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

• Published in: Social Psychiatry and Psychiatric Epidemiology 2018-04, Vol.53 (4), p.421-435
• Main Authors: Evans, Elizabeth A., Upchurch, Dawn M., Simpson, Tracy, Hamilton, Alison B., Hoggatt, Katherine J.
• Format: Article
• Language: English
• Subjects: Adult; Adult Survivors of Child Adverse Events - psychology; Adult Survivors of Child Adverse Events - statistics & numerical data; Adverse childhood experiences; Aged; Alcohol; Alcohol use; Alcoholism - epidemiology; Alcoholism - psychology; Analysis; Behavioral health care; Childhood; Community health services; Diagnostic and Statistical Manual of Mental Disorders; Disorders; Epidemiology; Female; Female-male relations; Gender; Gender aspects; Health Status Disparities; Humans; Logistic Models; Male; Medicine; Medicine & Public Health; Men; Mens health; Middle Aged; Military personnel; Original Paper; Predictive control; Prevalence; Psychiatry; Regression analysis; Self destructive behavior; Sex Distribution; Statistical analysis; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Surveys; United States - epidemiology; Veterans; Veterans - psychology; Veterans - statistics & numerical data; Women
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-017-1463-0

Purpose 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). Methods 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. Results 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. Conclusions 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.