Substantial evidence points to childhood victimization as a major risk factor for later drug abuse. At least two-thirds of patients in drug abuse treatment centers say they were physically or sexually abused as children. However, we know relatively little about the details of that apparent link between child abuse and later drug use. NIDA-supported researchers are working intensively on this critically important public health question.
Determining the exact relationship between child abuse and drug abuse is exceedingly difficult given the role that variables such as poverty, family dysfunction, the level of social support for victims, or the child's gender and age play. Further, not all child abuse victims later become drug abusers. What factors protect a child abuse victim from becoming a drug abuser? What factors make an abused child more vulnerable to drug abuse? In addition, child abuse victims may suffer severe emotional damage - even years later as adults. How can investigators conduct research without risk of exacerbating that damage?
NIDA has built a solid foundation of information and methodologies that researchers can use in seeking answers to these questions. For example, an expert panel convened by the Institute in 1996 reviewed the research on the role of childhood trauma in later drug abuse. Among the panel's conclusions was that the characteristics of the trauma, the child, and the child's environment interact to either buffer or aggravate the impact, which subsequently can produce a wide range of dysfunctional behaviors that can include drug abuse. (For examples of factors that may increase or lessen the impact of child abuse, see "Some Child Abuse Victims Are More Vulnerable Than Others to Drug Abuse.") NIDA researchers have extensively examined and evaluated risk and protective factors for drug abuse. Researchers have developed drug abuse prevention protocols that maximize protective factors and target risk factors. These findings can serve as a starting point for developing prevention approaches that specifically target abused children. In addition, research to better treat the emotional scars of drug abusers who are child abuse victims can draw on NIDA research on treating drug abusers with coexisting mental and emotional problems. (See "Innovative Treatment Helps Traumatized Drug Abusing Women.")
However, many challenges for research in this area are unique to child abuse. Because society must act decisively to deter child abuse and at the same time protect its victims, legal questions relating to privacy, confidentiality, and informed consent - and the legal rights of accused abusers - limit researchers' access to information about child abuse.
These challenges pose a different set of questions for researchers. How can abused children be appropriately identified and their experiences accurately classified? How can reports and statements about abusive incidents be gathered and evaluated? Researchers usually have approached their investigations retrospectively, looking back over time and examining the psychological histories of adult patients being treated for drug abuse. That is where studies have found the strong correlations between childhood abuse and the subsequent development of drug abuse in adolescence and adulthood.
However, these studies rely primarily on memories of adult drug abusers. Scientists have long wrestled with the subjectivity of memory. With this in mind, NIDA-funded scientists are evaluating and refining methods for gathering, assessing, and verifying retrospective recall and looking for other sources of information, including court records.
NIDA is well situated to help these researchers and others bridge bureaucratic and disciplinary gaps among the many governmental and social service entities - health and child welfare agencies, drug abuse treatment and prevention service providers, doctors and hospitals, and the justice system - that are seeking to expand their knowledge of, and response to, child abuse and drug abuse. NIDA can also bring past experience to bear to enhance integration of diverse scientific disciplines, pooling of resources, and rapid dissemination of research findings and viable prevention and treatment strategies. NIDA's current leadership role in the Interagency Consortium for Research on Violence Against Women and Violence Within the Family, which has child abuse as an important focus, is a prime example of how the Institute can respond to this need for coordination and cooperation.
In addition, NIDA continues to recruit, encourage, and support researchers who will seek further answers to questions surrounding the links between child abuse and drug abuse. For example, could early identification of child abuse victims coupled with intervention prevent subsequent drug abuse? Do child abuse victims respond differently to different drug abuse treatment approaches? Does a history of child abuse affect treatment, retention, and relapse outcomes? (See "Exploring the Role of Child Abuse in Later Drug Abuse: Researchers Face Broad Gaps in Information.")
The Institute also is planning a major scientific conference on drug abuse and the childhood environment that will address these and other issues related to children and drug abuse.
On the broad scale, NIDA's public health mission and experience will be of great value here, combining the expertise of its grantees and staff in many disciplines to shed more light on the elusive link between child abuse and drug abuse. And as our stockpile of science-based knowledge in this area grows, we can speed our pursuit of two goals: preventing abused children from becoming drug abusers and designing better treatments for that majority of drug abusers who report that they are also the victims of child abuse.