Disentangling the complex association between childhood sexual abuse and alcohol-related problems: a review of methodological issues and approaches

Abstract

This review describes and evaluates methodological approaches aimed at unraveling the association between childhood sexual abuse (CSA) and later misuse of alcohol, which is complicated by the significant overlap between factors that elevate risk for CSA exposure and those that increase risk for problem alcohol use. We critique methods used to distinguish direct effects of CSA events on alcohol-related outcomes from the effects of risk factors frequently present in families in which CSA exposure occurs (e.g., parental alcohol-related problems). These methods include measurement and adjustment for potentially confounding factors and the use of co-twin designs. The findings across methodological approaches provide support for a CSA-specific risk for alcohol misuse, despite the significant contribution of family background factors to overall risk, but much work remains to be done before a comprehensive model for this association can be proposed. Additional directions for research, including the incorporation of measured genes and the use of longitudinal designs, are proposed to further efforts to model the pathways from CSA to alcohol-related problems.

Figure 1

Three possible models of the association between childhood sexual abuse (CSA) and relative risk of alcohol-use disorder (AUD). Black bars = risk of AUD for a CSA-exposed individual in the general population. White bars = risk of AUD in the unexposed monozygotic (MZ) twin from an MZ discordant pair.