An estimated 20% of women in the United States report experiencing childhood sexual abuse (CSA) (1–3), a well-documented risk factor for a range of substance-related outcomes. CSA has been linked to elevated rates of alcohol abuse and dependence (4–8), adolescent alcohol use (9,10) regular smoking (6, 11), nicotine dependence (6, 7), cannabis use (6, 9), and cannabis use disorders (5, 8). Fewer investigations have focused on its association with early onset substance use, but the pattern is the same. Risk for early age at first drink (9, 10, 12), first cigarette (12, 13), first cannabis use (9, 12), regular drinking before age 10 (12), and heavy episodic drinking before age 15 (14) are greater in girls who have experienced CSA than in those who have not. Early initiation of substance use is a major public health concern because early use typically means longer than average lifetime exposure to substances of abuse and, even more importantly, exposure during a critical period of brain development, with the potential for serious and long-lasting consequences (15, 16). Additionally, risk for abuse or dependence is
