Assaults may amplify female alcoholism.

Psychological stress caused by rape and other violent attacks influences importantly the emergence of alcoholism in women, according to a new study.

"A vicious cycle apparently starts with being a physical-assault victim," asserts psychologist Dean G. Kilpatrick, director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston. "Assault increases women's risk of violence-related stress, which increases their risk of alcohol and substance abuse, which increases their risk of being assaulted again."

Kilpatrick urges screening female alcohol abusers for past assaults and the presence of post-traumatic stress disorder (PTSD), a cluster of symptoms that includes nightmares, inability to concentrate, and intrusive thoughts about a traumatic event. Treating an assault victim's PTSD may lessen her alcohol dependence, he theorized at the annual meeting of the Research Society on Alcoholism in Maui, Hawaii, last week.

Kilpatrick and his coworkers analyzed data from a national survey of 4,008 women, half between the ages of 18 and 34. Trained female interviewers randomly telephoned households containing at least one adult female. Three-quarters of the participants were interviewed 1 and 2 years later; most of the rest were reinterviewed once.

Each interview lasted about 35 minutes and included questions about exposure to violent assaults (rapes or attacks intended to kill or seriously injure the victim), current and past PTSD, and alcohol and illicit drug use. Initial interviews also covered family history of substance abuse and the tendency to seek out exciting and intense experiences (dubbed "sensation seeking").

In the first interview, about 1 in 8 women reported a prior rape and 1 in 10 cited other violent attacks. PTSD had afflicted 12 percent at some time in their lives and nearly 5 percent in the 6 months before the interview. More than 6 percent of the volunteers reported alcohol dependence during their lifetime; this condition had affected 3 percent in the prior year.

A history of both violent assault and PTSD occurred substantially more often in this latter group, after controlling for family history of substance abuse and sensation seeking, Kilpatrick contends. Compared to abstainers from alcohol and drugs, those who cited alcohol dependence over the past year encountered more violent assaults during the 2-year follow-up; women who abused two or more drugs simultaneously suffered the greatest number of new violent assaults.

Moreover, among women reporting no history of alcoholism, about 9 percent of those assaulted during the follow-up developed alcohol dependence, compared with around 1 percent of their nonassaulted counterparts. Women who first developed PTSD during the follow-up also showed an increased incidence of alcoholism.

The highest risk for alcoholism occurred in assault victims with a family history of substance abuse, a penchant for sensation seeking, and PTSD.

Federal statistics released last week indicate that most rapes occur before age 18 and many before age 11, which may partly explain why first assaults preceded alcohol use for some participants, he adds. Girls who grow up in families with one or more substance abusers may face an increased risk of violent assault during childhood or may receive inadequate parental attention as children, Kilpatrick holds.

The South Carolina researchers have begun a national telephone survey of 3,000 teenage boys and girls to examine the extent to which their findings generalize to both males and younger people.