Research Article| Volume 42, P9-17, February 2023

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An approach for studying the contributions of childhood sexual abuse and HPA axis dysregulation to substance use disorders

Published:December 07, 2022DOI:


      • Childhood sexual abuse survivors (CSA) are at increased risk for substance abuse and dependence
      • Biologically, CSA may alter interactions between the brain’s stress and reward systems, increasing risk for substance abuse
      • Novel approach used to test this hypothesis: adults in residential treatment for substance use disorders studied over time
      • High compliance demonstrated for morning cortisol level and the dexamethasone suppression test procedures
      • Correlations among CSA, basal cortisol, and dexamethasone suppression suggest effect sizes are small


      An environmental risk factor for substance abuse and dependence is childhood sexual abuse (CSA). We piloted an approach we developed to test the hypothesis that hypothalamic-pituitary-adrenal (HPA) axis dysregulation from the stress of CSA is a biological mediator. We based our hypothesis on the allostasis model. New admissions to residential treatment for substance use disorders (N = 41) were evaluated for CSA history and two HPA axis regulation measures at baseline, one month, and two months. The two HPA axis regulation measures were morning cortisol level and the dexamethasone suppression test. Five potential covariates were also measured to increase reliability of the findings. Feasibility outcomes were mostly favorable, and included rates of participation (57 %), attrition (46 % at one month and 71 % at two months), and compliance with data collection procedures (87 % for morning cortisol level and 84 % for the dexamethasone suppression test). High attrition rates at one and two months were entirely attributable to high rates of leaving treatment, an important consideration for future studies. Baseline correlations among variables showed a significant negative correlation between dexamethasone suppression and perceived stress, a potential covariate (rho = −0.458). This finding suggests that individuals with lower stress levels have better negative feedback regulation of the HPA axis, which results in the benefit of lower cortisol exposure—a finding congruent with the allostasis model.


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