Drug and Alcohol Dependence 49 (1997) 61–69 Child sexual abuse as a predictor of psychiatric co-morbidity and its implications for drug and alcohol treatment Tracey J. Jarvis *, Jan Copeland National Drug and Alcohol Research Centre, Uniersity of New South Wales, NSW 2052, Australia Received 7 October 1997; accepted 14 October 1997 Abstract A study of 180 women in and outside drug and alcohol treatment showed that CSA survivors had higher overall levels of psychological distress, compared with drug and alcohol treatment clients who had not experienced CSA. They reported elevated levels of anxiety, somatisation and dissociation but not depression. Higher rates of self-harm, eating disorders and sexual dysfunction were also reported by CSA survivors. Women with a history of both CSA and substance abuse were more likely to have attempted suicide than other women. The results highlight the need for improved liaison between substance abuse treatment programs and other health services. © 1997 Elsevier Science Ireland Ltd. Keywords: Women; Child sexual abuse; Psychiatric co-morbidity; Substance abuse; Dual diagnosis 1. Introduction Research suggests that childhood sexual abuse is an important clinical issue for many women in alcohol and other drug treatment programs. Rates of childhood sexual abuse (CSA) among women in such programs have been reported as high as 47% (Copeland and Hall, 1992) and even 74% (Rohsenow et al., 1988). CSA has also been linked to substance abuse or dependence in Epidemiological Catchment Area (ECA) studies (Bur- nam et al., 1988; Winfield et al., 1990). The nature of this relationship is likely to be com- plex. Burnam et al. (1988) highlighted the diversity of causal hypotheses, arguing that a relationship might exist ‘because sexual assault increases risk for disorder, because disorder increases risk for sexual assault, or because a third factor... increases risk for both’ (p. 846). One factor that might play a role in the relationship between CSA and substance abuse is the co-morbidity of psychiatric problems and substance abuse among CSA survivors. Substance abuse could be a means of coping with the aversive affective states arising from the experience of sexual trauma. Burnam et al. (1988) identified sexual assault at any age as a risk factor for the subsequent development of major depressive, phobic, panic and obsessive-compul- sive disorders (OCD). Childhood sexual trauma was a consistent predictor of depression and phobia. CSA has also been linked in the research with eating disorders (Bulik et al., 1989; Calam and Slade, 1989; Smolak et al., 1990; Abramson and Lucido, 1991), somatisation (Walker et al., 1992) and sexual dysfunction (Briere and Runtz, 1987; Hunter, 1991; Elliott and Briere, 1992; Pribor and Dinwiddie, 1992; Saunders et al., 1992). Further evidence for the link between mental health problems and CSA is given in studies of women and girls with alcohol and other drug problems. For exam- ple, studies of females with substance abuse have linked CSA with post-traumatic stress disorder (Kovach, 1986) and nervousness and sleeplessness (Edwall et al., 1989). The high prevalence of depression among drug and alcohol treatment clients is partially explained by the * Corresponding author, CBT Clinical Psychology Centre, 28 Har- row Road, Stanmore NSW 2048, Australia. 0376-8716/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved. PII S0376-8716(97)00139-7