Child Abuse and Neglect, Chronic Stress, and Drug Abuse

描述（由申请人提供）：慢性压力被认为是药物使用和依赖发展的一个主要因素，包括越来越容易从使用升级到滥用/依赖和复发。一个特别令人关注的童年压力源是童年虐待。这项申请要求提供资金进行二次分析，以审查虐待和忽视儿童以及创伤后应激障碍导致吸毒和相关问题的方式。这里提出的分析借鉴的数据从一个研究项目中，最初的样本908虐待和/或忽视的儿童进行匹配的基础上，年龄，种族，性别和近似的家庭社会阶层与一组667非虐待和非忽视的儿童，并前瞻性地跟踪到成年。具体目标是：（1）研究虐待和忽视儿童是否会导致成年后使用和滥用药物的风险增加;（2）研究创伤后应激障碍（PTSD）与药物使用和滥用之间的联系，以及PTSD作为虐待和忽视儿童与药物使用和滥用之间的中介的潜在作用;（3）研究其他潜在机制（例如，持续的压力源、心理社会功能障碍和生理压力反应性），这些因素可能充当儿童虐待和忽视导致药物使用和滥用的中介;（4）检查某些因素（例如，社会支持、坚韧性、学习成绩、智商和阅读能力）保护受虐待和被忽视的儿童不转向药物使用和滥用;（5）通过性别、种族/民族和背景因素来检查上述关系。这项研究通过以下方法解决了以往研究儿童期虐待和吸毒的许多局限性：（1）虐待和忽视的明确操作;（2）前瞻性设计;（3）单独的受虐待和被忽视群体;（4）男性和女性的大样本;（5）匹配的对照组;（6）评估虐待和忽视对青少年和成年期的长期影响;物质使用障碍和PTSD的诊断措施。研究结果将有助于确定重要的风险和保护因素，以针对药物预防/干预方案的虐待和忽视的儿童和青少年，以及在药物治疗方案的虐待和创伤后应激障碍的成年受害者。

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.