Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders

  • Elizabeth A. Evans
  • Dawn M. Upchurch
  • Tracy Simpson
  • Alison B. Hamilton
  • Katherine J. Hoggatt
Original Paper



To examine differences by US military Veteran status and gender in associations between childhood adversity and DSM-5 lifetime alcohol and drug use disorders (AUD/DUD).


We analyzed nationally representative data from 3119 Veterans (n = 379 women; n = 2740 men) and 33,182 civilians (n = 20,066 women; n = 13,116 men) as provided by the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). We used weighted multinomial logistic regression, tested interaction terms, and calculated predicted probabilities by Veteran status and gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pairwise comparisons.


Among civilians, women had lower AUD and DUD prevalence than men; however, with more childhood adversity, this gender gap narrowed for AUD and widened for DUD. Among Veterans, in contrast, similar proportions of women and men had AUD and DUD; with more childhood adversity, AUD-predicted probability among men surpassed that of women. Childhood adversity elevated AUD probability among civilian women to levels exhibited by Veteran women. Among men, Veterans with more childhood adversity were more likely than civilians to have AUD, and less likely to have DUD.


Childhood adversity alters the gender gap in AUD and DUD risk, and in ways that are different for Veterans compared with civilians. Department of Defense, Veterans Affairs, and community health centers can prevent and ameliorate the harmful effects of childhood adversity by adapting existing behavioral health efforts to be trauma informed, Veteran sensitive, and gender tailored.


Gender differences US military Veterans Childhood adversity DSM-5 alcohol use disorder DSM-5 drug use disorder National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Elizabeth A. Evans
    • 1
    • 2
    • 3
  • Dawn M. Upchurch
    • 4
  • Tracy Simpson
    • 5
  • Alison B. Hamilton
    • 1
    • 6
  • Katherine J. Hoggatt
    • 1
    • 7
  1. 1.VA Health Services Research and Development (HSR&D)Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.Department of Health Promotion and Policy, School of Public Health and Health SciencesUniversity of MassachusettsAmherstUSA
  3. 3.Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School-BaystateSpringfieldUSA
  4. 4.Department of Community Health Sciences, Fielding School of Public HealthUniversity of California, Los Angeles (UCLA)Los AngelesUSA
  5. 5.Seattle DivisionVA Puget Sound Health Care SystemSeattleUSA
  6. 6.Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesUSA
  7. 7.Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesUSA

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