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Alcohol Abuse as a Risk Factor

for and Consequence of

Child Abuse

Cathy Spatz Widom, Ph.D., with Susanne Hiller-Sturmhfel, Ph.D.

The relationship between child abuse and the use or abuse of alcohol has two aspects. First,
some findings have indicated that parental alcohol abuse may be associated with the physical
or sexual abuse of children. Research findings in this area remain inconsistent, however.
Second, the experience of being abused as a child may increase a persons risk for alcohol-
related problems as an adult. This relationship has best been demonstrated in women who had
been victims of childhood abuse. Several factors most likely contribute to or influence this
relationship, including coping skills; antisocial behavior; and psychological problems, such as
posttraumatic stress disorder. KEY WORDS: child abuse; AOD (alcohol or other drug) abuse; risk
factors; family AODU (AOD use, abuse, and dependence) history; family dysfunction; marital
conflict; sexual abuse; coping; antisocial behavior; posttraumatic stress disorder

A
ccording to research estimates, also can encompass a variety of abusive The first part of this article reviews
each year more than 1 million behaviors, ranging from fondling or studies assessing the alcohol-related and
children in the United States touching to sodomy, incest, or rape.
experience some form of abuse or neglect Neglect is defined as any situation in
(Widom 1993). Child abuse is one of which a child receives no care by a parent CATHY SPATZ WIDOM, PH.D., is a pro
the many types of violence associated or other primary caregiver or receives fessor in the Department of Psychiatry, New
with alcohol use and abuse, either as a care that is below acceptable commu Jersey Medical School, Newark, New Jersey.
consequence or as a causative factor. For nity or professional standards (e.g., fails
example, parental alcohol abuse may to provide adequate food, clothing, SUSANNE HILLER-STURMHOFEL PH.D.,
contribute to the abusive treatment of shelter, or medical attention). Emotional is a science editor of Alcohol Research
children. Furthermore, people who and psychological abuse, which may & Health.
have been abused as children may be occur in conjunction with the other
at increased risk for developing alcohol types of abuse previously mentioned, This research was supported in part by
abuse as adults. also can have profound long-term con- National Institute on Alcohol Abuse and
Child abuse manifests in various sequences for the child. Because this Alcoholism grants AA09238 and AA
forms, including physical abuse, sexual last type of abuse is difficult to define 11108, National Institute of Mental
abuse, neglect, and emotional or psycho- and identify, however, most research Health grant MH49467, and National
logical abuse (Widom 1989). Physical does not explicitly include emotional Institute of Justice grants 86IJCX
abuse refers to all types of maltreatment abuse in child abuse studies. Furthermore, 0033 and 89IJCX0007. Points of
that result in physical injuries, such as few studies have investigated specifi view are those of the authors and do not
bruises, welts, burns, abrasions, lacera cally the relationship between child necessarily represent the position of the
tions, cuts, or fractures. Sexual abuse neglect and alcohol use. United States Department of Justice.

52 Alcohol Research & Health


Alcohol and Child Abuse

non-alcohol-related factors that might lems were related to that parents violence Sexual Abuse. The relationship between
contribute to parental child abuse, against the child (see Miller et al. 1997). parental alcohol abuse and childhood
although these studies have produced Other studies have determined the sexual abuse (CSA) may be even more
inconsistent findings. child abuse potential (i.e., the types of complex, because the perpetrator of the
The second part of this article discipline imposed) of parents with and abuse may be the alcohol-abusing par
includes more conclusive research find without histories of alcohol and other ent or another person.2 For example,
ings concerning the relationship between drug (AOD) abuse. Ammerman and several studies found that CSA experi
childhood victimization, particularly colleagues (1999) found that parents ences for both men and women were
childhood abuse and neglect among with histories of AOD abuse had higher associated with family histories of alco
women, and subsequent adult alcohol child abuse potential than did parents holism (Miller et al. 1997). Similarly,
abuse. Within this discussion, the arti without such histories.1 In another Vogeltanz and colleagues (1999) identi
cle explores how future research may study, mothers with histories of alcohol fied parental drinking as a risk factor for
identify further characteristics that problems were more likely to use harsh CSA. Concurrently, most victims were
could increase a persons risk for devel punishment on their children compared abused by either another family mem
oping alcohol abuse as a consequence with women without such histories (see ber or by a stranger (Miller et al. 1997),
of childhood victimization. Miller et al. 1997). These results provide suggesting that parental alcohol abuse
some support for the hypothesis that may leave children more vulnerable to
parental alcohol abuse may be associ sexual abuse by others.
Factors That Contribute ated with physical child abuse. However, Fleming and colleagues (1997) have
to Parental Child Abuse further research is needed before firm supported the aforementioned hypoth
conclusions can be drawn about the esis and have found that several factors
Researchers have suggested that numer extent and nature of the connection are associated with a girls risk of being
ous factors play a role in parental child between parental alcohol abuse and sexually abused, such as experiencing
abuse. Some factors directly relate to subsequent child abuse. physical abuse, having a mother who
parental alcohol abuse, whereas other On the assumption that a relation- was mentally ill, being socially isolated,
factors do notor only do indirectly. and not having a person in which to
ship does exist between parental alcohol
problems and child abuse, researchers confide. Furthermore, whereas an alco
Physical Abuse. Although many people holic father was a risk factor for CSA
have begun to speculate about some of
might intuitively assume that parental by a family member, an alcoholic mother
alcohol use and abuse contributes to the possible mechanisms linking these
problems. For example, Miller and col was a risk factor for CSA by a person
child abuse, research in this area fre outside the family.
quently has produced inconsistent results leagues (1997) have suggested the fol
lowing three possible mechanisms: The mechanisms underlying this
(Widom 1993). For example, some association between parental alcohol
early studies on the relationship between abuse and CSA remain unclear. Possibly,
parental alcohol abuse and parental The cognitive disorganization
hypothesis posits that alcohol abuse parental alcohol abuse increases chil
perpetration of physical child abuse drens vulnerability to CSA by interfer
found only modest associations (see increases the likelihood of violence,
because it interferes with communi ing with the parents ability to provide
Miller et al. 1997). Other studies detected a supportive, nurturing, and protective
either no associations or associations cation among family members and
results in misinterpretation of social environment (Miller et al. 1997). For
limited to certain subgroups of alcohol- example, an alcohol-abusing parent
using parents (see Miller et al. 1997). cues, overestimation of perceived
threats, and underestimation of the might be less available to protect a child
These studies, however, frequently suf from extrafamilial CSA than a non-
fered from methodological limitations. consequences of violence.
alcohol-abusing parent.
Despite improvements in methodol
ogy, more recent studies also have found The deviance disavowal hypothesis
suggests that the perpetrator attributes Socioeconomic Status (SES). Several
inconsistent results regarding the asso studies have identified low SES as a fac
ciation between parental alcohol use and the violence to his or her alcohol
abuse and thus avoids or minimizes tor contributing to child maltreatment
child abuse. For example, a study among
personal responsibility for the vio (Coulton et al. 1999; Korbin 1998;
college students evaluated the partici
lent behavior. Drake and Pandey 1996). In addition,
pants recollection of childhood physi
cal, sexual, or emotional abuse and of
parental alcoholism, but found no sig The disinhibition hypothesis proposes 1
The study included only parents who met the criteria of
an alcohol-use disorder as well as another drug-use
nificant relationship between parental that alcohols pharmacological actions disorder, but excluded parents with only alcohol-use
alcohol use and the various types of on the brain interfere with the actions disorders.
child abuse (Harter and Taylor 2000). of those brain centers that control 2
Although both men and women can be victims as well as
Conversely, other retrospective studies (i.e., inhibit) socially unacceptable perpetrators of sexual abuse, most studies in this area
determined that a parents alcohol prob behaviors. focus on women (or girls) who are abused by men.

Vol. 25, No. 1, 2001 53


a low SES may both result from and Most of these studies have been con alcoholics are similar to or somewhat
contribute to alcohol abuse and depen ducted retrospectivelythat is, adoles higher than the rates found in the gen
dence. Accordingly, parental alcohol cent or adult study participants with or eral population (see Langeland and
abuse may act together with low SES without alcohol problems were asked Hartgers 1998). Overall, insufficient
to contribute to child abuse. about their childhood experiences of information exists from which to draw
abuse (e.g., Miller et al. 1993; Wilsnack firm conclusions about the relationship
Marital or Relationship Stress. et al. 1997). Fewer studies have been between childhood victimization and
Research shows that a stressful relation- conducted prospectivelythat is, have adult alcohol abuse in men (Langeland
ship between parents can markedly followed abused children through adult- and Hartgers 1998).
increase the risk of child abuse (see Miller hood to determine whether they devel Most studies on the correlation
et al. 1997; Fleming et al. 1997). For oped alcohol-related problems (e.g., between childhood victimization and
example, when such stress manifests Ireland and Widom 1994; Widom et al. adult alcohol abuse have been conducted
itself in the form of one spouse physi 1995). Studies also have differed with in women. These analyses have used a
cally abusing the other, the child also is respect to their participants. Some studies variety of samples, including women in
likely to experience such physical abuse recruited people undergoing treatment the general population, women with
(Ross 1996). Alcohol abuse by one or for alcoholism or other psychiatric dis court-documented histories of childhood
both spouses can lead to marital stress, orders (e.g., Miller et al. 1993), whereas abuse or neglect, and women undergo
including spouse abuse. This observa other studies have used general popula ing alcoholism treatment. With a few
tion reinforces the notion that parental tion samples (e.g., Wilsnack et al. 1997). exceptions (Widom et al. 1995), most
alcohol abuse potentially acts through These differences likely influenced the of these studies have focused on CSA.
several mechanisms to increase the risk applicability of the study results to the Wilsnack and colleagues (1997)
of child abuse. wider population, because not all vic investigated the relationship between
tims of child abuse seek treatment as CSA and adult drinking behavior in
Parental History of Abuse. Some studies adults, and people who do seek treat 1,099 women who participated in a 10-
have suggested that a parent who expe ment may have higher rates of alcohol year national survey on womens drinking.
rienced abuse as a child is more likely abuse than people who do not (Widom In this study, the investigators assessed
to be abusive toward his or her own et al. 1995). CSA retrospectively through self-reports
children, although this connection has Few studies have investigated the by the participants.3 Those women who
not been thoroughly confirmed by relationship between childhood victim had experienced CSA were significantly
research. For example, based on a liter ization and later alcohol use in men. In more likely than other women to report
ature review, Kaufman and Zigler (1987) a prospective study, Ireland and Widom one or more of the following alcohol-
have estimated that the rate of inter- (1994) followed 908 children with related behaviors and problems:
generational transmission of abuse is court-documented abuse or neglect his
approximately 30 percent. This means tories and a control group of 667 Alcohol consumption in the 30 days
that one-third of persons who were matched children without such histo before the survey interview
abused or neglected in childhood will ries. The investigators analyzed whether
abuse their own children, whereas the childhood victimization was associated Intoxication in the year before the
majority (i.e., two-thirds) of persons who with an increased risk of AOD-related survey interview
experienced child abuse will not abuse arrests as juveniles or adults. This analy
their own children (Widom 1989). Other sis found that for male subjects, a his- One or more alcohol-related problems
analyses have suggested that mothers who tory of childhood abuse did not signifi (e.g., fights with family members,
have a history of being physically or sexu cantly predict AOD arrests. In contrast, work problems, home accidents,
ally abused may have difficulty protecting such an abuse history significantly pre and problems with children) in the
their children from abuse by a spouse dicted adult (but not juvenile) AOD year before the interview
or other person (see Miller et al. 1997). arrests among female subjects. A fol
Thus, parental abuse history may affect lowup study of the same sample also One or more symptoms of alcohol
childrens risk of being abused. concluded that no relationship existed dependence (e.g., memory lapses
between childhood victimization and while drinking, morning drinking,
subsequent alcohol abuse in men, but and inability to stop or reduce
Child Abuse as a Risk found a significant increase in risk for
Factor for Later Alcohol women (Widom et al. 1995). An ear
Abuse lier prospective study also detected no
3
In this study, CSA was defined as (1) any intrafamilial
increased risk of adult alcohol abuse in sexual activity before age 18 that was unwanted by the
Numerous investigators have analyzed physically abused males (see Langeland woman or involved a family member at least 5 years older
the relationship between childhood and Hartgers 1998). Finally, retrospective than the woman or (2) any extrafamilial sexual activity
that occurred before age 18 and was unwanted or that
physical and sexual abuse and the devel studies found that the rates of childhood occurred before age 13 and involved a person at least 5
opment of adult alcohol problems. sexual or physical abuse among male years older than the woman.

54 Alcohol Research & Health


Alcohol and Child Abuse

drinking over time) in the year aggression). Conversely, women may be influence it. Some of those factors are
before the interview. more prone to internalizing pain and described in the following section.
suffering, which then may lead to self-
In another community-based study, destructive behaviors, including alcohol
Fleming and colleagues (1998) com
Factors Influencing the Relationship
abuse (Widom et al. 1995). Another Between Childhood Abuse and
pared the prevalence of CSA among possibility is that the men in the overall
alcohol-abusing women (as identified
Neglect and Adult Alcohol Abuse
sample were at high risk for alcohol
through their responses to the Alcohol abuse (approximately two-thirds of the Researchers have proposed several
Use Disorders Identification Test men in the sample met DSMIIIR4 hypotheses as to why victims of child
[AUDIT]) and non-alcohol-abusing criteria for alcohol abuse and/or depen abuse and neglect may be at increased
women. The study found that CSA by dence diagnosis) for a variety of reasons risk for alcohol abuse during adult-
itself did not significantly predict alco and that child abuse and neglect may hood. Thus, alcohol may serve as the
hol abuse. When considered together not have been an independent risk fac following (see Widom et al. 1995):
with other factors in a womans family tor for subsequent alcohol problems in
background (e.g., having a mother per these men. A mechanism to cope with or
ceived as cold or uncaring or having an Other researchers investigated the escape from the trauma of child-
alcoholic partner), however, a history of prevalence of CSA and other forms of hood victimization and the related
CSA became a significant predictor of childhood victimization among women depression
adult alcohol abuse. These findings undergoing alcoholism treatment and
indicate that no simple relationship various control groups (Miller et al. A way to reduce feelings of isolation
exists between CSA and adult drinking 1993). In that study, women receiving and loneliness
behavior and that numerous other fac alcoholism treatment were significantly
tors in a womans life influence this more likely to report CSA as well as Self-medication in an attempt to
relationship. father-to-daughter verbal aggression gain control over the experience
As mentioned earlier, Widom and and physical violence than women in
colleagues (1995) followed into young A way to improve self-esteem
the general population, women attend
adulthood both a large group of people
ing classes for first-time drunk-driving
who had been abused or neglected in A form of self-destructive behavior.
offenders, or women receiving treatment
childhood and a matched control group.
The investigators compared the levels of for other mental health problems (Miller Accordingly, factors such as poor
alcohol abuse and dependence in both et al. 1993). This relationship between coping skills, antisocial behavior, and
groups. The study found that for women, CSA and alcohol abuse was independent abuse-related posttraumatic stress dis
a history of childhood neglect (but not of parental alcohol problems, race, and order (PTSD) may help mediate the
abuse) significantly predicted the num the number of changes in childhood relationship between childhood victim
ber of alcohol-related symptoms experi family structure. Further analyses using ization and adult alcohol problems.
enced during adulthood, independent the same samples found that women
of parental AOD problems, childhood who reported father-to-daughter verbal Coping. Researchers have suggested
poverty, race, and age. However, neither aggression and violence during child- that for some victims of childhood
abuse nor neglect predicted the clinical hood were more likely than other women abuse, alcohol may serve as a coping
diagnoses of alcohol abuse or depen to have low self-esteem (Downs and mechanism to deal with the trauma
dence. Possibly, however, such relation- Miller 1998), suggesting that low self- associated with the abuse and its conse
ships were not detected, because the esteem may play a role in the link quences (Miller et al. 1997). For exam
courts intervention in these cases less between childhood victimization and ple, childhood victimization frequently
ened the effect of the abuse on the chil adult alcohol abuse. results in depression. People who lack
dren and improved the childrens long- In summary, various studies on the the proper coping mechanisms (e.g.,
term outcomes. relationship between childhood victim seeking help from others) to deal with
Finally, as mentioned earlier, abused ization and adult alcohol-use behaviors their experiences of childhood victim
and neglected males in the same study have yielded inconsistent results, although ization and the resulting depression
had no increased risk of adult alcohol several studies have indicated that par may use alcohol to make themselves
problems compared with control males. ticularly among women, childhood feel better. Because alcohol merely cov
The researchers suggest that the gender abuse and neglect may increase the risk ers, rather than cures, the problem, the
difference may result in part from dif for adult alcohol problems. Additional need for alcohol may persist or even
ferences in how men and women respond research is needed to clarify this rela increase over time, increasing the risk
to childhood victimization. For example, tionship and identify factors that may of developing alcohol abuse or depen
one common theory is that men may dence. This mechanism may be more
be more likely to express themselves 4
Diagnostic and Statistical Manual of Mental Disorders,
common in women than in men,
through externalizing behavior (e.g., Third Edition, Revised. because in men depression in most

Vol. 25, No. 1, 2001 55


cases appears to be a consequence of Researchers have identified several with PTSD symptoms had twice as
rather than a contributing factor to types of alcoholism, one of which is many alcohol-related symptoms as did
alcohol abuse (see Miller et al. 1997). characterized by high levels of antisocial victims without PTSD symptoms. These
Schuck and Widom (in press) also behavior that frequently begins mani authors suggest that PTSD may be one
examined the role of coping skills and festing during adolescence. Children of the mediators between childhood
other behavioral and psychological fac whose parents have this type of alco rape and alcohol use. For example,
tors (i.e., depression, isolation and lone holism may be particularly likely to be people experiencing PTSD symptoms
liness, feelings of worthlessness, and low abused during childhood. In addition, might use alcohol to gain relief from
self-esteem) in the relationship between those children are at increased risk for the persistent memories of the abuse.
childhood abuse and neglect and adult antisocial behavior and subsequent alco
alcohol problems. The study included hol problems themselves, both because
582 women with court-documented of a genetic predisposition and because Conclusion
childhood abuse and neglect. Of the of the experience of child abuse. There-
factors studied, only alcohol use as a fore, future studies of the link between Researchers have studied alcohol abuse
coping mechanism served as a mediator child abuse and later alcohol abuse need as both a contributor to and a conse
between child abuse and neglect and to address the potentially confounding quence of child abuse. To date, studies
subsequent alcohol problems. Thus, effects of a genetic predisposition for have not determined conclusively the
child abuse and neglect significantly alcohol problems (Widom 1993). role of parental alcohol abuse in the
increased the use of alcohol or other perpetration of physical or sexual child
drugs to cope, which, in turn, signifi PTSD. PTSD is caused by a persons abuse or neglect. However, several stud
cantly increased the number of alcohol experience of an extremely stressful sit ies have indicated that parental alcohol
problems. For the relationship between uation, such as threatened or actual abuse may increase a childs risk of
childhood neglect (but not abuse) and violence toward the person or toward experiencing physical or sexual abuse,
subsequent alcohol problems, depres someone close to that person. Symptoms either by a family member or by another
sion also was a mediator. of PTSD include persistent recollections person. Furthermore, researchers have
(e.g., dreams) of the trauma, avoidance proposed several hypotheses regarding
Antisocial Behavior. Several studies of any stimuli (e.g., places or people) the mechanisms through which parental
among children and adolescents who associated with the trauma, and persis alcohol abuse might contribute to the
had experienced child abuse found that tent symptoms of increased arousal (e.g., abuse or neglect of children.
externalizing and antisocial behaviors hypervigilance). PTSD is a relatively The relationship between childhood
(e.g., aggression, violence, hyperactivity, common consequence of physical or victimization and adult alcohol abuse
and delinquency) can be a consequence sexual child abuse (Miller et al. 1997; appears somewhat more solid, particu
of childhood victimization (see Miller Widom 1999), and researchers have larly for women who were victims of
et al. 1997; Widom 1989, 1997). In begun to investigate a possible link child abuse and neglect. Thus, studies
turn, persistent externalizing and anti- between child abuse, PTSD, and adult using various types of samples found that
social behaviors are strong predictors of alcohol problems, particularly among women who had experienced child-
AOD use. To explain this observation, women who previously had experienced hood maltreatment were more likely to
researchers have speculated that chil CSA. For example, one study found that have alcohol problems as adults than
dren or adolescents exhibiting such the prevalence of two or more alcohol other women and that women under-
oppositional and delinquent behaviors problems was significantly higher among going alcoholism treatment were more
may frequently become involved in women who had been victimized and likely to have been victims of child-
deviant peer groups that also promote experienced PTSD symptoms than hood victimization than other women.
AOD use. The temporal sequence of among women who had not been vic Too few studies have investigated the
these hypothesized relationships needs timized or who had been victimized relationship between childhood victim
further examination, however. but did not experience PTSD symp ization and adult alcohol use among
The relationship between childhood toms (see Miller et al. 1997). men to permit firm conclusions, but
victimization, antisocial behavior, and In another study, Epstein and col the evidence so far indicates that child
adult alcohol problems may apply par leagues (1998) investigated the link abuse and neglect is not an indepen
ticularly to victims of child abuse with between childhood rape, PTSD, and dent risk factor for subsequent alcohol
family histories of alcoholism. Research lifetime alcohol use in adult women. problems in men. Further research is
shows that children of alcoholic parents The study found that women with a greatly needed in this area. Additional
are at increased risk for alcohol prob history of childhood rape had twice as research also is needed on the factors
lems themselves (Kendler and Prescott many PTSD symptoms as did women that mediate or moderate the link
1997) and that in many cases, the risk without such a history. Furthermore, between childhood abuse and adult
is mediated by genetic rather than envi childhood rape victims had significantly alcohol-use patterns. Researchers have
ronmental influences (Prescott et al. more alcohol symptoms than did non- suggested several such factors, such as
1999). victims. Finally, childhood rape victims inadequate coping skills, antisocial

56 Alcohol Research & Health


Alcohol and Child Abuse

behavior, and PTSD, but the exact roles childhood rape and alcohol use in adult women. Clinical and Experimental Research 23(7):1136
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