Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders

  • Mary Jo Larson
  • Lisa Miller
  • Marion Becker
  • Erin Richardson
  • Nina Kammerer
  • Jennifer Thom
  • Joanne Gampel
  • Andrea Savage
Special Issue


This article documents the physical health burdens of participants in a large, federally funded cross-site study of specialized services for women with histories of trauma (physical or sexual abuse) and co-occurring substance abuse and mental health disorders. Nearly half of the 2729 women in the study (48%) reported serious physical illnesses that frequently limited their daily life activities or required them to use special equipment. Nearly half (46%) rated their health status as only fair or poor. Given the prevalence of physical illnesses in this population, behavioral service providers should discuss with clients their overall health and how it might hinder their participation in treatment for trauma, substance abuse, and mental illness, and policymakers should consider this need when designing behavioral health requirements, setting reimbursement rates, and allocating funds.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fullilove M, Fullilove R, Smith M, et al. Violence, trauma and post-traumatic stress disorder among women drug users.Journal of Traumatic Stress. 1993;6(4):533–543.Google Scholar
  2. 2.
    Miller BA, Downs WR, Testa M. Interrelationships between victimization experiences and women's alcohol use.Journal of Studies on Alcohol Supplement. 1993;11:109–117.Google Scholar
  3. 3.
    Najavits LM, Weiss RD, Shaw SR. The link between substance abuse and posttraumatic stress disorder in women: a research review.The American Journal of Addictions. 1997;6:273–283.Google Scholar
  4. 4.
    Yandow V. Alcoholism in women.Psychiatric Annals. 1989;19:243–247.Google Scholar
  5. 5.
    Zierler S, Feingold L, Laufer D, et al. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection.American Journal of Public Health. 1991;81(5):572–575.Google Scholar
  6. 6.
    Gil-Rivas V, Fiorentine R, Anglin MD. Sexual abuse, physical abuse, and posttraumatic stress disorder among women participating in outpatient drug abuse treatment.Journal of Psychoactive Drugs. 1996;28(1):95–102.Google Scholar
  7. 7.
    MacMillan HL, Fleming JE, Streiner DL, et al. Childhood abuse and lifetime psychopathology in a community sample.American Journal of Psychiatry. 2001;158(11):1878–1883.Google Scholar
  8. 8.
    Kaplan MJ, Klinetob NA. Childhood emotional trauma and chronic posttraumatic stress disorder in adult outpatients with treatment-resistant depression.Journal of Nervous Mental Disorders. 2000;188(9):596–601.Google Scholar
  9. 9.
    Felitti VJ. Long-term medical consequences of incest, rape, and molestation.Southern Medical Journal. 1991;84(3):328–331.Google Scholar
  10. 10.
    Campbell J, Jones AS, Dienemann J, et al. Intimate partner violence and physical health consequences.Archives of Internal Medicine. 2002;10(162):1157–1163.Google Scholar
  11. 11.
    Kovac SH, Klapow JC, Kroenke K, et al. Differing symptoms of abused versus nonabused women in obstetric-gynecology settings.American Journal of Obstetrics and Gynecology. 2003;188(3):707–713.Google Scholar
  12. 12.
    De Alba I, Samet JH, Saitz R. Burden of medical illness in drug and alcohol dependent persons without primary care.American Journal of Addictions. 2004;13(1):33–45.Google Scholar
  13. 13.
    Goodwin RD, Hoven CW, Murison R, et al. Association between childhood physical abuse and gastrointestinal disorders and migraine in adulthood.American Journal of Public Health. 2003;93(7):1065–1067.Google Scholar
  14. 14.
    Walker EA, Katon WJ, Hansom J, et al. Medical and psychiatric symptoms in women with childhood sexual abuse.Psychosomatic Medicine. 1992;54(6):658–664.Google Scholar
  15. 15.
    Romans S, Belaise C, Martin J, et al. Childhood abuse and later medical disorders in women. An epidemiological study.Psychotherapy Psychosomatics. 2002;71(3):141–150.Google Scholar
  16. 16.
    Bassuk EL, Dawson R, Perloff J, et al. Post-traumatic stress disorder in extremely poor women: implications for health care clinicians.Journal of the American Medical Women's Association. 2001;56(2):79–85.Google Scholar
  17. 17.
    Anda RF, Croft JB, Felitti VJ, et al. Adverse childhood experiences and smoking during adolescence and adulthood.The Journal of American Medical Association. 1999;282(17):1652–1658.Google Scholar
  18. 18.
    Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.American Journal of Preventive Medicine. 1998;14(4):245–258.Google Scholar
  19. 19.
    Zavala SK, French MT. Dangerous to your health: the role of chronic drug use in serious injuries and trauma.Medical Care. 2003;41(2):309–322.Google Scholar
  20. 20.
    Leonard S, Adler LE, Benhammou K, et al. Smoking and mental illness.Pharmacology Biochemistryand Behavior. 2001;70(4):561–570.Google Scholar
  21. 21.
    Neiman J, Haapaniemi HM, Hillbom M. Neurological complications of drug abuse: pathophysiological mechanisms.European Journal of Neurology. 2000;7(6):595–606.Google Scholar
  22. 22.
    Lange RA, Hillis LD. Cardiovascular complications of cocaine use.New England Journal of Medicine. 2001;345(5):351–358.Google Scholar
  23. 23.
    Savoca E. Psychiatric co-morbidity and hospital utilization in the general medical sector.Psychological Medicine. 1999;29(2):457–464.Google Scholar
  24. 24.
    Bao Y, Sturm R, Croghan TW. A national study of the effect of chronic pain on the use of health care by depressed persons.Psychiatric Services. 2003;54(5):693–697.Google Scholar
  25. 25.
    Farley M, Patsalides BM. Physical symptoms, posttraumatic stress disorder, and healthcare utilization of women with and without childhood physical and sexual abuse.Psychological Reports. 2001;89(3):595–606.Google Scholar
  26. 26.
    Hansen MS, Fink P, Frydenberg M, et al. Use of health services, mental illness, and self-rated disability and health in medical inpatients.Psychosomatic Medicine. 2002;64(4):668–675.Google Scholar
  27. 27.
    Newman MG, Clayton L, Zuellig A, et al. The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization.Psychological Medicine. September 2000;30:1063–1077.Google Scholar
  28. 28.
    McHugo GJ, Kammerer N, Jackson EW, et al. Women, Co-Occurring Disorders, and Violence Study:evaluation design and study population.Journal of Substance Abuse Treatment. In press.Google Scholar
  29. 29.
    Cocozza JC, Jackson EW, Morrissey J, et al. Outcomes for women with co-cccurring disorders and trauma: program-level effects.Journal of Substance Abuse Treatment. In press.Google Scholar
  30. 30.
    Morrissey JP, Ellis AR, Gatz M, et al. Outcomes for women with co-occurring disorders and trauma: person-level effects.Journal of Substance Abuse Treatment. In press.Google Scholar
  31. 31.
    Becker MA, Noether C, Larson MJ, et al. Characteristics of women engaged in treatment for trauma and co-occurring disorders: findings from a national multisite study.Journal of Community Psychology. 2005;33(6):1–15.Google Scholar
  32. 32.
    Eisen SV, Wilcox M, Leff HS, et al. Assessing behavioral health outcomes in outpatient programs: reliability and validity of the BASIS-32.Journal of Behavioral Health Services & Research. 1999;26(1):5–17.Google Scholar
  33. 33.
    Eisen SV, Leff HS, Schaefer E. Implementing outcome systems: lessons from a test of the BASIS-32 and the SF-36.Journal of Behavioral Health Services & Research. 1999;26(1):18–27.Google Scholar
  34. 34.
    Jans L, Stoddard S.Chartbook on Women and Disability in the United States. Washington, DC: US Dept of Education, National Institute on Disability & Rehabilitation Research; 1999. Available at: Accessed August 30, 2004.Google Scholar
  35. 35.
    Centers for Disease Control and Prevention.HIV/AIDS Surveillance Report. 2001;13(2). Atlanta: Public Health Service, Centers for Disease Control & Prevention. Available at: Scholar
  36. 36.
    Holmberg SD. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas.American Journal of Public Health. 1996;86(5):642–654.Google Scholar
  37. 37.
    Marsh CM. Psychiatric presentations of medical illness.Psychiatric Clinics of North America. 1997;20(1):181–204.Google Scholar
  38. 38.
    Samet JH, Larson MJ, Horton NJ, et al. Linking alcohol and drug dependent adults to primary medical care: a randomized controlled trial of a multidisciplinary health evaluation in a detoxification unit.Addiction. 2003;98:509–516.Google Scholar
  39. 39.
    Rosenblum A, Joseph H, Fong C, et al. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities.The Journal of American Medical Association. 2003;289(18):2370–2378.Google Scholar
  40. 40.
    Larson MJ, Paasche-Orlow M, Saitz R, et al.Persistent Pain Promotes Return to Substance Use After Detoxification Presentation. Paper presented at: College of Problems on Drug Dependence; June 16, 2004; San Juan, Puerto Rico.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2005

Authors and Affiliations

  • Mary Jo Larson
    • 1
  • Lisa Miller
    • 1
  • Marion Becker
    • 2
  • Erin Richardson
    • 1
  • Nina Kammerer
    • 3
  • Jennifer Thom
    • 4
  • Joanne Gampel
    • 5
  • Andrea Savage
    • 6
  1. 1.Principal Research Scientist, New England Research Institutes IncWatertown
  2. 2.the Mental Health Institute at the University of South FloridaTampa
  3. 3.the Department of Anthropology at Brandeis UniversityWaltham
  4. 4.ETR AssociatesStockton
  5. 5.the Center for Substance Abuse Treatment/SAMHSARockville
  6. 6.Program in Social Welfare at City University of New York Graduate Center, Hunter CollegeNew York

Personalised recommendations