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Child Abuse
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.
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.
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
behavior, and PTSD, but the exact roles childhood rape and alcohol use in adult women. Clinical and Experimental Research 23(7):1136
of these factors must be elucidated further. Child Abuse & Neglect 22(3):223234, 1998. 1144, 1999.
Once the mechanisms underlying FLEMING, J.; MULLEN, P.; AND BAMMER, G. A study ROSS, S. Risk of physical abuse to children of
the relationship between child abuse of potential risk factors for sexual abuse in child-
spouse abusing parents. Child Abuse & Neglect
and adult alcohol abuse are better hood. Child Abuse & Neglect 21(1):4958, 1997.
20(7):589598, 1996.
understood, clinicians, social workers, FLEMING, J.; MULLEN, P.E.; SIBTHORPE, B.;
and other interested groups can use ATTEWELL, R.; AND BAMMER, G. The relationship SCHUCK, A.M., AND WIDOM, C.S. Childhood
that knowledge to intervene with the between childhood sexual abuse and alcohol victimization and alcohol symptoms in females:
victims of child abuse and help pre- abuse in womenA case-control study. Addiction An examination of causality and hypothesized
93(12):17871798, 1998. mediators. Child Abuse & Neglect, in press.
vent subsequent alcohol problems in
those victims. For example, such HARTER, S.L., AND TAYLOR, T.L. Parental alco
VOGELTANZ, N.D.; WILSNACK, S.C.; HARRIS,
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