Abstract
Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships can impact neurological development, specifically through interference with physiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis), brain structure and functioning (e.g., the hippocampus and prefrontal cortex), and neuropsychological development (e.g., executive functioning and emotion regulation) across the lifespan. Further, we discuss the impact of exposure to violence on the development of relational capacity, including attachment, internal working models, and subsequent interpersonal relationships across the lifespan, and how these developmental pathways can lead to continued problematic substance use in women.
Highlights
Substance use among women is a major public health concern
It is for this reason that we use the term interpersonal violence (IPV), to highlight the developmental and intergenerational nature of violence in relationships and that violence in relationships is not exclusive to violence between partners
Given that women are more often victims of interpersonal violence than are men [3], we focus on the pathways to substance use for women using a developmental-relational approach, and describe the importance of gender-specific programming for women who have experienced IPV and who use substances
Summary
There is recognition of the concurrent challenges associated with substance use and the barriers to reduce use for women (e.g., poverty, untreated mental health difficulties [1,2]) Another challenge is women’s experiences with interpersonal violence. Experiences with violence in relationships often begin before women enter adulthood (e.g., via childhood maltreatment, witnessing violence between parents) and continue throughout adolescence and into early adulthood It is for this reason that we use the term interpersonal violence (IPV), to highlight the developmental and intergenerational nature of violence in relationships and that violence in relationships is not exclusive to violence between partners. Public Health 2019, 16, 4861 and relational—through which early and ongoing experiences with IPV can lead to substance use Though these developmental mechanisms may exist for both women and men, this paper will focus on what we know about these processes among women. Given that women are more often victims of interpersonal violence than are men [3], we focus on the pathways to substance use for women using a developmental-relational approach, and describe the importance of gender-specific programming for women who have experienced IPV and who use substances
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