Pathways From Childhood Maltreatment to Adult Drug Use: The Distinct Roles of Internalizing and Externalizing...

Numerous studies have reported associations between child maltreatment and drug use and abuse. We ask whether internalizing and externalizing symptoms during young adulthood mediate the relationship between childhood maltreatment and illicit drug use and use of prescribed medications later in middle adulthood.

Using a prospective cohort design, a large group of court-substantiated cases of childhood maltreatment (ages 0-11) and demographically matched controls were followed into adulthood. Internalizing symptoms (depression and anxiety), externalizing symptoms (antisocial personality disorder), and drug abuse and dependence symptoms were assessed in young adulthood (M age = 29) in interviews during 1989-1995 (N = 1,196). Information about the use of illicit drugs and prescribed medications was obtained in middle adulthood in interviews during 2003-2005 (N = 807, M age = 41). Parallel mediation models were tested for depression and anxiety separately using path analysis.

Childhood maltreatment predicted more internalizing and externalizing symptoms during young adulthood. Internalizing symptoms during young adulthood mediated the effect of childhood maltreatment on prescription drug use in middle adulthood. In contrast, externalizing symptoms mediated the relationship between childhood maltreatment and illicit drug use in middle adulthood, despite controls for drug abuse/dependence symptoms in young adulthood.

These new findings suggest that efforts should be directed at reducing internalizing symptoms of anxiety and depression and externalizing symptoms in maltreated children to reduce the risk for drug use later in life. The unique mediating effects of internalizing versus externalizing symptoms on prescription drug and illicit drug use, respectively, suggest the need for tailored interventions for different kinds of drug use.