Relatedly, traumatic exposures, particularly when experienced in childhood, rarely occur in isolation. Childhood physical and sexual abuse often occurs in the context of a stressful rearing environment characterized by other types of interpersonal violence (IPV) including parental physical violence (Bottoms et al. 2016), and/or parental mental health and substance use problems (Sartor et al. 2008). Therefore, individuals who meet criteria for AUD, CUD, and TUD are more likely to have experienced childhood maltreatment (Dohrenwend, 2000; Khoury et al. 2010; Sartor et al. 2012), in addition to other related familial risk factors, such as parental substance use and parental violence (Howell et al. 2014). Due to the clustering of both adverse childhood experiences, and adult substance use and psychiatric disorders, disentangling the specific effects of any individual risk factor to any particular SUD are challenging (Sartor et al. 2008). Although such investigations are rare, a recent study conducted with a Canadian general population-based sample reported independent effects of three adverse childhood events (physical and sexual abuse, and witnessing parental domestic violence), when mutually adjusted for, in alcohol and drug dependence (Fuller-Thomson et al. 2016). While this study examined variation by gender, differences by race/ethnicity were not explicitly investigated.
