Advertisement

The Relationship Between Post-Traumatic Stress Symptoms and Substance Use Among Adolescents Involved with Child Welfare: Implications for Emerging Adulthood

  • Abby L. Goldstein
  • Christine Wekerle
  • Lil Tonmyr
  • Tiffany Thornton
  • Randall Waechter
  • Jessica Pereira
  • Ronald Chung
  • MAP Research Team
Article

Abstract

The purpose of the present study was to examine the role of posttraumatic stress symptoms (PTSS) in predicting substance use and substance-related problems in a sample of older youth and emerging adults involved with child welfare. The sample was drawn from the Maltreatment and Adolescent Pathways (MAP) longitudinal study (Wekerle et al. 2009). Participants were 253 youth and emerging adults (ages 15–20; M = 16.87, SD = 1.04; 61.4% female and 38.6% male) who were involved with child welfare. Multiple regression analyses were conducted to examine the impact of PTSS using subscales from the Trauma Symptom Checklist for Children (TSCC; Briere 1996). Outcome variables were past year alcohol, marijuana and illicit drug use; as well as alcohol and drug problems. Controlling for gender, age, child welfare status and child maltreatment, both dissociation and anger emerged as significant predictors of substance use and related problems. The implications of these findings for older youth and emerging adults exiting the child welfare system are discussed.

Keywords

Substance use PTSD Child maltreatment Child welfare Adolescence Emerging adulthood 

Notes

Acknowledgments

Dr. Goldstein was supported by a Connaught Foundation Start-Up Award. The MAP Longitudinal Study (Dr. Wekerle, PI) has received funding from: the Canadian Institutes of Health Research, The Ministry of Child and Youth Services Ontario, The Ontario Mental Health Foundation, The Children’s Hospital of Eastern Ontario (CHEO) Centre of Excellence in Child and Youth Mental Health, CIHR/Ontario Women’s Health Council Mid-Career Award (to Dr. Wekerle), The Public Health Agency of Canada (Interchange Assignment to Dr. Wekerle) and the Centre for Excellence in Research in Child Welfare.

References

  1. Adewuya, A. (2005). Validation of the alcohol use disorder identification test (AUDIT) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol and Alcoholism, 40(6), 575–577.PubMedCrossRefGoogle Scholar
  2. Adlaf, E. M., Begin, P. & Sawka, E. (Eds.). (2005). Canadian Addiction Survey (CAS): A national survey of Canadians’ use of alcohol and other drugs: Prevalence of use and related harms: Detailed report. Ottawa: Canadian Centre on Substance Abuse.Google Scholar
  3. Adlaf, E. M., & Paglia-Boak, A. (2005). Drug use among Ontario students, 1977–2005: Detailed OSDUS findings. CAMH Research Document Series, No. 16. Toronto: Centre for Addiction and Mental Health http://www.camh.net/research/osdus.html
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press.Google Scholar
  5. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late tends through the twenties. American Psychologist, 55, 469–480.PubMedCrossRefGoogle Scholar
  6. Arnett, J. J. (2004). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press.Google Scholar
  7. Arnett, J. J. (2005). The developmental context of substance use in emerging adulthood. Journal of Drug Issues, 35, 235–254.Google Scholar
  8. Arnett, J. J. (2007). Afterword: Aging out of care – Toward realizing the possibilities of emerging adulthood. New Directions for Youth Development, 113, 151–161.PubMedCrossRefGoogle Scholar
  9. Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall.Google Scholar
  10. Bennett, D. S., Sullivan, M. W., & Lewis, M. (2005). Children’s adjustment as a function of maltreatment, shame, and anger. Child Maltreatment, 10, 311–323.PubMedCrossRefGoogle Scholar
  11. Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., et al. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190.CrossRefGoogle Scholar
  12. Briere, J. (1996). Trauma symptom checklist for children (TSCC), professional manual. Odessa: Psychological Assessment Resources.Google Scholar
  13. Carpenter, L. L., Gawuga, C. E., Tyrka, A. R., Lee, J. K., Anderson, G. M., & Price, L. H. (2010). Association between plasma il-6 response to acute stress and early-life adversity in healthy adults. The International Journal of Neuropsychopharmacology, 35(13), 2617–2623.CrossRefGoogle Scholar
  14. Cummins, L. H., Chan, K. K., Burns, K. M., Blume, A. W., Larimer, M., & Marlatt, G. A. (2003). Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: Screening for drug and alcohol risk. Journal of Studies on Alcohol, 64(5), 727–732.PubMedGoogle Scholar
  15. Danielson, C. K., Amstadter, A. B., Dangelmaier, R. E., Resnick, H. S., Saunders, B. E., & Kilpatrick, D. G. (2009). Does typography of substance abuse and dependence differ as a function of exposure to child maltreatment. Journal of Child & Adolescent Substance Abuse, 18(4), 323–342.CrossRefGoogle Scholar
  16. Dodge, D. A. (2003). Do social information-processing patterns mediate aggressive behavior? In B. Lahey, T. E. Moffit, & A. Caspi (Eds.), Causes of conduct disorder and juvenile delinquency (pp. 254–274). New York: Guilford Press.Google Scholar
  17. Eftekhari, A., Turner, A. P., & Larimer, M. E. (2004). Anger expression, coping, and substance use in adolescent offenders. Addictive Behaviors, 29(5), 1001–1008.PubMedCrossRefGoogle Scholar
  18. Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.Google Scholar
  19. Fiellin, D. A., Reid, M. C., & O’Connor, P. G. (2000). Screening for alcohol problems in primary care: A systematic review. Archives of International Medicine, 160(13), 1977–1989.CrossRefGoogle Scholar
  20. Flynn, R. J., & Vincent, D. (2008). Canada. In M. S. Stein & E. R. Munro (Eds.), Young people’s transitions from care to adulthood: International research and practice. London: Jessica Kingsley Publishers.Google Scholar
  21. Gilbert, R., Spatz Widom, C., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burdern and consequences of child maltreatment in high-income countries. Lancet, 373(9657), 68–81.PubMedCrossRefGoogle Scholar
  22. Goldstein, A. L., Flett, G. L., & Wekerle, C. (2010). Child maltreatment, alcohol use and drinking consequences among male and female college students: an examination of drinking motives as mediators. Addictive Behaviors, 35, 636–639.PubMedCrossRefGoogle Scholar
  23. Goldstein, A. L., Leslie, B., Wekerle, C., Leung, E., & Erickson, P. (2010). Child welfare and street involvement among young women: Implications of homelessness for the transition out of care. Social Development Issues, 32, 16–34.Google Scholar
  24. Health Canada, Controlled Substances and Tobacco Directorate (2010). The Canadian Alcohol and Drug Use Monitoring Survey. Ottawa, ONGoogle Scholar
  25. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158(8), 1184–1190.Google Scholar
  26. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future National Survey Results on Drug Use, 1975–2006. Volume I: Secondary School Students (NIH Publication No. 07-205). Bethesda, MD: National Institute on Drug AbuseGoogle Scholar
  27. Keller, T. E., Salazar, A. M., & Courtney, M. E. (2010). Prevalence and timing of diagnosable mental health, alcohol, and substance use problems among older adolescents in the child welfare system. Child and Youth Services Review, 32(4), 626–634.CrossRefGoogle Scholar
  28. Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the National Survey of Adolescents. Journal of Consulting and Clinical Psychology, 71(4), 692–700.PubMedCrossRefGoogle Scholar
  29. Kingston, S., & Raghavan, C. (2009). The relationship of sexual abuse, early initiation of substance use, and adolescent trauma to PTSD. Journal of Traumatic Stress, 22(1), 65–68.PubMedCrossRefGoogle Scholar
  30. Knight, J. R., Sherritt, L., Harris, S. K., Gates, E. C., & Chang, G. (2003). Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcoholism, Clinical and Experimental Research, 27(1), 67–73.PubMedCrossRefGoogle Scholar
  31. Knight, J. R., Shrier, L. A., Bravender, T. D., Farrell, M., Vander Bilt, J., & Shaffer, H. J. (1999). A new brief screen for adolescent substance abuse. Archives of Pediatrics & Adolescent Medicine, 153(6), 591–596.Google Scholar
  32. Levy, S., Sherritt, L., Harris, S. K., Gates, E. C., Holder, D. W., Kulig, J. W., et al. (2004). Test retest reliability of adolescents’ self-report of substance use. Alcoholism, Clinical and Experimental Research, 28(8), 1236–1241.PubMedCrossRefGoogle Scholar
  33. Lipschitz, D. S., Rasmusson, A. M., Anyan, W., Gueorguieva, R., Billingslea, E. M., Cromwell, P. F., et al. (2003). Posttraumatic stress disorder and substance use in inner-city adolescent girls. The Journal of Nervous and Mental Disease, 191(11), 714–721.PubMedCrossRefGoogle Scholar
  34. Lubman, D. I., Allen, N. B., Rogers, N., Cementon, E., & Bonomo, Y. (2007). The impact of co occuring mood and anxiety disorders among substance-abusing youth. Journal of Affective Disorders, 103(1–3), 105–112.PubMedCrossRefGoogle Scholar
  35. MacFie, J., Cicchetti, D., & Toth, S. L. (2001). The development of dissociation in maltreated preschool-aged children. Development and Psychopathology, 13, 233–254.PubMedCrossRefGoogle Scholar
  36. McMillen, J. C., & Raghavan, R. (2009). Pediatric to adult mental health services use of young people leaving the foster care system. The Journal of Adolescent Health, 44(1), 7–13.PubMedCrossRefGoogle Scholar
  37. Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33(4), 453–463.CrossRefGoogle Scholar
  38. Narendorf, S. C., & McMillen, J. C. (2010). Substance use and substance use disorders as foster youth transition to adulthood. Children and Youth Services Review, 32(1), 11–119.CrossRefGoogle Scholar
  39. Ontario Association of Children’s Aid Societies. (2010). Your children’s aid: child welfare report 2009/10. Toronto: Ontario Association for Children’s Aid Societies.Google Scholar
  40. Paglia-Boak, A., Mann, R. E., Adlaf, E. M., & Rehm, J. (2009). Drug use among Ontario students, 1977–2009: OSDUHS highlights (CAMH Research Document Series No. 28). Toronto, ON: Centre for Addiction and Mental Health.Google Scholar
  41. Pereda, N., Guilera, G., Forns, M., & Gómez-Benito, J. (2009). The international epidemiology of child sexual abuse: A continuation of Finkelhor (1994). Child Abuse & Neglect, 33, 331–342.CrossRefGoogle Scholar
  42. Piccinelli, M., Tessari, E., Bortolomasi, M., et al. (1997). Efficacy of the Alcohol Use disorders Identification Test as a screening tool for hazardous alcohol intake and related disorders in primary care: A validity study. British Medical Journal, 314(7078), 420–424.PubMedGoogle Scholar
  43. Public Health Agency of Canada. (2010). Canadian Incidence Study of Reported Child Abuse and Neglect – 2008: Major Findings. Ottawa, ON.Google Scholar
  44. Reid, C., & Dudding, P. (2006). Building a future together: Issues and outcomes for transition-aged youth. Ottawa: Centre of Excellence for Child Welfare.Google Scholar
  45. Sadowski, C. M., & Friedrich, W. N. (2000). Psychometric properties of the trauma symptom checklist for children (TSCC) with psychiatrically hospitalized adolescents. Child Maltreatment, 5(4), 364–372.PubMedCrossRefGoogle Scholar
  46. Saunders, J. B., Aasland, O. G., Babor, T. F., Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative projects on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.PubMedCrossRefGoogle Scholar
  47. Savitz, J. B., van der Merwe, L., Newman, T. K., Solms, M., Stein, D. J., & Ramesar, R. S. (2008). The relationship between childhood abuse and dissociation. Is it influenced by catechol-O- methyltransferase (COMT) activity? The International Journal of Neuropsychopharmacology, 11(2), 149–161.PubMedCrossRefGoogle Scholar
  48. Schafer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C., et al. (2010). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both – A multi-center study. Drug and Alcohol Dependence, 109(1-3), 84–89.PubMedCrossRefGoogle Scholar
  49. Simon, N. M., Herlands, N. N., Marks, E. H., Mancini, C., Letamendi, A., Li, Z., et al. (2009). Childhood maltreatment linked to greater symptom severity and poorer quality of life and function in social anxiety disorder. Depression and Anxiety, 26(11), 1027–1032.PubMedCrossRefGoogle Scholar
  50. SPSS. (2010). Chicago, IL.Google Scholar
  51. Tonmyr, L., Thornton, T., Draca, J., & Wekerle, C. (2010). The childhood maltreatment and adolescent substance use relationship: A critical review. Current Psychiatry Reviews, 6(3), 223–234.CrossRefGoogle Scholar
  52. Trocmé, N., Fallon, B., MacLaurin, B., Sinha, V., Black, T., Fast, E., et al. (2010). Canadian incidence study of reported child abuse and neglect – 2008: Major findings. Ottawa: Public Health Agency of Canada.Google Scholar
  53. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2010). Child Maltreatment 2009. Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can.
  54. Vaughn, M. G., Ollie, M. T., McMillen, J. C., Scott, L. J., & Munson, M. (2007). Substance use and abuse among older youth in foster care. Addictive Behaviors, 32(9), 1929–1935.PubMedCrossRefGoogle Scholar
  55. Wekerle, C., Leung, E., Goldstein, A. L., Thornton, T., & Tonmyr, L. (2009). Substance use among adolecents in child welfare versus adolescents in the general population: A comparison of the maltreatment and adolescent pathways (MAP) longitudinal study and Ontario student drug use survey (OSDUS) datasets. Ottawa: Report prepared for Health Canada.Google Scholar
  56. Wekerle, C., Leung, E., Wall, A. M., MacMillan, H., Boyle, M., Trocme, N., et al. (2009). The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth. Journal of Child Abuse & Neglect, 33(1), 45–58.CrossRefGoogle Scholar
  57. Wilsnack, S. C., Vogeltanz, N. D., Klassen, A. D., & Harris, T. R. (1997). Childhood sexual abuse and women's substance abuse: national survey findings. Journal of Studies on Alcohol, 58(3), 264–271.PubMedGoogle Scholar
  58. Wright, M. O., Crawford, E., & Del Castillo, D. (2009). Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas. Child Abuse & Neglect, 33, 59–68.CrossRefGoogle Scholar
  59. Wu, P., Bird, H. R., Liu, X., Duarte, C. S., Fuller, C., Fan, B., et al. (2010). Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children. Journal of Studies on Alcohol and Drugs, 71(3), 326–334.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Abby L. Goldstein
    • 1
  • Christine Wekerle
    • 2
  • Lil Tonmyr
    • 3
  • Tiffany Thornton
    • 4
  • Randall Waechter
    • 2
  • Jessica Pereira
    • 1
  • Ronald Chung
    • 2
  • MAP Research Team
  1. 1.OISEUniversity of TorontoTorontoCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Public Health Agency of CanadaOttawaCanada
  4. 4.Health CanadaOttawaCanada

Personalised recommendations