Childhood sexual abuse and women's substance abuse: national survey findings.

OBJECTIVE: Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse, and elevated rates of alcohol and drug disorders among female psychiatric patients with histories of CSA. The present study examines the relationship of CSA to women's use of alcohol and other drugs in a large, nationally representative sample of U.S. women. METHOD: As part of a national survey of women's drinking, 1,099 women were asked about sexual experiences occurring before age 18. Women who reported sexual experiences classified as abusive were compared to women without histories of CSA on nine measures of substance use, self-perception of anxiousness, the occurrence of one or more lifetime depressive episodes, five measures of sexual dysfunction, and early onset of masturbation and consensual sexual intercourse. RESULTS: Results of logit analyses, controlling for age, ethnicity and parental education, indicated that women with histories of CSA were significantly more likely than women without CSA histories to report recent alcohol use, intoxication, drinking-related problems and alcohol dependence symptoms; lifetime use of prescribed psychoactive drugs and illicit drugs; depression and anxiety; pain that prevented intercourse; and consensual sexual intercourse before age 15. CONCLUSIONS: Findings from this U.S. national sample support those of previous clinical studies and suggest that women's experience of sexual abuse in childhood may be an important risk factor for later substance abuse, psychopathology and sexual dysfunction. Implications of these findings for future research, treatment and prevention are discussed.

Reliability of retrospective self-reports of alcohol consumption among women: data from a U.S. national sample.

Drinking histories (retrospective self-reports) can be a valuable resource for time-ordered analyses of causes and consequences of drinking. However, there is a scarcity of data on the reliability of drinking histories from general population samples. We report here on the reliability and consistency of reported ages of onset and typical drinking frequencies, quantities and volume, from drinking histories provided in 1981 and 1986 by national samples of women drinkers with and without drinking problems. Statistical reliability was generally modest, yet large percentages of women gave exactly the same reports 5 years apart. Reliability was apparently reduced by limited response options, and was lower among younger drinkers, whose drinking was more changeable between 1981 and 1986. We discuss ways to improve reliability and to make best use of drinking histories.

Predicting onset and chronicity of women's problem drinking: a five-year longitudinal analysis.

BACKGROUND: Longitudinal studies of adult drinking have typically excluded or sampled only small numbers of problem drinking women, and have measured a limited range of influences on women's drinking behavior. METHODS: To study the development of women's problem drinking over time, five-year follow-up interviews were conducted with two groups of respondents from a 1981 national survey of women's drinking: 143 problem drinkers and 157 nonproblem drinkers. Regression analyses examined effects of 1981 predictors on six measures of 1986 problem drinking, for problem drinkers and nonproblem drinkers separately. RESULTS: Among 1981 nonproblem drinkers, predictors of onset of problem drinking indicators by 1986 included younger age, cohabiting, and lifetime use of drugs other than alcohol. The most consistent predictor of persistent (chronic) problem drinking was sexual dysfunction; other predictor included being employed part-time or never married, and experiencing recent depression. Divorce or separation predicted lower levels of subsequent alcohol dependance among problem drinkers. CONCLUSIONS: Findings suggest that different personal and social factors predict the onset of problem drinking as compared with its continuation, and point to nontraditional life-style, sexual dysfunction, and role deprivation as potentially important variables.

Prevalence and patterns of same-gender sexual contact among men.

The prevalence and patterns of same-gender sexual contact among men are key components of models of the spread of HIV infection and AIDS in the U.S. population. Previous estimates by Kinsey et al. from data collected between 1938 and 1948 have been widely criticized for inadequacies of sample design. New lower-bound estimates of prevalence developed from data from a national sample survey conducted in 1970 indicate that minimums of 20.3 percent of adult men in the United States in 1970 had sexual contact to orgasm with another man at some time in life; 6.7 percent had such contact after age 19; and between 1.6 and 2.0 percent had such contact within the previous year. Although these estimates incorporate adjustments for missing data, the likelihood of underreporting suggests that these estimates might be lower bounds on the prevalence of same-gender sex among men. Two sets of alternative estimates are derived to assess the sensitivity of these estimates to the assumptions made in imputing values to missing data. Detailed estimates are presented by frequency of contact, age, education, and marital status; and supporting estimates are derived from a 1988 national survey. Data from both the 1970 and 1988 surveys indicate that never-married men are more likely than other men to have had same-gender sexual contacts within the last year. The 1970 survey also indicates, however, that approximately half the men estimated to have such contacts are found among the more numerous population of currently or previously married men.

Sexual experience and drinking among women in a U.S. national survey.

A 1981 national survey of 917 women provided rates of major sexual experiences and dysfunctions for the entire sample and across alcohol abstention/consumption categories. Most women drinkers (heavier drinkers most often) reported that drinking lessens sexual inhibition and helps them feel close to others; only 8% reported becoming less particular in sexual partner choice, 22% more sexually assertive, but over half (60%) had been targets of other drinkers' sexual aggression. On a sexual dysfunction index combining lifetime lack of sexual interest, lifetime lack or low frequency of orgasm with a partner, and vaginismus, moderate drinkers scored significantly lower than lighter and heavier drinkers. The heaviest drinking women had the highest rates of lifetime sexual disinterest and lack of orgasm with a partner. "Temporary abstainers" (who drank in the past 12 months but not the last 30 days) also had elevated sexual dysfunction rates, particularly those with substantial drinking histories. Several nontraditional sexual behaviors were correlated with heavier drinking, which was also related to morally liberal sexual attitudes. The study's findings may show the effects of a generalized moral value framework in which one large portion of the nation's population, especially females, is subject to pervasive proscriptions of behavioral, including their drinking and sexuality, while others vary in the freedom they find to drink and be sexual. More suppressed traditional sexuality occurs more frequently with lighter drinking and abstention, as is also true of sexual dysfunction. At heavier drinking levels suppressed and dysfunctional sexuality and heavy drinking may be both cause and consequence in a vicious circle, sometimes escaped by temporary or lasting abstention.

Retrospective analysis of lifetime changes in women's drinking behavior.

Retrospective data on drinking behavior and related life experiences have been a neglected resource in research on alcohol use in the general population. Data from a 1981 national survey of women's drinking indicate the potential value of retrospective data analysis. The 1981 data provide comparative ages of onset for drinking behavior, drinking consequences, and health problems, and allow comparisons among different cohorts of women. The data also show the variability in women's lifetime drinking patterns and the time-ordering of heavy drinking in relation to onset of depression and reproductive dysfunction.

Women's drinking and drinking problems: patterns from a 1981 national survey.

A 1981 national survey of women's drinking interviewed 917 women in the general population, stratified on the basis of screening interviews to include 500 moderate-to-heavy drinkers. The survey found no evidence of any major recent increase in women's drinking, and no evidence of unusually heavy drinking among working wives. Adverse drinking consequences and episodes of extreme drinking were most common among women aged 21-34; women who were unmarried, divorced or separated, or cohabiting; and women with frequent drinkers as spouses or companions. Alcohol-related behavior problems and symptoms of alcohol dependence were closely related to levels of alcohol consumption. Among women averaging one ounce or more of ethanol per day, 45 per cent had driven while intoxicated in the past year, and 36 per cent reported memory lapses while drinking. Women at this consumption level were also more likely to report experiences with depression (61 per cent). Women with extremely high consumption levels were more likely to have histories of obstetrical and gynecological problems. Some women with alcohol-related problems reported periods of temporary abstention, a pattern not studied heretofore.

Drinking and reproductive dysfunction among women in a 1981 national survey.

This paper presents the first data available on drinking and reproductive dysfunction from a representative national sample of women. In this stratified household sample of 917 women (weighted n = 2552), dysmenorrhea, heavy menstrual flow, and premenstrual discomfort increased with drinking level and were particularly strongly associated with reported consumption of 6 or more drinks a day at least once a week. Women who consumed 6 or more drinks/day at least 5 times a week had elevated rates of gynecologic surgery other than hysterectomy, but hysterectomy was less common among women averaging 2 oz or more of ethanol/day, with age effects controlled. Lifetime rates of obstetric disorders showed significant elevations at upper levels of drinking (6 or more drinks/day at least 3 times a week for miscarriage or stillbirth and prematurity, and 6 or more drinks/day at least 5 times a week for infertility and birth defects). An unexpected finding was the high rates of menstrual disorders, hysterectomy, miscarriage or stillbirth, and prematurity among temporary abstainers (women reporting alcohol consumption in the past 12 months but not the past 30 days) who had previously drunk only infrequently.