Gender differences in pathways from physical and sexual abuse to early substance use

Early substance use (i.e., before age 14) is a known risk factor for substance use disorder, but scarce research has examined gender differences in pathways to early substance use. This study applies a developmental traumatology perspective to examine the relations between child physical and sexual abuse and early substance use among youths investigated by child protective services (CPS), a population with high risk for substance use disorder. Drawing from the first National Survey of Child and Adolescent Well-Being (NSCAW), a sample of 11-13 year olds (n = 467 girls, n = 329 boys) was examined. Multiple group path analysis assessed gender differences in the relations between physical and sexual abuse severity and early substance use and indirect effects via internalizing problems, externalizing problems, and posttraumatic stress. Focal measures included the child-reported Parent-Child Conflict Tactics Scale (physical abuse severity), the Trauma Symptom Checklist for Children (posttraumatic stress), the Youth Self-Report (internalizing and externalizing problems), and the NSCAW's caseworker-alleged abuse (sexual abuse severity) and child substance abuse modules (any current alcohol, marijuana, hard drug, inhalant, or nonmedical prescription drug use). Significant indirect effects of physical abuse severity to early substance use were found through externalizing behavior problems in girls only (β = 0.068; 95% CI = 0.029, 0.130; p = 0.004), with a significantly stronger relation between externalizing problems and early substance use in girls. Results suggest gender differences in the sequelae of trauma as they relate to early onset substance use and the need to integrate mental health and substance use services.