A trauma model of substance use: Elaboration and preliminary validation

Adriano Schimmenti; Joël Billieux; Gianluca Santoro; Silvia Casale; Vladan Starcevic

doi:10.1016/j.addbeh.2022.107431

A trauma model of substance use: Elaboration and preliminary validation

Addict Behav. 2022 Nov:134:107431. doi: 10.1016/j.addbeh.2022.107431. Epub 2022 Jul 16.

Authors

Adriano Schimmenti¹, Joël Billieux², Gianluca Santoro³, Silvia Casale⁴, Vladan Starcevic⁵

Affiliations

¹ Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy. Electronic address: adriano.schimmenti@unikore.it.
² Institute of Psychology, University of Lausanne, Géopolis CH-1015, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), CH-1011 Lausanne, Switzerland. Electronic address: joel.billieux@unil.ch.
³ Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy. Electronic address: gianluca.santoro@unikore.it.
⁴ Department of Health Sciences, Psychology Unit, University of Florence, Via di San Salvi12, 50135 Florence, Italy. Electronic address: silvia.casale@unifi.it.
⁵ University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, PO Box 63, Penrith, NSW 2751, Australia. Electronic address: vladan.starcevic@sydney.edu.au.

PMID: 35905595
DOI: 10.1016/j.addbeh.2022.107431

Abstract

The current study expands on and integrates previous theoretical models concerning the pathways that link child maltreatment to substance use disorder. The proposed model, based on the self-medication hypothesis, suggests that experiences of neglect and abuse during childhood can lead to substance use and abuse both directly and indirectly, via dissociation resulting from failed attempts to integrate experiences of maltreatment in childhood. The model was tested on ten substances (painkillers, stimulants, sedatives, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, and methamphetamine) via structural equation modeling (SEM) in a sample comprising 1040 community-dwelling adults (67 % women) aged between 18 and 78 (M = 29.55, SD = 11.37). Fit indexes of the SEM were good, thus supporting the hypothesized model. Specific forms of child maltreatment were related to increased use of specific substances; however, experience of childhood neglect (both physical and emotional) was found to have a central role in predicting use of most substances. Although no single pathway can fully explain the origins of substance abuse, the current study provides evidence of a critical developmental pathway to it, with implications for theory and clinical practice.

Keywords: Addictive behaviors; Child maltreatment; Dissociation; Self-medication hypothesis; Substance use.