摘要：Objectives. We sought to study the association between adverse events occurring in childhood and adolescence and lifetime alcohol dependence in a representative sample of American adults. Methods. With data from the National Epidemiologic Survey on Alcohol and Related Conditions, we conducted logistic regression multivariate analyses to examine the impact of adverse events occurring in childhood (aged < 18 years) on the lifetime prevalence of alcohol dependence. We controlled for age at drinking onset, binge drinking, alcoholism in parents and grandparents of respondents, and demographic characteristics. Results. Adverse childhood events were associated with familial alcoholism and with early and binge drinking, and therefore, we controlled for these potential confounders. Experiencing 2 or more adverse childhood events, compared with none, significantly increased the risk for alcohol dependence, even after we controlled for sociodemographic variables and disorder-specific potential confounders not considered in the extant literature (adjusted odds ratio = 1.37; 95% confidence interval = 1.06, 1.77). Conclusions. Individuals who experienced 2 or more adverse childhood events are at increased risk for lifetime alcohol dependence. A better understanding of the factors underlying the risk for alcohol dependence is important for developing better prevention and early intervention measures. Alcohol dependence is a major public health problem. National findings indicate that nearly an eighth of Americans (12.5%) met criteria at some point in their lives for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ), 1 alcohol dependence 2 and that alcohol dependence is associated with significant disability and with poor mental health. 3 A better understanding of the factors underlying the risk for alcohol dependence is important for developing better prevention and early intervention measures. Research in treated and untreated populations consistently shows that adverse childhood events (i.e., events occurring before the child is aged 18 years) predict alcohol dependence. 2 , 4 – 6 Data from a survey conducted in the early 1990s suggested that several adverse events increased the risk for alcohol dependence after sociodemographic variables were controlled for, and the joint effect of exposure to multiple adverse events was stronger than the effect of a single adverse event. 2 A questionnaire survey of health maintenance organization (HMO) members suggested a linear relationship between the number of adverse childhood events and the probability of responding positively to single questions on having an alcohol problem or considering oneself alcoholic. 5 For example, compared with those not reporting any adverse childhood events, individuals reporting 1 and 2 adverse childhood events were 2 and 4 times more likely, respectively, to consider themselves alcoholics. These studies suggest that the number of adverse childhood events is a more powerful predictor of adult alcohol-use disorders than any specific adverse childhood event. The cumulative stress associated with experiencing several adverse childhood events has been associated with increased risk for negative mental health outcomes 7 and might explain the increased propensity to use alcohol and eventually become alcohol dependent, perhaps seeking relief from the enduring impact of these events. Even though adverse childhood events have been shown to be associated with alcohol dependence, information is lacking on whether this association remains significant after one controls for other known strong risk factors that may confound the association. Three such strong risk factors arise from an extensive literature. First, familial alcoholism is a strong risk factor for alcohol dependence. 8 – 10 Second, early drinking onset predicts alcohol dependence in both cross-sectional and prospective studies, 11 , 12 and twin studies suggest that the association is because of familial sources, reflecting shared environmental and genetic factors 12 and unique environmental factors. 11 Third, binge drinking is associated with the onset and chronicity of alcohol dependence in cross-sectional 13 and prospective studies. 14 – 16 Whether the association between adverse childhood events and lifetime alcohol dependence remains significant after one controls for these strong risk factors is unknown. We addressed this question with data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large, nationally representative survey of American adults that includes information about adverse childhood events, age at drinking onset, binge drinking, and alcoholism in parents and grandparents of respondents. The NESARC data provide a uniquely advantageous opportunity to study the impact of adverse childhood events on alcohol dependence among adults. We hypothesized that adverse childhood events would be significantly associated with lifetime alcohol dependence and that the magnitude of this association would remain significant after we controlled for alcoholism in the 2 preceding generations and for binge and early drinking.
