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Rural women with substance use disorders may have experienced significantly more childhood trauma than their male counterparts, according to new research from the West Virginia University School of Medicine.

The study — led by Erin Winstanley, an associate professor in the Department of Behavioral Medicine and Psychiatry and Department of Neuroscience — explored the incidence of childhood trauma in the lives of people with substance use disorders. The women who participated in the study reported 4.5 types of adverse childhood experiences, on average. In contrast, the men reported 3.3.

“And for women, about one in four had been forced to have sex before the age of 18,” Winstanley said. “That’s astoundingly high. Even the rate for males, which is 8% and seems really low, is actually quite high.”

Her findings appeared in the Journal of Substance Abuse Treatment. Her team included other School of Medicine researchers: James Mahoney, Laura Lander, James Berry, Patrick Marshalek, Wanhong Zheng and Marc Haut. The project was noteworthy for focusing on a rural population.

“Rural and Appalachian areas have higher rates of overdose deaths compared to urban areas, and it is important to understand factors that may explain these differences,” Winstanley said.

The study involved 173 participants who received treatment at a rural buprenorphine clinic between June 2018 and June 2019. Buprenorphine/naloxone — or Suboxone — is a medication that doctors prescribe to treat opioid use disorder.

The participants completed a survey on adverse childhood experiences. They answered such questions as “How many times were you taken from your parent’s or guardian’s home and made to live somewhere else?” and “Before age 18, did a boyfriend, girlfriend or significant other ever verbally or physically abuse you?”

When researchers analyzed the responses, they divided the experiences into eight categories: mental health problems, alcohol or drug use, emotional abuse, physical abuse, teen dating violence, sexual abuse, neglect and family dissolution.

Overall, they found that more than half of the participants — 54.3% — reported at least four categories of adverse childhood experiences.

For comparison, 15.8% of Americans in general report that many types. And 13.4% of West Virginians do. In particular, women in the study were significantly more likely to have been sexually abused: 42.4% of them reported sexual abuse during childhood, whereas 10.6% of men did. More specifically, 25.9% of women and 8.2% of men reported being forced to have sex before age 18.

“Setting gender-based differences aside, the rates of sexual abuse for both males and females was notably high,” Winstanley said. “And the other thing you have to keep in mind that this is only what happened before they were 18. One of the things that we’re also interested in is accumulation of risk across the life course. Oftentimes, many people who may have experienced sexual or physical abuse during their childhood may go on to experience it in adulthood.”

This accumulation of trauma may lead to sadness, anxiety, anger and other negative emotions. In turn, these negative emotions might cause someone to “use alcohol and drugs to self-medicate,” Winstanley said.

“It helps to understand some of the complex things that these folks are trying to cope with,” she said.

Insights like these highlight the usefulness of screening substance-use-disorder patients for adverse childhood experiences.

But it’s not enough to “know about the potentially traumatic events children were exposed to,” Winstanley says. “The real question is, how might that knowledge impact their treatment planning?”

What she and her colleagues have discovered may do more than simply inform treatment plans.

Their findings may also obviate some of those plans by helping to stop substance use disorders from developing in the first place.

“We know when you look at the population level, the average age of onset of mental health disorders precedes substance use disorders,” she said. “So, there are some people who think that provision of child and adolescent mental health services could be a primary prevention for substance use.”