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Childhood Sexual Abuse and Substance Abuse Disorder

Aryaman Singh


Child sexual abuse can be defined as any type of sexual activity with a minor, i.e. any individual younger than the age of consent of a particular country. Children lack the capacity to comprehend the situation, and as such are unable to provide voluntary consent. Abuse is not only restricted to physical contact- it includes exhibitionism, involving a child in pornography or child prostitution, and online child-luring by cyber predators. According to the Rape, Abuse, and Incest National Network (RAINN) as many as 93% of survivors under the age of 18 know the abuser. About one in 10 children will be abused before their 18th birthday. The rates of reported sexual abuse have shown a gradual decline over the years for reasons unknown (a drop of 47% from 1993 to 2005-06), and it is estimated that only 38% of survivors disclose the fact that they have been abused. The consequences of such activity can be devastating, often resulting in a lifetime of post-traumatic stress disorder, depression, and/or anxiety. Survivors have a propensity to turn to substances as a way of coping with the abuse. This has been portrayed many times in media, most recently in the five-part drama miniseries Patrick Melrose. In this blog post, I will highlight the correlation between childhood sexual abuse and future substance abuse disorder, and assert that childhood sexual abuse substantially increases the risk of substance abuse.
There is a difference in the likelihood of reporting substance abuse between survivors of sexual abuse and the general population. Female adult survivors are nearly three times more likely to report substance abuse problems (40.5% compared to 14% in the general population), and male adult survivors are 2.6% more likely to report substance abuse (65% versus 25% in the general population). A study (Kendler et al., 2000) found that women who report childhood sexual abuse are at an increased risk for developing psychiatric and substance abuse disorders in adulthood. Another study (Molnar et al., 2001) found that, when other childhood adversities are controlled for, there were significant associations between childhood sexual abuse and the subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 in men. In respondents who reported no other adversities, the odds of depression and substance problems were higher. A study in New Zealand (Fergusson et al., 1996) found that individuals who reported childhood abuse had higher rates of major depression, anxiety disorder, conduct disorder, substance use disorder, and suicidal behaviour than those not reporting CSA (p < .002). 
Not all coping mechanisms are destructive or maladaptive, but addiction is both. Unfortunately, addiction also happens to be one of the more common coping mechanisms. Survivors of childhood sexual abuse have to endure hellish circumstances for extended periods of time. Most survivors don’t report their abuse due to the shame and guilt associated with it, and they often develop the belief that they caused (and deserved) the abuse. The passivity of people who are aware of the abuse but do nothing to stop it does nothing to change this belief. Alcohol and drugs provide the survivors with the escape that they crave.
It’s evident that childhood sexual abuse results in an increased risk of substance abuse in adulthood. This abuse is a pertinent issue not just because of the aftermath, but also because the rates of reporting are alarmingly low. Research and data collection are challenging due to the sensitive nature of the situation. Substances are cheap and accessible, but ultimately pernicious. The relief is ephemeral and people tend to develop a tolerance to the effects of the drugs. This, in turn, paves the way for addiction. Increased awareness regarding child sexual abuse and an emphasis on counseling and reporting are of paramount importance.   
References
·       Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of general psychiatry, 57(10), 953-959.
·       Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American journal of public health, 91(5), 753.
·       Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1996). Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 35(10), 1365-1374.
·       Simpson, T. L., & Miller, W. R. (2002). Concomitance between childhood sexual and physical abuse and substance use problems: A review. Clinical psychology review, 22(1), 27-77.
·       Adult Manifestations of Childhood Sexual Abuse. (2011, August). Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Adult-Manifestations-of-Childhood-Sexual-Abuse?IsMobileSet=false
·       Child Sexual Abuse. (n.d.). Retrieved from https://www.rainn.org/articles/child-sexual-abuse
·       Child Sexual Abuse Statistics. (n.d.). Retrieved from https://www.d2l.org/the-issue/statistics/

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