The Joint Effect of Childhood Abuse and Homelessness on Substance Use in Adulthood

Abstract

Background

Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited. Objective: To estimate independent and joint effects of childhood abuse and homelessness on substance use risk during emerging adulthood and adulthood. Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we measured associations between exposure to physical or sexual abuse in childhood, homelessness in childhood or emerging adulthood, or exposure to both traumas and outcomes of binge drinking, marijuana use, cocaine use, methamphetamine use, and prescription opioid misuse during emerging adulthood (Wave III, ages 18–26 years) and adulthood (Wave IV, ages 24–32 years). Results: In adjusted analyses, exposure to childhood abuse alone, homelessness alone, and both childhood abuse and homelessness were significant correlates of most substance use indicators in emerging adulthood. Those jointly exposed to childhood abuse and homelessness had disproportionate risk of substance use, particularly use of cocaine (adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.70, 6.71) and methamphetamine (AOR = 6.59, 95% CI: 3.87, 11.21). The independent and combined effects of abuse and homelessness generally persisted into adulthood though associations tended to weaken. Conclusions/Importance: Those with exposure to abuse, homelessness, and both adverse outcomes constitute a high-risk population for substance use. Addressing abuse and homelessness should be a component of preventing drug risk for screening, treatment, and prevention efforts.

Keywords:

• Add health
• childhood abuse
• sexual abuse
• physical abuse
• homelessness
• substance use

Acknowledgements

This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill. Special acknowledgment is due to Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Statement of integrity

The article enclosed does not include any overlapping information in prior publications or submissions under review. This manuscript is currently not under review at any other journal, nor will it be submitted to any other journal while under consideration by Substance Use and Misuse.

Additional information

Funding

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations (P01-HD31921) and the National Institute on Drug Abuse (R01DA036414). Additional support was provided by the NYU-City University of New York (CUNY) Health Promotion and Prevention Research Center Core Project (U48DP005008), and by Ending HIV/AIDS among People Who Use Drugs: Overcoming Challenges project (P30DA011041).