Childhood Adverse Events & Current Traumatic Distress: A California Prison Population

1. Childhood Adverse Events & Current Traumatic Distress:A California Prison Population Nena Messina, Ph.D., Christine Grella, Ph.D., William Burdon, Ph.D., & Michael Prendergast, Ph.D. UCLA Integrated Substance Abuse Programs Substance Abuse Research Consortium Pasadena, CA May 21st, 2007

2. Purpose of the Study • To describe the prevalence of multiple types of childhood adverse events among men and women offenders who participated in a prison-based substance abuse treatment program. • To assess the relationship of cumulative childhood adverse events to current traumatic distress.

3. Overwhelming Prevalence of Exposure to Childhood Adverse Events (CAEs) Previous research focused on women: • 77% - 90% report histories of CAEs • 29% - 70% report childhood emotional and physical abuse • 19% to 59% report childhood sexual abuse • 60% report witnessing frequent domestic violence • 59% - 90% report continued physical/sexual abuse in adolescent and adult relationships

4. Childhood Trauma is Linked with Poor Mental Health Among Women Offenders Histories of childhood trauma often linked to: • Post-Traumatic Stress Disorder • Depression • Personality Disorders • Panic Disorders • Eating Disorders • And, co-occurring Substance Abuse Disorders

5. Women Offenders Also Have Physical Health Problems Drug-dependent women often suffer from: • Anemia, hepatitis, toxemia, hypertension, diabetes, & asthma • Gynecological problems, STD’s, & HIV (due to prostitution & increased injection drug use) • Dental problems • Obesity & other eating disorders • Exacerbated by barriers to health services in the community

6. Men Often Excluded from Trauma Research • It is important to explore the health and social consequences, and corresponding treatment implications, for both men and women who report histories of childhood maltreatment. • Childhood abuse of men is common yet, under-reported, under-recognized, and under-treated

7. Negative Effects of Childhood Trauma Among Male Offenders Histories of childhood trauma often linked to: • Personality Disorders • Depression & Suicide Ideation • Post-Traumatic Stress Disorder • Aggression • Legal Trouble • And, co-occurring Substance Abuse Disorders

8. Adverse Childhood Events (ACE) Studies:HMO Sample ACE Studies identified a link between child abuse and lifetime physical health problems for both men & women: • ACEs correlated with multiple risk factors for leading causes of death (Felitti et al., 1998) • ACEs correlated with early and chronic drug dependency (Dube et al., 2003) • ACEs correlated with histories of attempted suicide (Dube et al., 2005)

9. Drug-Dependent Women Offenders vs. Drug-Dependent Men Offenders • It is likely that an offender population will report a higher degree of childhood maltreatment than those in the general population. • Based on findings from previous literature of drug-dependent offenders and previous findings from the ACE studies, we formulated three hypotheses:

10. Research Hypothesis 1 • Drug-dependent women offenders will report more abuse prior to the age of 16, compared with drug-dependent men offenders.

11. Research Hypothesis 2 • Greater exposure to CAEs would be associated with greater histories of: • mental health treatment, • use of psychotropic medication, • earlier criminal and drug-using behaviors, regardless of gender.

12. Research Hypothesis 3 • Greater exposure to CAEs, combined with the pre-existing substance abuse and criminal histories, would increase the likelihood of adult mental health disorders, regardless of gender.

13. Data Come from the California Department of Corrections Prison Treatment Initiative Participating Prison-Based Substance Abuse Programs: • Central CA Women’s Facility • Sierra Conservation Center • California Rehabilitation Center • Baseline Fire Camp

14. Sample Description (N=741) • Men (n=425) and Women (n=316) • Predominantly White (36%) or Black (29%); • Never Married (50%) or Divorced/Separated (32%); • About 34 years old; • Approximately 11 years of school; • 60% unemployed; • Primary drug problems – 33% methamphetamine; • 22 prior arrests on average.

15. Childhood Adverse Events (CAEs) (Prior to the Age of 16) Abuse and Neglect • Emotional abuse and neglect • Physical neglect • Physical abuse • Sexual abuse Household Dysfunction • Family violence • Parental separation/divorce • Incarceration of family member • Out of home placement • Parental substance abuse Data obtained from the Life Stressor Checklist-R (Wolfe & Kimerling, 1997).

16. Mental Health Measure: Trauma Symptom Checklist-40 Dissociation, Anxiety, Depression, Sexual Abuse Trauma Index, Sexual Problems, Sleep Disturbance, Traumatic Distress Score. (Briere, 1996).

17. Women Reported Greater Exposure to Abuse vs. Men Hypothesis 1 - Supported *Bivariate Comparisons Significant at p<.01.

18. Men Report More Dysfunctionvs. Women *Bivariate Comparisons Significant at p<.01.

19. Increased Problem Behaviors with Greater Exposure to CAEs for Both Men and Women (N=747) *Bivariate Comparisons Significant at p<.01. Hypothesis 2 – Supported

20. Earlier Involvement in Drugs & Crime with Greater Exposure to CAEs for Both Men and Women (N=747) All Comparisons Significant at p<.001. Hypothesis 2 - Supported

21. Women with >5 CAEs Had Greater Psychological Impairment *Bivariate Comparisons Significant at p<.01.

22. Increased Traumatic Distress with Greater Exposure to CAEs for Men All Mental Health Comparisons Significant at p<.001.

23. Increased Traumatic Distress with Greater Exposure to CAEs for Women All Mental Health Comparisons Significant at p<.001.

24. Women Have Higher Levels Traumatic Distress Overall All Mental Health Comparisons Significant at p<.001.

25. Findings and Implications Public Health Relevance: • A need for early prevention and intervention initiatives (Nurse home-visits for at-risk mom’s and adolescent treatment programs) Prison programs may need: • To use comprehensive diagnostic assessments at intake to assess diverse psychological needs • To provide a specific treatment track for co-disordered participants that includes appropriate community-based aftercare

26. This study was supported by an Interagency Agreement (#C97.355 & #C98.346)between the California Department of Corrections, the Office of Substance Abuse Programs and UCLA Integrated Substance Abuse Programs (ISAP)