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)
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ABSTRACT |
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INTRODUCTION |
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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., 2000).
Many authors have suggested that the conflicts underlying trauma are the main psychological factors contributing to alcoholism (McCord and McCord, 1962; Blane, 1968
). 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., 2002). 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., 2002
). 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, 1999
; 2001
).
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.
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METHODS |
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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.
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RESULTS |
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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 (2 = 0.0; d.f. = 1; P > 0.05), father's death (
2 = 0.0; d.f. = 1; P > 0.05), mother's serious illness (
2 = 2.2; d.f. = 1; P > 0.05), father's serious illness (
2 = 3.1; d.f. = 1; P > 0.05), adoption (
2 = 0.0; d.f. = 1; P > 0.05), missing an organ (
2 = 0.0; d.f. = 1; P > 0.05), accident (
2 = 0.0; d.f. = 1; P > 0.05), chronic illness (
2 = 0.0; d.f. = 1; P > 0.05), sibling's death (
2 = 0.0; d.f. = 1; P > 0.05).
The two groups did not differ in marital status (2 = 2.2; d.f. = 3; P > 0.05), education level (
2 = 0.9; d.f. = 2; P > 0.05), occupation (
2 = 3.2; d.f. = 1; P > 0.05), or living conditions (
2 = 2.1; d.f. = 1; P > 0.05). All statistical findings are listed in Table 1.
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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).
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DISCUSSION |
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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., 2000). 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., 1997). 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., 1997; Windle et al., 1995
). Our study showed a high rate of sexual abuseharassment 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 abuseneglect, 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, 1993). 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., 1998
; Estaugh and Power, 1991
; Kendler et al., 1996
; Forney et al., 1989
). 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., 1995). 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.
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