Category: Addictive Behaviors
A significant proportion of individuals who seek treatment for substance use disorders (SUDs) endorse a history of sexual abuse (SA). Studies have shown that individuals who have SA histories are prone to maladaptive and avoidant coping, and that those who engage in more avoidant coping are more likely to use alcohol in response to stress when compared to individuals who use more active coping. There are also gender differences in coping strategies in response to stress, with women using more active coping strategies (like emotional support) when compared to men. This secondary analysis of a randomized control trial (N=158) that compared two group therapies for SUDs–the Women’s Recovery Group and Group Drug Counseling–explores the different coping strategies used by participants with a history of SA versus those with no SA history, as well as gender differences in coping, using a modified version of the Brief COPE. Eligible participants were >18 years of age, substance dependent, and had used substances in the past 60 days. We hypothesized that participants without a history of SA would endorse more active coping strategies (i.e., active coping, positive reframing, acceptance, religion, and emotional support), whereas participants with a history of SA would endorse more avoidant coping strategies (i.e., denial, behavioral disengagement, and self-blame). Among the subgroup reporting a history of SA (n=49), we hypothesized that avoidant coping styles would be associated with worse substance use severity at baseline and worse SUD outcomes at end of treatment (12 weeks) and that women would endorse more coping strategies, particularly the use of emotional support. Contrary to our hypotheses, at baseline, participants with a history of SA were significantly more likely to report using two types of active coping strategies: positive reframing (t=-2.2, df=156, p=.03) and acceptance coping (t=-2.3, df=156, p =.02) compared to participants without SA histories. At end of treatment (12 weeks), participants with a SA history were still significantly more likely to report using coping strategies that are considered active: emotional support (t=-2.1, df=128, p=.04) and active coping (t=-3.2, df=114.9, p=.00); however they were also more likely to use two types of avoidant coping strategies: denial (t=-2.7, df=128, p=.01) and self-blame (t=-2.3, df=128, p=.02). Baseline substance use of participants with SA histories was not associated with baseline coping strategies; however at 12 weeks (end of treatment) use of denial strategies was significantly correlated with number of heavy drinking days (r=.37, p=.02) and number of drinks per drinking day (r=.65, p=.01). There were no significant gender differences in coping at baseline; however at 12 weeks (end of treatment), women with a history of SA were more likely to endorse using denial strategies (t=-2.7, df=39, p=.01) when compared to men with SA histories. Use of denial as a coping mechanism at end of treatment is associated with increased alcohol use. Women with a history of SA may be more likely to use such strategies even after completing treatment. Assisting women with SA histories in SUD treatment to learn more adaptive coping may be one strategy to improve SUD treatment outcomes.