The current study expands on and integrates previous theoretical models concerning the pathways that link child maltreatment to substance use disorder. The proposed model, based on the self-medication hypothesis, suggests that experiences of neglect and abuse during childhood can lead to substance use and abuse both directly and indirectly, via dissociation resulting from failed attempts to integrate experiences of maltreatment in childhood. The model was tested on ten substances (painkillers, stimulants, sedatives, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, and methamphetamine) via structural equation modeling (SEM) in a sample comprising 1040 community-dwelling adults (67% women) aged between 18 and 78 (M = 29.55, SD = 11.37). Fit indexes of the SEM were good, thus supporting the hypothesized model. Specific forms of child maltreatment were related to increased use of specific substances; however, experience of childhood neglect (both physical and emotional) was found to have a central role in predicting use of most substances. Although no single pathway can fully explain the origins of substance abuse, the current study provides evidence of a critical developmental pathway to it, with implications for theory and clinical practice.

目前的研究扩展并整合了先前有关将儿童虐待与药物滥用障碍联系起来的途径的理论模型。所提出的模型基于自我药疗假说，表明童年时期的忽视和虐待经历可能会直接或间接地导致物质使用和虐待，因为未能尝试整合童年时期的虐待经历而导致分离。该模型通过结构方程模型 (SEM) 在包含 1040 名社区居住成年人（67% 为女性）的样本中对 10 种物质（止痛药、兴奋剂、镇静剂、大麻、可卡因、摇头丸、致幻剂、海洛因、吸入剂和甲基苯丙胺）进行了测试年龄在 18 岁至 78 岁之间（M = 29.55，SD = 11.37）。SEM的拟合指数良好，支持了假设的模型。虐待儿童的具体形式与特定物质的使用增加有关；然而，人们发现童年被忽视的经历（身体和情感上的）在预测大多数物质的使用方面具有核心作用。尽管没有任何单一途径可以完全解释药物滥用的起源，但当前的研究提供了药物滥用的关键发展途径的证据，并对理论和临床实践具有影响。