Victimization among substance-abusing women. Worse health outcomes

Although women with a history of victimization are known to have increased somatic symptoms, health care utilization, and substance abuse, the health effects of victimization on substance-abusing women are uncertain.

To examine whether a history of victimization among substance-abusing women is associated with more medical problems or emergency department visits.

Interview data were collected from 2322 women seeking publicly funded addiction treatment from September 1992 to January 1996. We compared women with a lifetime history of physical or sexual abuse with those without such a history by bivariate and multivariable analyses. Variables included episodic medical disease, chronic medical disease, recent emergency department visits, substance abuse characteristics, and demographic data.

The prevalence of victimization was 42%. In bivariate analyses, the following variables had significant association with victimization histories: episodic medical disease, recent emergency department visit, chronic medical disease, primary care physician's awareness of substance abuse history, ethnicity, and lower income. Alcohol and crack cocaine users had higher prevalence of victimization compared with heroin or noncrack cocaine users (P = .001). In the logistic regression, the following variables remained independently and significantly associated with victimization: episodic medical disease (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.70-2.73), physician awareness of substance abuse (OR, 1.78; 95% CI, 1.42-2.23), emergency department visit (OR, 1.57; 95% CI, 1.22-2.03), chronic medical disease (OR, 1.51; 95% CI, 1.19-1.92), and lower income.

Victimization in urban, poor, substance-abusing women is associated with more medical disease and health care utilization. Interventions that focus on the interconnected problems these women face may more effectively affect this challenging population.