Some study limitations are noted. (1) Respondents reporting early onset alcohol dependence (<18 years) were excluded to eliminate reverse causation as an explanation of the findings. Adding these cases did not substantially impact the impact the significance (all associations p<0.001) or magnitude (range of increase in ORs: 0.02–0.10) of associations. (2) We excluded cases of alcohol abuse as uninformative. Sensitivity analyses indicated that this was an appropriate strategy. Including respondents with alcohol abuse in the reference group produced essentially no change in the associations. Adding respondents with alcohol abuse to the case group (those with alcohol dependence) did not change the significance of associations, but led to slight decreases in the magnitude of ORs (range −0.16 to −0.34), which supports our decision to exclude cases of alcohol abuse as they would partially mask the maltreatment-dependence associations. (3) Due to model restrictions, interaction analyses did not adjust for co-occurring maltreatments. However, since co-occurring maltreatments did not explain the main effects of sexual abuse, physical abuse, emotional abuse and physical neglect on alcohol dependence, they are unlikely to explain the interaction effects.
