The prevalence of sexual abuse and its impact on the onset of drug use among adolescents in therapeutic community drug treatment

Assessing the prevalence of sexual abuse among adolescents is problematic because they are generally reluctant to disclose abusive experiences. Often the abuse is ongoing and may involve family members with whom the adolescent lives or with whom there may be strong emotional attachments. Statistics based on self-reports of childhood victimization suggest that issues of childhood abuse are critical factors in the initiation of drug use. The current study describes the prevalence of sexual abuse among a sample of 938 adolescents admitted to residential therapeutic communities for the treatment of substance abuse and related disorders. The data indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than boys (64% vs. 24%). A history of sexual abuse correlates with several social, behavioral, and psychological characteristics of clients at entry to treatment, including greater drug use, more severe psychopathology, family drug use and more deviant peer associations. Cox regression analyses show that a history of sexual abuse is related to earlier onset of alcohol and illicit drug use. One explanation of the findings is the self-medication hypoth- esis (Cavailo & Schiff, 1989) which states that drug use functions to ameliorate feelings of depression, and poor self-esteem which often accompany childhood abuse.