The relationship between sexual and physical abuse and
substance abuse consequences
Jane Liebschutz, M.D., M.P.H.
*, Jacqueline B. Savetsky, M.P.H.
Richard Saitz, M.D., M.P.H.
, Nicholas J. Horton, Sc.D.
Christine Lloyd-Travaglini, M.P.H.
, Jeffrey H. Samet, M.D., M.A., M.P.H.
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine,
Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA 02118, USA
Department of Social and Behavioral Sciences, Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA 02118, USA
Department of Epidemiology and Biostatistics, Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA 02118, USA
Received 15 August 2001; received in revised form 7 December 2001; accepted 21 January 2002
This study examines the relationship between a history of physical and sexual abuse (PhySexAbuse) and drug and alcohol related
consequences. We performed a cross-sectional analysis of data from 359 male and 111 female subjects recruited from an inpatient
detoxification unit. The Inventory of Drug Use Consequences (InDUC), measured negative life consequences of substance use. Eighty-one
percent of women and 69% of men report past PhySexAbuse, starting at a median age of 13 and 11, respectively. In bivariate and mul-
tivariable analyses, PhySexAbuse was significantly associated with more substance abuse consequences ( p < 0.001). For men, age 17
years at first PhySexAbuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse
( p = 0.048). For women, the association of PhySexAbuse with substance use consequences was similar across all ages ( p = 0.59). Future
research should develop interventions to lessen the substance abuse consequences of physical and sexual abuse. D 2002 Elsevier Science Inc.
All rights reserved.
Keywords: Physical abuse; Sexual abuse; Childhood abuse; Substance use consequences; Detoxification
Studies of interpersonal trauma and substance abuse in
women have shown a strong association between the two
conditions. The nature of the association appears to be com-
plex, in that a history of interpersonal trauma increases the
risk for substance abuse, and substance abuse increases the
risk for interpersonal trauma.
There is a great deal of evidence showing a close link
between interpersonal violence and substance abuse(Res-
nick, Acierno, & Kilpatrick, 1997). The vast majority of
studies have been cross-sectional studies of women, al-
though a few have looked at the association in men. In a
prospective study of 3000 women followed for two years,
interpersonal assault increased subsequent use of alcohol
and drugs even in those women without prior history of
substance abuse. Women who used drugs at study entry had
an increased risk of subsequent assault, although women
who used alcohol alone did not have this increased risk
(Kilpatrick, Acierno, Resnick, & Saunders, 1997). Other in-
vestigators have looked retrospectively at histories of inter-
personal violence among both male and female clients of
drug treatment programs and found that, while prevalent,
histories of interpersonal violence do not appear to correlate
with worse treatment outcomes (Gil-Rivas, Fiorentine,
Anglin, & Taylor, 1997; Hien & Scheier, 1996).
In an attempt to clarify the mediating factors between
trauma and substance abuse outcomes, Clark and colleagues
stratified 150 male and female methadone maintenance
clients into those with no history of interpersonal or envi-
ronmental trauma; those with past trauma but no Posttrau-
matic Stress Disorder (PTSD); those with trauma and PTSD
but no recent symptoms; and those with trauma, PTSD
0740-5472/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved.
PII: S 0740-5472(02)00220-9
* Corresponding author. Boston Medical Center, 91 East Concord
Street, Suite 200, Boston, MA 02118, USA. Tel.: +1-617-414-7399; fax:
E-mail address: email@example.com (J. Liebschutz).
Journal of Substance Abuse Treatment 22 (2002) 121 –128