Several potential mediators may form part of the causal pathway. For example, childhood maltreatment increases risk for post-traumatic stress disorder (46, 47), major depression (48), and personality disorders (25); these disorders may limit ability to remit from dependence. Individuals with a history of childhood maltreatment may also be less resilient in overcoming substance dependence due to a reduced sense of autonomy (which could affect their confidence in taking the steps needed to recover) (49), reliance on avoidance-based coping strategies (50, 51), and strained interpersonal relations (and resulting reduced social support) (52). The effects of childhood maltreatment may also be biologically mediated, as inhibitory brain processes have been shown to differ by childhood maltreatment status (53). Individuals with and without childhood maltreatment may also differ in treatment-seeking, which could affect persistence. Although no nicotine treatment information was available in the present study, we ran exploratory post-hoc analyses on the effect of childhood maltreatment on alcohol persistence, controlling for demographics, other childhood adversities, and professional treatment for alcohol problems (i.e., use of medical, psychiatric, or social services for alcohol problems). The pattern
