title: Physical and sexual abuse history and addiction treatment outcomes.
abstract: OBJECTIVE
  Prior research on patients with substance use disorders has shown that lifetime physical or sexual abuse is associated with more impaired functioning at treatment intake. The present study sought to determine whether physical or sexual abuse also predicted treatment response (posttreatment outcomes) of individuals with substance use disorders.
  
  
  METHODS
  Male (n = 19,989) and female (n = 622) veterans with substance use disorders were assessed with the Addiction Severity Index (ASI) early in treatment and reassessed an average of 12 months later. Treatment outcomes were compared for patients who did and did not report prior physical or sexual abuse in the initial ASI interview.
  
  
  RESULTS
  Lifetime physical or sexual abuse predicted worse outcomes in six of seven domains of functioning, after controlling for baseline functioning, psychiatric diagnoses and demographic variables. Although women were more likely than men to report being abused, the effect of abuse on treatment outcomes was similar for both genders. Psychiatric problems at baseline mediated the effect of abuse history on outcomes. Abuse history moderated the effect of treatment intensity (contacts per month) on outcomes: More frequent treatment contacts were more beneficial for abused patients than for nonabused patients.
  
  
  CONCLUSIONS
  Individuals with substance use disorders who have a history of physical or sexual abuse may have higher risk for problematic treatment outcomes as a result of greater psychiatric problems, deficits in social support and possible difficulties in establishing treatment alliance. Clinicians may consider increasing the duration and intensity of treatment to temper the negative effects of abuse on later functioning.
authors.affiliation: National Center for PTSD and Center for Health Care Evaluation, Department of Veterans Affairs, 795 Willow Road (352-117), Menlo Park, California 94025, USA. crosen@stanford.edu
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.forename: Paige C
authors.initials: PC
authors.lastname: Ouimette
authors.forename: Javaid I
authors.initials: JI
authors.lastname: Sheikh
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Gregg
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D017579:Domestic Violence / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data