Child Abuse and Neglect, Chronic Stress, and Drug Abuse

描述（由申请人提供）：慢性压力被认为是物质使用和依赖发展的一个主要因素，包括从使用到滥用/依赖和复发的脆弱性增加。一个特别令人关注的童年压力源是童年虐待。这项申请要求资金进行二次分析，以检查儿童虐待和忽视以及创伤后应激障碍导致吸毒和相关问题的方式。这里提出的分析利用了一个研究项目的数据，在这个研究项目中，908名受虐待和/或被忽视的儿童的初始样本根据年龄、种族、性别和大致的家庭社会阶层与667名未受虐待和未被忽视的儿童进行了匹配，并对其进行了随访，直到成年。具体目的是：(1)研究儿童虐待和忽视是否会导致成年后吸毒和滥用的风险增加；(2)探讨创伤后应激障碍（PTSD）与药物使用和滥用的关系，以及PTSD在儿童虐待和忽视与药物使用和滥用之间的中介作用；(3)检查其他可能的机制（例如，持续压力源、社会心理功能障碍和生理应激反应），这些机制可能作为儿童虐待和忽视导致药物使用和滥用的中介；(4)研究某些因素（如社会支持、适应力、学业成绩、智商和阅读能力）是否能保护受虐待和被忽视儿童不转向吸毒和滥用药物；(5)通过性别、种族/民族和背景因素来检验上述关系。本研究通过使用以下方法解决了以前研究儿童虐待和药物使用的许多局限性：1)虐待和忽视的明确操作化；2)前瞻性设计；3)将受虐待和被忽视的群体分开；4)大量的男性和女性样本；5)匹配的对照组；6)评估虐待和忽视的长期后果，从青春期到成年；7)物质使用障碍和创伤后应激障碍的诊断措施。这些发现将有助于确定重要的风险因素和保护因素，以针对受虐待和被忽视的儿童和青少年的药物预防/干预项目，以及针对受虐待的成年受害者和创伤后应激障碍患者的药物治疗项目。

DESCRIPTION (provided by applicant): Chronic stress has been cited as a major factor in the development of substance use and dependence, including increasing vulnerability for escalation from use to abuse/dependence and relapse. One childhood stressor of particular concern is childhood maltreatment. This application requests funds to conduct secondary analyses to examine the ways in which child abuse and neglect and PTSD lead to drug use and related problems. The analyses proposed here draw upon data from a research project in which an initial sample of 908 abused and/or neglected children were matched on the basis of age, race, sex, and approximate family social class with a group of 667 non-abused and non-neglected children and followed prospectively into adulthood. The specific aims are: (1) to examine whether the child abuse and neglect leads to increased risk for drug use and abuse in adulthood; (2) to examine the association between posttraumatic stress disorder (PTSD) and drug use and abuse and the potential role of PTSD as a mediator between child abuse and neglect and drug use and abuse; (3) to examine other potential mechanisms (e.g., continuing stressors, psychosocial dysfunction, and physiological stress responsivity) which may act as mediators through which child abuse and neglect leads to drug use and abuse; (4) to examine whether certain factors (e.g., social support, hardiness, academic achievement, IQ, and reading ability) protect abused and neglected children from turning to drug use and abuse; and (5) to examine the above relationships by gender, race/ethnicity, and contextual factors. This study addresses many of the limitations of previous studies examining childhood maltreatment and drug use by using: 1) an unambiguous operationalization of abuse and neglect; 2) a prospective design; 3) separate abused and neglected groups; 4) a large sample of men and women; 5) a matched comparison group; 6) assessment of the long-term consequences of abuse and neglect beyond adolescence and into adulthood; and 7) diagnostic measures of substance use disorders and PTSD. The findings will help identify important risk and protective factors to be targeted in drug prevention/intervention programs for abused and neglected children and adolescents as well as in drug treatment programs for adult victims of maltreatment and persons with PTSD.