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Childhood adversity, substance use disorders affect male/female veterans, civilians differently

Study findings indicated that, among civilians, fewer women than men have alcohol or drug use disorders, but the gender difference in the prevalence of these disorders is not seen among veterans. The researchers also found that childhood adversity increased the risk for these disorders among veterans differently for each gender and differently than the civilian population.

"In general, right now we don't assess for childhood adversity until there's a problem, in particular with alcohol or drugs, or attempts to harm oneself or others. However, we know that childhood adversity is an early life experience that is associated with anxiety, depression and other risk factors for later health and social problems,” Elizabeth A. Evans, PhD, from the VA Greater Los Angeles Healthcare System, and the department of health promotion and policy, School of Public Health and Health Sciences, University of Massachusetts, said in a press release. "A lot of studies of childhood adversity focus on sexual abuse among women, and they only examine data on patients treated in clinical settings.”

Researchers assessed nationally representative data from 2012 to 2013 on 379 female and 2,740 male veterans, and 20,066 female and 13,116 male civilians to determine differences by military veteran status and gender in relationship to childhood adversity and DSM-5 lifetime alcohol and drug use disorders.

They tested interaction terms then calculated predicted probabilities by veteran status and gender after adjusting for covariates. Respondents were asked to score questions regarding abuse or neglect on a five-point scale (never, almost never, sometimes, fairly often or very often) and those regarding general household dysfunction with yes/no answers. Eleven types of childhood adversity were considered: physical, sexual, emotional abuse; psychical, emotional neglect; battered mother; parental substance use, incarceration, mental illness, suicide attempt and suicide.

The results showed that female civilians had lower prevalence of alcohol and drug use disorders compared with male civilians; however, this gender gap lessened for alcohol use disorder and expanded for drug use disorder when civilians were exposed to more childhood adversity. Veterans had similar proportions of women and men with alcohol and drug use disorders, but increased childhood adversity heightened men's alcohol risk and women's drug risk.

Childhood adversity increased alcohol use disorder probability in both civilian and veteran women to similar levels. Notably, 68% of female veterans report some childhood adversity and the highest rates of childhood sexual abuse.

“As the role of women in our nation's military expands, we need to better understand the gender-specific patterns of alcohol and drug use and whether patterns by gender are different for veterans and if so, why,” Evans said in the release. “Provision of health and social services can be improved to better meet the needs of all veterans, and in particular for women.”

Male veterans with more childhood adversity were more likely than male civilians to have alcohol use disorder, and less likely to have drug use disorders. According to Evans, more than 50% of civilian and veteran men have been exposed to physical abuse, neglect and household dysfunction in childhood, which is linked to their alcohol and drug use in adulthood.

“One of the implications of this study is the need to assess for childhood adversity, to help people recognize its relationship with substance use and cope with its health impacts,” Evans said in the release. “When people join the military or when veterans access health care at the VA or in the community would be good times to assess and treat childhood adversity, and we're often missing those opportunities now.” – by Savannah Demko

Disclosures: Evans reports no relevant financial disclosures.