Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders
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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.
KeywordsGender 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.
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.
- 1.Institute of Medicine (IOM) (2013) Substance use disorders in the US armed forces. The National Academies Press, Washington, DC. https://doi.org/10.17226/13441. Accessed 2 May 2017
- 4.Substance Abuse and Mental Health Services Administration (SAMHSA) (2016) Results from the 2015 National Survey on Drug Use and Health-Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf. Accessed 22 May 2017
- 7.Brady KT, Back SE, Greenfield SF (2009) Women and addiction: a comprehensive handbook. The Guilford Press, New YorkGoogle Scholar
- 11.Woodruff T, Kelty R, Segal DR (2006) Propensity to serve and motivation to enlist among American combat soldiers. Armed Forces Soc 3(32): 366 – 353Google Scholar
- 13.Carroll TD, Currier JM, McCormick WH, Drescher KD (2017) Adverse childhood experiences and risk for suicidal behavior in male Iraq and Afghanistan veterans seeking PTSD treatment. Psychol Trauma Epub ahead of printGoogle Scholar
- 16.Montgomery AE, Cutuli JJ, Evans-Chase M, Treglia D, Culhane DP (2013) Relationship among adverse childhood experiences, history of active military service, and adult outcomes: homelessness, mental health, and physical health. Am J Public Health 103(Suppl 2):S262–S268CrossRefPubMedPubMedCentralGoogle Scholar
- 18.US Department of Veteran Affairs (2017) Profile of Veterans: 2015Data from the American Community Survey. Prepared by the National Center for Veterans Analysis and Statistics. https://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2015.pdf. Published March 2017. Accessed 22 May 2017
- 20.Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF (2003) Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 111(3):564 – 72Google Scholar
- 23.Evans EA, Grella CE, Upchurch DM (2017) Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders. Soc Psychiatry Psychiatr Epidemiol (Epub ahead of print) Google Scholar
- 24.Green JG, McLaughlin KA, Berglund PA et al (2010) Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 67(2):113 – 23Google Scholar
- 26.Dong M, Anda RF, Dube SR, Giles WH, Felitti VJ (2003) The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse Negl 27(6):625 – 39Google Scholar
- 28.Cavanaugh CE, Petras H, Martins SS (2015) Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States. Soc Psychiatry Psychiatr Epidemiol 50(8):1257–1266CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Grant BF, Amsbary M, Chu A (2014) Source and Accuracy Statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism, RockvilleGoogle Scholar
- 31.Centers for Disease Control and Prevention (CDC) (2014) Summary Health Statistics for US Adults: National Health Interview Survey, 2012. National Center for Health Statistics, HyattsvilleGoogle Scholar
- 32.Smith SM, Goldstein RB, Grant BF (2016) The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J Psychiatr Res 82:16–22CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Myers B, McLaughlin KA, Wang S, Blanco C, Stein DJ (2014) Associations between childhood adversity, adult stressful life events, and past-year drug use disorders in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Psychol Addict Behav 28(4):1117–1126CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Hernán MA, Robins JM (2016). Causal Inference. Boca Raton: Chapman & Hall/CRC, forthcoming. https://www.hsph.harvard.edu/miguel-hernan/causal-inference-book/. Accessed 2 May 2017
- 42.Institute of Medicine (IOM) (2014). Capturing social and behavioral domains in electronic health records: phase 1. The National Academies Press, Washington, DC. https://doi.org/10.17226/18709. Accessed October 8, 2017
- 43.Ames G, Cunradi C (2017) Alcohol use and preventing alcohol-related problems among young adults in the military. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh284/252-257.htm. Accessed 22 May 2017