Association of childhood maltreatment with alcohol use disorder in adulthood and potential mediation by stress regulation

Abstract

Background: While childhood maltreatment (CM) is a well-established risk factor for alcohol use disorder (AUD) during adolescence and young adulthood, few longitudinal studies have assessed this association into midlife. In addition, mechanisms of the association as well as the influence of CM exposure timing on AUD risk remain unclear. This study examined the longitudinal association of CM (including the age of initiation) with AUD in adulthood, and whether this association is explained by stress regulation.Methods: Data were drawn from the Seattle Social Development Project (SSDP), a longitudinal study that recruited students entering the 5th grade from lower income neighborhoods in Seattle, WA. CM was examined both as a binary variable (yes/no experience) and a multinomial categorical variable based on age of initiation (no CM, CM initiation prior to age 10, CM initiation ages 10-17). AUD was defined as ever meeting DSM-IV criteria for alcohol abuse or dependence between ages 27 and 47. The stress regulation variable was examined as a continuous score based on the mean value (range 1-5) of four items measured at age 27. Modified Poisson regression models were used to estimate prevalence ratios (PR) for AUD in adulthood by CM exposure as well as the timing of initiation of CM. PR from models with and without adjustment for stress regulation were compared to assess whether stress regulation attenuated the association. Results: The overall prevalence of CM in the analytic sample was 34.6%. Exposure to any CM was associated with a 44% higher prevalence of AUD in adulthood compared to no CM before (aPR=1.44, 95% CI: 1.19, 1.76) and after (aPR=1.44, 95% CI: 1.19, 1.76) adjustment for stress regulation. The association of CM with AUD was pronounced among those who experienced CM initiation prior to age 10 (aPR=1.48, 95% CI: 1.21, 1.81) compared to those who experienced CM initiation between ages 10 to 17 (aPR=1.23, 95% CI: 0.77, 1.98). Conclusions: CM, particularly when initiated prior to age 10, was associated with increased prevalence of AUD between ages 27 and 47. Stress regulation did not appear to explain this association. These results underscore the need for trauma-informed prevention and treatment approaches for AUD across the life course.