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The impact of childhood abuse on inpatient substance users: Specific links with risky sex, aggression, and emotion dysregulation
Open accessAbstract
Adults with substance use disorders (SUDs) report a high prevalence of childhood abuse. Research in the general population suggests specific types of abuse lead to particular negative outcomes; it is not known whether this pattern holds for adults with SUDs. We hypothesized that specific types of abuse would be associated with particular behavioral and emotional outcomes among substance users. That is, childhood sexual abuse would be associated with risky sex behaviors, childhood physical abuse with aggression, and childhood emotional abuse with emotion dysregulation. 280 inpatients (M age=43.3; 69.7% male; 88.4% African American) in substance use treatment completed the Childhood Trauma Questionnaire (CTQ), HIV Risk-Taking Behavior Scale, Addiction Severity Index, Difficulties with Emotion Regulation Scale (DERS), Distress Tolerance Scale (DTS), and Affect Intensity and Dimensions of Affiliation Motivation (AIM). Consistent with our hypotheses, the CTQ sexual abuse subscale uniquely predicted exchanging sex for cocaine and heroin, number of arrests for prostitution, engaging in unprotected sex with a casual partner during the prior year, and experiencing low sexual arousal when sober. The physical abuse subscale uniquely predicted number of arrests for assault and weapons offenses. The emotional abuse subscale uniquely predicted the DERS total score, AIM score, and DTS score. Among substance users, different types of abuse are uniquely associated with specific negative effects. Assessment of specific abuse types among substance users may be informative in treatment planning and relapse prevention.
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“Consistent with this, CPA has been linked to antisocial outcomes including substance abuse, aggression, criminality and violence (Banducci et al., 2014; Lansford et al., 2010).”
From Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters (2022) · cites this paper as Banducci et al., 2014
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“Avoidance and numbing symptoms are also associated with several ASrelated outcomes among African American women, including violence (Semiatin et al., 2017), aggressive behavior (Banducci et al., 2014), and alcohol dependence (Goldstein et al., 2017).”
From Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters (2022) · cites this paper as Banducci et al., 2014
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“Adults with substance use disorders (SUDs) report higher rates of child abuse than adults without SUDs (Banducci et al., 2014a, 2014b).”
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“Total DERS scores were used in the current study, consistent with extant literature (Banducci et al. 2014).”
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“Childhood trauma (CT) is a promising potential etiological factor underlying DT. CT has been shown to impair stress reactivity and emotion regulation in self-report (e.g., Banducci et al., 2014) and laboratory designs (e.g., Birn et al., 2014; Hagan et al., 2014).”
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“Studies have shown that CSA exposure is associated with early sexual debut [5,6] and other RSBs including having multiple sexual partners [7], engaging in multiple-person sex [6,8], and exchanging sex for money or drugs [5,6,9].”
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“…trauma is signi fi cantly associated with poor self-regulation in general (Walters, 2018; Xie et al., 2020), as well as with poor emotion regulation (Banducci et al., 2014; Gagnon et al., 2013) and impulsivity more speci fi cally (i.e. behavioral regulation; Carli et al., 2014; Ramakrishnan et…”
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“Across these studies, greater CT severity was associated with lower perceived DT in college student, community, and treatmentseeking samples (Arens et al., 2014; Banducci et al., 2014; Koball et al., 2016).”
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“Emotion regulation, as a psychological variable, has been given special attention from researchers in recent decades (Golman, 1995);[5,6] Several evidence exists on the relationship of emotion regulation with success and failure in different areas of life,[7,8] adaptation to life stressors (Eisenberg, Fabes, Guthrie,…”
BackgroundMey, L. S., Khairudin, R., Muda, T. E. A. T., Nor, H. A. M., & Kamaluddin, M. R. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.816373 · Cited by 9
“Studies have demonstrated that maltreatment histories are relatively common among individuals receiving treatment for substance and drug abuse (Funk et al., 2003; Banducci et al., 2014; Loy et al., 2020a).”
BackgroundAlley, J. C., McDonnell, A. S., & Diamond, L. M. (2024) · Scientific Reports · doi:10.1038/s41598-024-58389-w · Cited by 7
Korpel, P. O. J., Varkevisser, T., Hoppenbrouwers, S. S., van Honk, J., & Geuze, E. (2019) · Chronic Stress · doi:10.1177/2470547019871901 · Cited by 6
“, physical, sexual, or emotional), may differentially impact the development of (impulsive) aggression in adulthood.(64,65) Such factors might be taken into account by future endeavors that seek to study impulsive aggression problems (or psychopathy) in veterans.”
BackgroundYoung Women’s Perspectives of Their Adolescent Treatment Programs: A Qualitative Study
Clark, M. G., Buchanan, R., & Leve, L. D. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15020373 · Cited by 6
“Additionally, adults with histories of childhood trauma are more likely to exchange sex for drugs or money [5,6], be arrested for prostitution, have unprotected sex with casual partners [1], and have a high sensitivity to social rejection which leads to more risky sexual encounters [7].”
BackgroundImpulsiveness, and trait displaced aggression among drug using female sex traders
Clingan, S. E., Fisher, D. G., Pedersen, W. C., Reynolds, G. L., & Xandre, P. E. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.03.027 · Cited by 6
Leblanc, N. M., Crean, H. F., Dyer, T. V., Zhang, C., Turpin, R., Zhang, N., Smith, M. D. R., McMahon, J. M., & Nelson, L. E. (2021) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01871-z · Cited by 6
The unique contribution of childhood maltreatment types to risk-taking behavior and self-esteem
Kızıltepe, R., Duman, M. E., Sağel-Çetiner, E., & Hecker, T. (2023) · Current Psychology · doi:10.1007/s12144-023-04300-1 · Cited by 5
“The literature documented that child sexual abuse is associated with sexual risk-taking behavior (Banducci et al., 2014; Senn & Carey, 2010).”
BackgroundChen, J., Wang, D., Tian, Y., Zhu, R., Li, Y., Jia, L., Fu, F., Tang, S., Wang, X., Wang, L., et al. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01775-2 · Cited by 6
“In support of this theory, emotional processing, including the perception, experience, and regulation of emotions, has been identified as a candidate for latent vulnerability to SUDs [3, 6, 17, 39, 45, 55].”
Zenón, F., Jorge, I., Cruz, A. M., Suarez, E. L., Segarra, A. C., Vázquez, J., Meléndez, L. M., & Serrano, H. (2015) · PROTEOMICS - CLINICAL APPLICATIONS · doi:10.1002/prca.201400204 · Cited by 5
“AIDS Read.”
BackgroundInfluentialSexual Function and Alcohol and Other Drug Use
Hallinan, R. (2020) · Springer eBooks · doi:10.1007/978-3-030-36391-8_85 · Cited by 5
Age at First Sexual Activity: Clinical and Cognitive Associations
Harries, M. D., Paglia, H. A., Redden, S., & Grant, J. (2018) · Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists · doi:10.1177/104012371803000205 · Cited by 4
“15,16 Young males who were sexually traumatized as children also are more likely to engage in risky sexual behavior.”
Zadafshar, B., Sharifi, T., Ahmadi, R., & Chorami, M. (2021) · Journal of Client-centered Nursing Care · doi:10.32598/jccnc.7.3.379.1 · Cited by 5
Jaén, S. F., G., J. M. R., & Olvera, F. J. D. R. (2020) · Terapia psicológica · doi:10.4067/s0718-48082020000300317 · Cited by 5
“Entre las características de las personas que han sufrido ASI también se asocian incremento de psicopatologías, comportamientos sexuales de riesgo, inicio temprano de consumo de alcohol o drogas y arrestos relacionados por el uso de sustancias (Banducci et al., 2014).”
BackgroundVillalba, K., Domenico, L. H., Cook, R. L., O’Connor, J., Michael-Samaroo, K., Espejo, M. J. D. P., Martin, P., & Dévieux, J. G. (2023) · PLOS ONE · doi:10.1371/journal.pone.0279325 · Cited by 5
“Substantial evidence shows that women who experienced lifetime abuse are twice as likely to suffer from AUD when compared to women who experienced either childhood abuse or intimate partner violence alone [14–16].”
BackgroundMiller, K. M., Briggs, H. E., Elkins, J., Kim, I., & Mowbray, O. P. (2018) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-018-0221-0 · Cited by 5
Aboelmagd, A. N., Mahrous, E. S. Y., & Hassan, S. S. (2019) · International Journal of Nursing and Health Science · doi:10.14445/24547484/ijnhs-v5i2p103 · Cited by 4
“org Page 13 for behavioral, physical and mental health problems such as perpetrating or being a victim of violence, depression, smoking, obesity, high-risk sexual behaviors, unintended pregnancy, alcohol and drug misuse[5], [6].”
BackgroundPrevalence of Childhood Victimization Experiences in Psychiatric Patients: a Systematic Review
Mesquita, C. D. S., Basto-Pereira, M., & Maia, Â. (2016) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-016-9697-8 · Cited by 4
“Different problems, as fear, feeling of insecurity, guilt, interpersonal problems, and the emotional suffering and psychopathological symptoms, have different intervention needs (Adshead 2000; Banduccia et al. 2014).”
BackgroundReyes, M., & Clark, E. M. (2024) · Sexuality & Culture · doi:10.1007/s12119-024-10197-0 · Cited by 3
“Sexual risk-taking has been defined as having (a) short-term sexual relationships (e.g., Banducci et al., 2014; Davis et al., 2007; Kiene et al., 2009; Seth et al., 2011), (b) sexual intercourse without protection against pregnancy or STIs (e.g., Banducci et al., 2014; George et al., 2014; Kiene et…”
Flores, J., Brake, C., Hood, C. O., & Badour, C. L. (2020) · Journal of American College Health · doi:10.1080/07448481.2020.1819289 · Cited by 3
Noureddine, A., Malaeb, D. N., Sawma, T., Sakr, F., Dabbous, M., Obeïd, S., Hallit, S. R., & Fekih‐Romdhane, F. (2025) · Middle East Current Psychiatry · doi:10.1186/s43045-025-00541-x · Cited by 3
“In particular, more severe exposure to trauma in childhood was linked to lower levels of both perceived (self-reported) [11–14] and behavioral [15] distress tolerance.”
Preventing child abuse and neglect
Efe, E. (2017) · Archives of Nursing Practice and Care · doi:10.17352/2581-4265.000028 · Cited by 3
Harris, C. E., Allbaugh, L. J., & Kaslow, N. J. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00364-y · Cited by 2
“Avoidance and numbing symptoms are also associated with several AS- related outcomes among African American women, including violence (Semiatin et al., 2017), aggressive behavior (Banducci et al., 2014), and alcohol dependence (Goldstein et al., 2017).”
BackgroundPsicopatologia, esperienze traumatiche e attaccamento nella prostituzione adolescenziale
Petrocchi, C., D’Aguanno, M., Velotti, P., & Zavattini, G. C. (2017) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2016-003003 · Cited by 2
Basting, E. J., Medenblik, A. M., Schlachta, S., Garner, A. R., Shorey, R. C., & Stuart, G. L. (2025) · Archives of Sexual Behavior · doi:10.1007/s10508-025-03123-4 · Cited by 2
“…and develop PTSD symptoms may be especially vulnerable to CSB and SUDs due to associated elevations in negative affect and emotion dysregulation (Banducci et al., 2014; Mandavia et al., 2016), which could increase the likelihood of using these maladaptive behaviors to regulate emotions (Garke…”
da Costa, I. F., Tomaz, M. P. B., de Araújo, M. G., Medeiros, N. D. S. B., & Galdino, M. K. C. (2019) · Psico · doi:10.15448/1980-8623.2019.1.29581 · Cited by 2
Transitions from Care to Work for Vulnerable Young People in Spain, England, and Argentina
Estefanía, M. M., Dixon, J., & Incarnato, M. (2020) · doi:10.1093/oso/9780190937768.003.0011 · Cited by 2
Goddard, C., Broadley, K., & Hunt, S. (2017) · doi:10.1002/9781118976111.ch9 · Cited by 2
Guo, T., Zhong, K., Zhu, N., Li, C., & Kong, F. (2025) · The Journal of Positive Psychology · doi:10.1080/17439760.2025.2491457 · Cited by 2
“Another possible explanation is that different forms of trauma exert distinct impacts on individuals’ psychological and behavioral outcomes (Banducci et al., 2014).”
Canal, O. M. M., Carrillo, D. J. V., Padilla-Sarmiento, S. L., Carrillo-Sierra, S.-M., Villamizar-Carrillo, A. P., Fernández‐Montalvo, J., Pérez, O. R., Cepeda-Pineda, D., & Rivera-Porras, D. (2026) · Behavioral Sciences · doi:10.3390/bs16040589 · Cited by 2
Metadata
- Authors
- Banducci, A. N., Hoffman, E. M., Lejuez, C. W., & Koenen, K. C.
- Affiliations
- University of Maryland, College Park (US)
- Columbia University (US)
- Corresponding author
- Banducci, Anne N.
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 38
- Issue
- 5
- Pages
- 928-938
- ISSN
- 0145-2134 (ISSN-L)
- PMC
- PMC4065225
- OpenAlex
- W2069126377
- Cited by
- 125
- References
- 72
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 7 · 2022: 7 · 2021: 8 · 2020: 15 · 2019: 12 · 2018: 15 · 2017: 18 · 2016: 17 · 2015: 13
- FWCI
- 18.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Child Abuse & Neglect (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (1 F31 DA035033-01, R01 DA19405)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Keywords
- childhood abuse, substance use disorders, child sexual abuse, child physical abuse, childhood emotional abuse, sexual risk behavior, aggression, emotional dysregulation, distress tolerance, affect intensity, HIV risk behavior, inpatient substance use treatment, African American adults
- MeSH terms
- Adult, Affective Symptoms, Aggression, Arousal, Child, Child Abuse, Female, Humans, Male, Substance-Related Disorders, Unsafe Sex
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