CHILDHOOD TRAUMA IN ALCOHOLICS

Hasan Mirsal*, Ayhan Kalyoncu, Özkan Pektas, Devran Tan and Mansur Beyazyürek

Department of Psychiatry, Faculty of Medicine, Maltepe University, Istanbul, Turkey

* Author to whom correspondence should be addressed at: Balkl Rum Hastanesi Vakf, Anatolia Klinikleri, BelgradKap Yolu No:2 Zeytinburnu, Istanbul, Turkey. E-mail: hmirsal{at}superonline.com

(Received 20 February 2003; first review notified 9 April 2003; in revised form 10 October 2003; accepted 2 December 2003)


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Aims: Many studies have been conducted to evaluate the relationship between childhood trauma and alcoholism. In this study 80 alcoholics were chosen according to their hospitalization order. The control group consisted of 60 subjects, with no history of alcohol use, matched with the patient group in age and sex. Methods: A sociodemographic and clinical data form, a questionnaire focusing on traumatic life experiences in childhood and The Childhood Trauma Questionnaire, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were applied to both groups. Results: Significant differences were found between the two groups on traumatic life experiences in childhood. Results suggested that childhood trauma positively correlates with anxiety and affective symptoms among alcoholics. Conclusions: Further studies are needed concerning this issue.


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Many studies have been made on how alcoholism relates to traumatic experiences in adulthood (Helzer et al., 1987Go). Especially, the relationship between posttraumatic stress disorder and ‘addiction’ has been analysed in various aspects (Spiegel, 1989Go; Langlay, 1997Go). Furthermore, development of alcoholism has been explained within the framework of trauma psychology (Nadelson and Notman, 1984Go).

Trauma typically occurs when the individual's life is under threat or when a serious loss has been experienced. Unless trauma is resolved in some way this may lead to alcohol and drug misuse. In addition, aggressive behaviour and post-traumatic stress disorder may develop (Crimmins et al., 2000Go).

Many authors have suggested that the conflicts underlying trauma are the main psychological factors contributing to alcoholism (McCord and McCord, 1962Go; Blane, 1968Go). This conflict is related to parental rejection, overprotection, or imposing too much responsibility.

Traumatic childhood experiences increase the prevalence of psychiatric disorders in adult years. One of the main limitations of these studies is ‘the objectivity of trauma definition’. In studies, certain psychiatric disorders accompanying alcohol misuse have been found more frequently among subjects with childhood trauma. Adult alcohol misuse has been linked to childhood abuse and family dysfunction. However, little information is available on the contribution of multiple adverse childhood experiences (ACE) in combination with parental alcohol misuse, to the risk of later alcohol misuse (Dube et al., 2002Go). Children in alcoholic households are more likely to have adverse experiences. The risk of alcoholism and depression in adulthood increases as the number of reported adverse experiences increases, regardless of parental alcohol misuse. Depression among adult children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having had adverse childhood experiences in a home with alcohol-misusing parents (Anda et al., 2002Go). Depression and anger have been found to be more prevalent in alcoholics who lived through traumatic experiences such as emotional, physical, and sexual abuse. A history of childhood trauma was correlated with adult depression in alcoholics (Roy, 1999Go; 2001Go).

This study investigates past traumatic experiences in alcoholics. We hypothesized that alcoholics would differ from non-alcoholics in the childhood trauma history and adverse childhood experiences.


    METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
In this study eighty patients were evaluated, all of them were diagnosed as alcohol dependent according to DSM IV diagnostic criteria. The age range of patients was 20–60 years. The patient group was formed according to their order of hospitalization. Sixty volunteers, who had no alcohol use disorder nor psychiatric disorder history, were chosen from non-psychiatric clinics (internal medicine and general surgery) to form a control group. The control group had referred with gastrointestinal signs and symptoms. The two groups were matched in age and sex. A sociodemographic and clinical data form, traumatic life experiences questionnaire, The Childhood Trauma Questionnaire, the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were applied on both patient and control groups. The questionnaire aimed to determine incidents such as death of mother, death of father, divorce, lack of peace in the family, mother suffering from a serious illness, father suffering from a serious illness, being adopted, father leaving the family, mother leaving the family, missing an organ, accident, surgery, chronic illness, physical violence, lack of mother's affection, lack of father's affection, sexual abuse, death of a sibling, sibling having a serious illness experienced during the first 18 years of life. The questionnaire was based on the study carried out by Fink and his associates (Fink et al., 1995Go). Information was obtained by interviewing the patient. The patients were also interviewed concerning first- and second-degree family members with alcohol problems. Whenever possible, family members were contacted by telephone or interviewed in person to collect family history data. Diagnostic interviews were conducted by the first author, and other interviews and rating scales were conducted by the co-authors. All interviews and rating scales were applied after the standard detoxification treatment had been completed. All of this information was subsequently reviewed in weekly consensus meetings. The other scales used in our study are listed as follows.

  1. Childhood Trauma Questionnaire. The original version of this questionnaire (Fink et al., 1995Go) is a self-report scale composed of 69 items that retrospectively identify emotional injuries and parental neglect during childhood and adolescence. It is based on a 5-section Likert type rating and the scoring ranges from 1 to 5. High scores show more frequent emotional abuse during childhood and adolescence. The original version is divided into five subscales. In Turkey, a 40-item version of this scale is used and its reliability, validity and factor structure study was tested on university students. This version consists of three subscales: emotional abuse and neglect, physical abuse and sexual abuse. In this study this 40-item scale has been used (Aslan et al., 1999Go).
  2. The Structured Clinical Interview for Axis I Disorders (SCID-I) was used for alcohol dependence diagnosis (First et al., 1997Go). The non-patient version (SCID NP) was used for the control group. The Turkish clinical version of these interviews have been demonstrated to be valid and reliable for the Turkish population (Çorapçoglu et al., 1999Go).
  3. Hamilton Depression Rating Scale (Hamilton, 1960Go). This is a 17-item scale that rates the level and severity of the patient's depression. The scale is administered by a professional clinician. The validity and reliability of this study was based on a Turkish sample (Akdemir et al., 1996Go).
  4. Hamilton Anxiety Rating Scale (Hamilton, 1959Go). This is a semi-quantitative scale designed to determine the intensity of the patient's anxiety. The validity and reliability of this study was based on a Turkish sample (Yazici et al., 1998Go).

Statistical methods
All analyses were carried out using the SPSS for Windows 10.0 version. Groups were compared using Student's t-test for continuous variables and chi-squared tests for categorical variables. The Pearson correlation test was used to compare the parametric variables.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The patient and the control groups were compatible in age and sex. The patient group numbered 80 (53 men, 27 women) and control group numbered 60 (40 men, 20 women). The average age of the patient group was 44.2 (SD = 8.9) years. The highest level of past traumatic experiences was found in the section, ‘lack of peace in the family’ (32%). The assessments for divorce ({chi}2 = 13.5; d.f. = 1; P < 0.05), lack of peace in the family ({chi}2 = 28.6; d.f. = 2; P < 0.001), father leaving house ({chi}2 = 15.4; d.f. = 1; P < 0.001), mother leaving house ({chi}2 = 8.9; d.f. = 1; P < 0.05), surgery (appendectomy etc.) ({chi}2 = 13.5; d.f. = 1; P < 0.01), physical violence ({chi}2 = 32.3; d.f. = 2; P < 0.01), lack of mother's affection ({chi}2 = 27.4; d.f. = 2; P < 0.0001), lack of father's affection ({chi}2 = 9.8; d.f. = 1; P < 0.0001), sexual abuse ({chi}2 = 8.0; d.f. = 1; P < 0.05), sibling's illness ({chi}2 = 8.8; d.f. = 1; P < 0.05) showed significant statistical differences between the two groups.

During the first 18 years of life no significant differences were found between the two groups. The resultant assessments were as follows; mother's death ({chi}2 = 0.0; d.f. = 1; P > 0.05), father's death ({chi}2 = 0.0; d.f. = 1; P > 0.05), mother's serious illness ({chi}2 = 2.2; d.f. = 1; P > 0.05), father's serious illness ({chi}2 = 3.1; d.f. = 1; P > 0.05), adoption ({chi}2 = 0.0; d.f. = 1; P > 0.05), missing an organ ({chi}2 = 0.0; d.f. = 1; P > 0.05), accident ({chi}2 = 0.0; d.f. = 1; P > 0.05), chronic illness ({chi}2 = 0.0; d.f. = 1; P > 0.05), sibling's death ({chi}2 = 0.0; d.f. = 1; P > 0.05).

The two groups did not differ in marital status ({chi}2 = 2.2; d.f. = 3; P > 0.05), education level ({chi}2 = 0.9; d.f. = 2; P > 0.05), occupation ({chi}2 = 3.2; d.f. = 1; P > 0.05), or living conditions ({chi}2 = 2.1; d.f. = 1; P > 0.05). All statistical findings are listed in Table 1.


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Table 1. Traumatic life experiences and the age of their occurrence

 
The overall scores of the two groups on The Childhood Trauma Questionnaire were significantly different. In the patient group the score was 79.0 (SD = 16.2), whereas for the control group this score was 43.6 (SD = 8.9). In addition, significant differences were found on emotional abuse– emotional neglect, physical abuse and sexual abuse subscales. The average score on the emotional abuse subscale (or emotional neglect subscales) was 37.2 (SD = 10.9) for the patients and 22.4 (SD = 8.6) for the controls. The physical abuse subscale score was 31.1 (SD = 11.5) for the patients and 18.1 (SD = 3.8) for the controls; the average score on the sexual abuse subscale was 11.1 (SD = 5.3) for the patients and 3.1 (SD = 2.2) for the controls.

The average score on the Hamilton Depression Rating Scale was 28.9 (SD = 8.3) in the patient group and 17.5 (SD = 6.5) in the control group. There is a significant difference between the two groups on the Hamilton Depression Rating Scale.

The overall results for the Hamilton Anxiety Rating Scale were also significantly different. The average score was 17.7 (SD = 6.6) for the patients and 7.4 (SD = 2.8) for the controls.

A positive correlation was found with the Hamilton Depression Rating Scale, Hamilton Anxiety Scale and the subscales of The Childhood Trauma Questionnaire (r = 0.7, P < 0.0001; r = 0.5, P < 0.0001, respectively).

Also, no significant differences between the sexes were found between The Childhood Trauma Questionnaire total and subscale scores (F = 0.76, P > 0.05; F = 0.70, P > 0.05; F = 0.67, P > 0.05; F = 0.80, P > 0.05).


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Alcoholism is a disorder caused by many aetiological factors. These can be divided into four primary groups, one of which is the ‘psychodynamic’ aspect. According to psychodynamic theories, alcohol misuse is a means of coping with the anxiety arising from ‘a rigid and fairly dominant superego’ imposed on the individual. Psychological, behavioural and sociocultural theories also offer explanations for the origins of alcoholism (Schuckit, 2000Go). When attending to an issue as broad as trauma, all these theories should be considered. The period when the trauma is experienced may also determine how these theories relate. For instance, while a trauma in early childhood might be explained by psychodynamic theories, trauma experienced in later years might be better explained within the framework of other psychological theories. In this study, a ‘descriptive’ approach has been used rather than trying to explain the aetiological role of traumatic experiences.

In a study group that had applied for alcoholism treatment the level of ‘physical violence in the family’ was found to be fairly high (37%). In this study 14% of the physical violence was experienced in childhood (Easton et al., 2000Go). Our study group had a physical violence rate of 11.2%.

Clinical observations in the early years of alcohol abuse disorders suggest that inappropriate parental treatment and some other traumas in childhood seem to precede alcoholism. A history of childhood physical violence was found to occur six to 12 times, and sexual abuse 18 to 21 times more often in the alcoholics. In this study sexual abuse was higher in women, whereas other forms of physical violence seemed to be more prevalent in men. Death of a close friend, lack of peace in the family and legal complications were more frequent life events in the study group compared with the control group (Clark et al., 1997Go). The level of lack of peace in the family was found to be considerably high in our study (51.2%).

The issue of sexual abuse merits close attention when dealing with childhood traumas in alcoholics. The intensity of the trauma, rather than incidence has been of primary concern (Brabant et al., 1997Go; Windle et al., 1995Go). Our study showed a high rate of ‘sexual abuse–harassment’ of 15.0%.

The Childhood Trauma Questionnaire has also revealed higher rates of traumatic experiences in alcoholic patients. In the validity-reliability study of this scale executed among university students in our country a three-factor structure based on emotional abuse–neglect, physical abuse and sexual abuse emerged. The original version of the scale, however, consisted of six dimensions. These were ‘separation and losses, physical neglect, emotional abuse or violence, physical abuse or violence, witnessing an incident of violence, sexual abuse or violence’. In our study, assessments were based on three subscales. The higher level of overall points on The Childhood Trauma Questionnaire when compared with that of control group seem to support the fact that traumatic experiences are more prevalent among alcoholic patients. Furthermore, the overall points on the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale were higher in alcoholic patients. The higher level of scores on these scales, together with the positive correlation with The Childhood Trauma Questionnaire subscales, should be interrelated in the context of the psychopathology of alcoholism.

Some studies have focused on totally different aspects of traumatic experiences. In one study examining family relations, it was found that ‘poor, inadequate relationships’ accelerate development of alcohol abuse (DeFronzo and Pawlak, 1993Go). Among other factors affecting the development of alcoholism are parents' divorce and/or death. A deficiency in family function due to mother and/or father leaving home is also considered a significant traumatic experience (Hope et al., 1998Go; Estaugh and Power, 1991Go; Kendler et al., 1996Go; Forney et al., 1989Go). Divorce, lack of peace in the family, father leaving the family, mother leaving the family, lack of mother's affection, lack of father's affection, and physical violence variables were found to be significantly different between the two groups. In the alcoholics group these ‘adverse childhood experiences’ were found to be more often than in the control group. We found divorce rate 20.0% and lack of peace in the family rate 51.2%. These factors were higher in the patient group. Father leaving and mother leaving the family were found to be considerably high in our study. This means there were ‘family dysfunctions’ in the alcoholics group.

Furthermore, there is a significant difference between the two groups with respect to ‘experiencing surgery in childhood’. In the alcoholics group, childhood experiences of surgery were more widespread. Thus, surgery might be considered as an adverse childhood experience for our alcoholics group.

Interestingly, in our study, no statistically significant differences were found between the two groups with respect to the ‘mother's death, father's death, mother suffering from a serious illness, father suffering from a serious illness, being adopted, missing an organ, accident, chronic illness, death of a sibling’ variables. This finding might be meaningful within the sociocultural structure of our country. For example, where responsibilities and the roles of the deceased person might be undertaken by someone else from the expanded family. Therefore, some ‘adverse childhood experiences’ may not be considered as a ‘traumatic event’.

Addressing unresolved intrapsychic trauma associated with childhood abuse may improve treatment outcomes and reduce relapse rates among alcoholics (Windle et al., 1995Go). Our preliminary study on the relationship between alcoholism and past traumatic experiences offers additional information for improving the efficacy of clinical interventions throughout the treatment period.

With regard to the ages in which traumatic events have been experienced, father's death was found to be significantly different between the two groups. In the alcoholics group, father's death has been experienced at an older age (approximately around the age of 15) than in the control group. Corresponding to the adolescence period, this age range might be meaningful. The fact that the ages in which other traumatic events have been experienced did not differ between the two groups could be related to the relatively small number of traumatic events reported in the study.

In conclusion, our findings suggest that past traumatic experiences are strongly associated with alcoholism. Although the association is evident, past traumatic life experiences might not to be a causative factor in alcoholism. The limitation in our study would be the retrospective assessment of traumatic life experiences. Subjects were queried on their memories of childhood traumas. Also, detailed statistical analyses were not made for childhood trauma experienced, other drug use and dependence, other psychiatric disorders, and family history of psychiatric disorders. These limitations are obstacles to arriving at specific conclusions. But in our country, there are no large samples or any other specific studies regarding childhood traumas in alcoholism. Further prospective studies regarding this issue are needed.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Akdemir, A., Örsel, S. D., Dag, I., Türkçapar, H., Isscan, N. and Özbay, H. (1996) [Clinical use and the reliability and validity of the Turkish version of the Hamilton Depression Rating Scale.] The Journal of Psychiatry Psychology Psychopharmacology 4, 251–259. [In Turkish.]

Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R. and Williamson, D. F. (2002) Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Journal of Psychiatric Services 53, 1001–1009.[CrossRef]

Aslan, H. and Alparslan, N. (1999) [The reliability, validity and factor structure of the Childhood Trauma Questionnaire among a group of university students.] Turkish Journal of Psychiatry 10, 275–285. [In Turkish.]

Blane, H. T. (1968) The Personality of the Alcoholic: Guises of Dependency. Harper and Row, New York.

Brabant, S., Forsyth, C. J. and LeBlanc, J. B. (1997) Childhood sexual trauma and substance misuse: a pilot study. Substance Use and Misuse 32, 1417–1431.[Medline]

Clark, D. B., Lesnick, L. and Hegedus, A. M. (1997) Traumas and other adverse life events in adolescents with alcohol abuse and dependence. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1744–1751.[CrossRef][ISI][Medline]

Crimmins, S. M., Cleary, S. D., Brownstein, H. H., Spunt, B. J. and Warley, R. M. (2000) Trauma, drugs and violence among juvenile offenders. Journal of Psychoactive Drugs 32, 43–54.[ISI][Medline]

Çorapçoglu, A., Aydemir, Ö., Yildiz, M., Esen, A. and Köroglu, E. (1999) [Structured Clinical Interview for Axis I Disorders, Clinical Version.] Hekimler Yayin Birlig(breve)i, Ankara. [In Turkish.]

DeFronzo, J. and Pawlak, R. (1993) Effects of social bonds and childhood experiences on alcohol abuse and smoking. Journal of Social Psychology 133, 635–642.[ISI][Medline]

Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J. and Croft, J. B. (2002) Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviours 27, 713–725.[CrossRef][ISI][Medline]

Easton, C. J., Swan S. and Sinha, R. (2000) Prevalence of family violence in clients entering substance abuse treatment. Journal of Substance Abuse and Treatment 18, 23–28.[CrossRef]

Estaugh, V. and Power, C. (1991) Family disruption in early life and drinking in young adulthood. Alcohol and Alcoholism 26, 639–644.[ISI][Medline]

Fink, L. A., Bernstein, D., Handelsman, L., Foote, J. and Lovejoy, M. (1995) Initial reliability and validity of the childhood trauma interview: a new multidimensional measure of childhood interpersonal trauma. American Journal of Psychiatry 152, 1329–1335.[Abstract]

First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1997) Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I), Clinical Version. American Psychiatric Association, Washington, DC.

Forney, M. A., Forney, P. D. and Ripley, W. K. (1989) Predictor variables of adolescent drinking. Advances in Alcohol and Substance Abuse 8, 97–117.

Hamilton, M. (1959) The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50–55.[ISI]

Hamilton, M. (1960) A rating scale for depression. Journal of Neurology and Neurosurgical Psychiatry 23, 56–62.

Helzer, J., Robins, L. and McEvoy, L. (1987) Posttraumatic stress disorder in the general population: Findings of The Epidemiologic Catchment Area Survey. New England Journal of Medicine 317, 1630–1634.[Abstract]

Hope, S., Power, C. and Rodgers, B. (1998) The relationship between parental separation in childhood and problem drinking in adulthood. Addiction 93, 505–514.[CrossRef][ISI][Medline]

Kendler, K. S., Neale, M. C., Prescott, C. A., Kessler, R. C, Heath, A. C., Corey, L. A. and Eaves, L. J. (1996) Childhood parental loss and alcoholism in women: a causal analysis using a twin-family design. Psychological Medicine 26, 79–95.[ISI][Medline]

Langlay, M. (1997) Posttraumatic Stress Disorder and Addiction: What Are the Links. In The Principles and Practice of Addictions in Psychiatry, Miller, N. S. ed, pp. 279–296. W. B. Saunders, Philadelphia.

McCord, W. and McCord, J. (1962) A longitudinal study of the personality of alcoholics. In Society, Culture, and Drinking Patterns, Pittman, D. J. and Snyder, C. R. eds. pp. 186–201. Wiley, New York.

Nadelson, C. and Notman, M. (1984) Psychodynamics of sexual assault experiences. In Victims of Sexual Aggression: Treatment of Children Women and Men. Stuart, I. and Greer, J. eds. pp. 3–17. Van Nostrand Reinhold, New York.

Roy, A. (1999) Childhood trauma and depression in alcoholics: relationship to hostility. Journal of Affective Disorders 56, 215–218.[CrossRef][ISI][Medline]

Roy, A. (2001) Childhood trauma and attempted suicide in alcoholics. Journal of Nervous and Mental Disorders 189, 120–121.

Schuckit, M. A. (2000) Alcohol-Related Disorders. In Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 7th edn, Benjamin, J. S. and Virginia, S., eds. pp. 953–971. Lippincott, Williams and Wilkins, Maryland.

Spiegel, D. (1989) Hypnosis in the treatment of posttraumatic stress disorder. Psychiatry Clinics of North America 12, 295–305.[ISI][Medline]

Windle, M., Windle, R. C., Scheidt, D. M. and Miller, G. B. (1995) Physical and sexual abuse and associated mental disorders among alcoholic inpatients. American Journal of Psychiatry 152, 1322–1328.[Abstract]

Yazici, M. K., Demir, B., Tanriverdi, N., Karaagaoglu, E. and Yolaç, P. (1998) [Hamilton Anxiety Rating Scale: interrater reliability and validity study.] Turkish Journal of Psychiatry 9, 114–117. [In Turkish.]





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