Academic journal article Alcohol Research: Current Reviews

Early Life Stress as a Predictor of Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder

Academic journal article Alcohol Research: Current Reviews

Early Life Stress as a Predictor of Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder

Article excerpt

Overview

Although various forms of stress experienced during adulthood can be antecedents for the onset of alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD), stressful events suffered during childhood may produce mechanistically distinct changes in the developing nervous system that increase lifelong risks for the co-occurrence of both disorders. (1) Early life stress (ELS) has been characterized as any form of severe trauma experienced before age 18 that could lead to pathological consequences in adulthood. (2) The trauma may have resulted from maltreatment, such as sexual, physical, or emotional abuse; or stressful life events, such as loss of a parent, economic adversity, or family violence.

Unfortunately, childhood maltreatment is all too common. In 2014, child protective service agencies received an estimated 3.6 million referrals involving approximately 6.6 million children. (3) Roughly, 702,000 of these referrals, 9.4 out of 1,000 children nationally, were considered victims of maltreatment (abuse or neglect). Percentages were similar for boys (48.9%) and girls (50.7%). However, for children younger than age 6, percentages for boys were consistendy larger than they were for girls, whereas for older age groups, percentages for girls were larger than they were for boys. Although these numbers are appalling, they likely represent only the tip of the iceberg, as they do not include cases that go unreported or unverified and do not include other forms of ELS.

There has been growing awareness that the consequences of ELS extend beyond immediate effects, such as fear, injury, or isolation, to include lifelong ramifications on risks for an array of physical (e.g., cardiovascular disease, cancer, diabetes, fractures, and autoimmune disorders) and mental health (e.g., depression, anxiety, PTSD, and substance use disorder) problems, as well as on symptom severity and response to treatment. The idea that such effects could be a result of ELS-induced, long-term alterations in the central nervous system and other biological systems was initially met with some resistance in the scientific community. (4) However, a robust body of evidence now supports the validity of such hypotheses. Findings from a growing number of studies, beginning with the landmark Adverse Childhood Experiences study, suggest that there is a "dose-response" relationship between ELS and adult pathology, such that greater trauma is associated with greater risks for negative sequelae. (5) Moreover, studies of ELS report significant gender-specific prevalence, not only in the types and durations of trauma exposure, but also in rates of psychiatric outcomes such as depression, dissociation, and PTSD. (6) Studies also report physiological consequences, such as reduced hippocampal volume. (7) In general, findings of clinical studies suggest that ELS-induced sequelae are more severe in females than in males, and preclinical studies support this notion. (8)

ELS increases the risk for a variety of adulthood psychiatric and metabolic disorders, but it has a particularly powerful influence on the emergence of AUD and PTSD. Not only are individuals who lived through significant ELS at high risk for developing AUD, but they also have increased risk of a more severe form of the disorder characterized by early age of onset. (9) The increased risk for AUD associated with early childhood maltreatment remains sustained into middle life, (10) implicating long-term changes in key neural circuitry regulating the stress response and the reward systems. Studies have also shown that the risk for developing AUD in adulthood correlates with the number of adverse childhood experiences endured. (11) This dose-dependent effect (severity and frequency) of stress can result from an acute and toxic exposure but is often the consequence of chronic maltreatment. (12) Typically, these individuals have been exposed to multiple and varied types of abuse. …

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