Substance Abuse Treatment Capacity
Childhood physical and sexual abuse and neglect have a staggering impact on the prevalence of substance abuse in adulthood. Current treatment capacity is inadequate to meet the need.
Facts and Discussion Points:
1--Up to two-thirds of both men and women in substance abuse treatment report childhood abuse or neglect.1
2--Seventy-five percent of women in treatment programs for drug and alcohol abuse report having been sexually abused.2
3--HMO adult members who had experienced multiple childhood exposures to abuse and violence had a 4- to 12-fold increased risk of alcoholism and drug abuse, and a 2- to 4-fold increase in smoking.3
4--Adults abused during childhood are more than twice as likely as those not abused during childhood to abuse substances.4
5--In a study of 100 adult consumers with polytoxic drug abuse, 70% of the female and 56% of the male drug users had been sexually abused before the age of sixteen. Forty percent of the male and 50% of the female participants had a history of severe sexual abuse with sexual intercourse. In over 50%, friends or relatives were the perpetrators; parents were not perpetrators in any of the cases. More than 40% also showed a history of physical abuse. Significantly more drug users than alcohol abusers had a sexual trauma. Especially severe sexual abuse was associated with abuse of hard illegal drugs.5
6--Nine out of ten children who need drug treatment are not getting it. One million, one hundred thousand American children 12- to 17-years-old have problems with drugs and alcohol. Only about 122,000 of them received treatment in 2000.6
7--Teenagers with alcohol and drug problems are 6 to 12 times more likely to have a history of being physically abused and 18 to 21 times more likely to have been sexually abused than those without alcohol and drug problems.7
8--About 4.7 million Americans age 12 and older are abusing or dependent on illegal drugs. Of that number, 3.9 million received no treatment in 2000.8
* Nearly 8% of individuals in the U.S.—20 million people—will have full-blown PTSD in their lifetime. Fifty to sixty percent of consumers with PTSD (10 to 12 million people) will develop alcohol or substance abuse. Many of these people do not get the help they need because the problem (PTSD) is not identified and they don’t receive appropriate treatment.9
* Substance abuse (SA) treatment recovery rates are very poor for clients who have histories of victimization and are treated in programs where the link between trauma and SA is not dealt with. Money spent on treatment for SA is often lost due to high relapse rates from un-addressed problems.10
* Nearly 90% of alcoholic women were sexually abused as children or suffered severe violence at the hands of a parent.11
* Seventy-one to ninety percent of adolescent and teenage girls and 23% to 42% of adolescent and teenage boys in a Maine inpatient substance abuse treatment program reported histories of childhood sexual abuse.12
Recommendations:
1---Address trauma in all SAMHSA policies and activities concerned with the substance abuse treatment gap. Thoroughly investigate and deal with unresolved trauma as a causative or co-occurring factor in addiction development—in all prevention and/or early intervention programs, all treatment approaches and programs, all public education campaigns, and in all related funding and insurance coverage programs.
2---Train substance abuse treatment providers to assess clients/consumers for abuse/trauma histories and to provide or refer to experienced trauma services.
3---Routinely assess all clients in treatment for substance abuse for physical and/or sexual abuse and refer to appropriate trauma services if needed.
4---Encourage all substance abuse services staff to integrate concept of trauma as direct and primary cause of a majority of substance use.
5---Clients in substance abuse programs who are assessed as having trauma histories should learn the direct connection between trauma and substance abuse as self-medication.
6---All substance abuse programs should actively support and integrate the teaching and use of trauma symptom management skills as an alternative to substance use.
Substance Abuse Treatment Capacity References
1. Center for Substance Abuse Treatment. (2000). Substance abuse treatment for persons with child abuse and neglect issues. Treatment Improvement Protocol (TIP) Series. Number 36. DHHS Publication No. (SMA) 00-3357. Washington, DC: U.S. Printing Office.
2. SAMHSA Center for Drug Abuse Treatment. (1994). Practical approaches in the treatment of women who abuse alcohol and other drugs. US Public Health Service. Rockville, MD: SAMHSA.
3. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med, 14:245-258.
4. Stein, J. A., Golding, J. M., Siegel, J. M., Burnam, M. A., Sorenson, S. B. (1988). Long-term psychological sequelae of child sexual abuse: The Los Angeles Epidemiologic Catchment Area Study. In G. E. Wyatt, & G. J. Powell (Eds.), Lasting Effects of Child Sexual Abuse. Sage Focus Editions, Vol. 100 (pp.135-154). Newbury Park, CA: Sage Publications.
5. Schafer, M. (February 2000). Sexual and physical abuse during early childhood or adolescence and later drug addiction. Psychother Psychosom Med Psychol, Vol.50 (2), pp.38-50.
6. SAMHSA. (August 16, 2002). National and state estimates of the drug abuse treatment gap. OAS Publication. See www.samhsa.gov/oas/newpubs.htm#2k2pub
7. Clark, H. W., McClanahan, T. M., Sees, K. L. (Spring 1997). Cultural aspects of adolescent addiction and treatment. Valparaiso University Law Review. Vol. 31(2).
8. SAMHSA. (2000). The National Household Survey on Drug Abuse (NHSDA). See www.samhsa.gov/oas/oas.html
9. Marshall, R. (May 2001). Lead author of study presented at the 154th annual meeting of the American Psychiatric Association.
10. R. Mazelis (personal communication, April 2002).
11. Miller, B., Downs, W. (1993). Journal of Studies in Alcohol, Supplement No. 11:109-117.
12. Rohsenow, D. J., Corbett, R., Devine, D. (1988). Chemical Dependency Treatment Program, Mid-Maine Medical Center, Waterville, Maine. Molested as children: A hidden contribution to substance abuse? Journal of Substance Abuse Treatment, Vol. 5, pp.13-18.