3-5 times), 3 (6-10) to 4 (10+) Females Males Problem Drinking M = 9.41 (12.47) M = 10.28 (12.39)
  11. 11. Results Males
  12. 12. Results Females
  13. 13. Discussion • Emotion symptoms pertinent for predicting problem drinking in females • Anxiety + Anger had explanatory roles • Only the emotion symptom of anger important in explaining CSA  alcohol problems in males • Emotion symptoms were full mediators in females, but only partial mediators in males  More complex in males?
  14. 14. FROM CHILDHOOD MALTREATMENT TO ADOLESCENT PROBLEM DRINKING: MEDIATION THROUGH PTSD SYMPTOMS AND DRINKING TO COPE Stewart, S. H., Hudson, A., Thompson, K., & Wekerle, C.
  15. 15. Background Childhood maltreatment (abuse and neglect)  myriad negative consequences  School drop out  Violence perpetration  Internalizing symptoms (e.g., PTSD)  Alcohol/other drug misuse Langeland et al., 2004; Stewart, 1996
  16. 16. Background Links between childhood maltreatment and alcohol misuse well-established  Mechanisms? • PTSD is a possible negative outcome of child maltreatment • Research suggests: e.g., Zahradnik et al., 2011 PTSD Symptoms Childhood Maltreatment Alcohol Problems
  17. 17. Motives CopingEnhancement Social Conformity Source Valence Positive Negative External Internal Cooper, 1994
  18. 18. Motives: Links to Problems CopingEnhancement Social Conformity Source Valence Positive Negative External Internal Cooper, 1994
  19. 19. Current Study Objective: to understand links between childhood maltreatment and alcohol problems in a vulnerable sample of youth (child welfare sample) • Examine both PTSD symptoms and coping drinking motives as mediators of childhood maltreatment- alcohol problems relation • Examine chained mediation model • Maltreatment  PTSD  coping motives  alcohol problems Stewart, 1996
  20. 20. Method – Participants & Design • Subset of participants from the MAP project (Wekerle et al., 2009) • N = 568; 54% female • Mage =15.9 years (SD = 1.07) • Used pseudo-longitudinal design • Two waves of data over 6 months • 74% retention over two waves
  21. 21. Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998) – wave 1 When you were growing up…. Physical abuse Emotional abuse Sexual abuse Emotional neglect (28 items total) 1 = never . . . 5 = very often
  22. 22. Trauma Symptom Checklist for Children (TSCC; Briere, 1996) – waves 1 and 2 PTSD scale Hyperarousal Reexperiencing Avoidance Numbing Suitable for children / adolescents Likert scale 0 (never) to 3 (almost all of the time) Good psychometric properties (Ohan et al., 2002; Elliot & Briere, 1994)
  23. 23. The Drinking Motives Questionnaire-Revised (DMQ-R, Cooper, 1994) – waves 1 and 2 • Four motives for drinking: • Social “To celebrate a special occasion with friends” • Enhancement “Because it’s fun” • Coping “To forget about your problems” • Conformity “To fit in with a group you like”
  24. 24. Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989) – waves 1 and 2 • Measure of problem drinking in adolescents • 23 negative consequences of drinking • Frequency in past 12 mths 0 (never), 1 (1-2 times), 2 (3-5 times), 3 (6-10) to 4 (10+)
  25. 25. Results
  26. 26. Discussion • PTSD symptoms pertinent for explaining relation of maltreatment in childhood to problem drinking in adolescence • Extends Zahradnik et al. (2011) beyond First Nations youth • Idea that maltreatment survivors are drinking to deal with PTSD evidenced by further mediation through drinking to cope • Both mediators were necessary for mediation  More complex than PTSD or drinking to cope alone  Suggests pathway that unfolds over time
  27. 27. Limitations • Issues with retrospective self-reports of CSA (e.g., unwillingness to disclose, memory distortions) and self- reports of alcohol use (accuracy issues, esp. in youth) • Study 1: Gender norm influences on self-reported emotion symptoms • Study 1: Cross-sectional data (cannot infer causality) • Study 2 Pseudo-longitudinal design (2 waves vs optimal 4)
  28. 28. Implications Study 1 • Screening for CSA • Emotion symptoms as targets for tailored interventions • ‘Gendered’ approach Study 2 • Screening for maltreatment • PTSD symptoms and coping motives as targets for tailored interventions • Focus on both mediators What do these studies mean for targeted interventions in youth receiving child welfare services? Negative affect management; CBT for PTSD; motivation- matched interventions for substance misuse
  29. 29. Motivation-matched Interventions • Motivation-matched treatments ― Individualized coping skills ― Target at-risk youth with specific risky, motivations for substance use • Evidence of effectiveness ― Higher abstinence; lower concern ― Abstinence, reduced binging, reduced problem drinking Conrod et al., 2000 Conrod et al., 2006
  30. 30. Acknowledgements MAP Collaborators, advisory board, and research staff Ontario Association of Children's Aid Societies Child Welfare League of Canada First Nations Child and Family Caring Society Youth Participants
  31. 31. Acknowledgements

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