Victimization,Substance Use,and Sexual Aggression in Male Adolescent Sexual Offenders

Abstract

Relations among childhood victimization, substance use prior to the commission of a sexual offense, and force used during a sexual offense were examined in a sample of residentially based, male juvenile sex offenders (n = 406; M_age = 16.6). Marshall and Marshall’s (2000) theory of sex offending proposes that childhood victimization, among other factors, creates a vulnerability to offend, which when paired with disinhibition (e.g., from substance use) may lead to sexual offending. Guided by this theory, we examined whether substance use prior to the commission of a sexual offense mediated the relation between trauma and force used in sexual offending. Six mediation analyses were used to examine subtypes of childhood victimization and the effects of cumulative victimization. Results provided support for partial mediation of substance use prior to a sexual offense on the effects of cumulative victimization on force used during a sexual offense. Theoretical and clinical implications are discussed.

Keywords

juvenile sex offender childhood victimization substance use juvenile offender childhood trauma

Youth involved in the juvenile justice system report experiencing traumatic events at rates of more than 90% (Abram et al., 2004; Carrion & Steiner, 2000). Although not all youth who experience trauma will suffer from negative consequences, exposure to traumatic events is associated with delinquency (e.g., Dembo, Schmeidler, Nini-Gough, & Manning, 1998; Maxfield & Widom, 1996; Stouthamer-Loeber, Loeber, Homish, & Wei, 2001; Widom & Maxfield, 2001) and substance use (Finkelhor, 2009; Kilpatrick et al., 2000; Widom, Marmorstein, & White, 2006), among other adverse outcomes, at rates greater than chance. For example, childhood abuse or neglect has been found to increase the likelihood of a juvenile arrest by 59% (Widom & Maxfield, 1996). Furthermore, data on youth with abuse or neglect histories indicate that they are 1.5 times more likely than controls to report illicit drug use (Widom et al., 2006). Despite these documented associations between trauma and substance use, and trauma and delinquency, there have been few attempts to integrate these constructs (e.g., Evans, Spirito, Celio, Dyl, & Hunt, 2007; Wilson & Widom, 2009). We are not aware of any investigations integrating these constructs in samples of juveniles with sexual offense histories. Given higher rates of victimization in juvenile sex offenders when compared with nonsexually offending youth (Leibowitz, Burton, & Howard, 2012; Seto & Lalumière, 2010), there is a pressing need to understand these relations within this population.

Childhood Trauma among Sexually Abusive Youth

In investigations of juvenile sex offenders, reported rates of sexual victimization range from less than 10% to more than 90% (Awad & Saunders, 1991; Benoit & Kennedy, 1992; Burton, 2000; Cooper, Murphy, & Haynes, 1996; Fagan & Wexler, 1988; Fehrenbach, Smith, Monastersky, & Deisher, 1986; Hunter & Figueredo, 2000; Moody, Brissie, & Kim, 1994; Ryan, Miyoshi, Metzner, Krugman, & Fryer, 1996; Worling, 1995; Veneziano, Veneziano, & LeGrand, 2000). Results of a meta-analysis of more than 50 studies suggest the rate of sexual victimization for juvenile sexual abusers is close to 40% (Burton & Schatz, 2003). In a meta-analysis of 31 studies investigating sexual abuse history in juvenile sex offenders, all but 2 studies reported that adolescent sex offenders had a more frequent sexual abuse history compared with nonsexual offenders (Seto & Lalumière, 2010). Thus, despite the wide range of prevalence rates, the consensus in the literature is that juvenile sex offenders have high rates of sexual victimization histories, and their victimization rates are generally higher when compared with nonsexual offenders.

Perpetrators of child sexual abuse who have themselves been sexually victimized report higher rates of emotional and physical neglect and also emotional and physical abuse compared with nonsexually victimized perpetrators (Burton, Duty, & Leibowitz, 2011). In addition to sexual victimization, physical abuse has been documented in 20% to 50% of juvenile sex offenders (Hunter & Figueredo, 2000). Moreover, child neglect and exposure to family/domestic violence have also been associated with juvenile sexual offending (Center for Sex Offender Management, 2000). Seto and Lalumière (2010), in their meta-analysis, found that a majority of the 20 studies that examined physical abuse showed a higher prevalence in juvenile sex offenders compared with nonsexually offending delinquent youth, with effect sizes (Cohen’s d) ranging from .05 to .19, depending on how physical abuse data were collected. In addition, 9 of 11 studies showed higher rates of emotional abuse or neglect, measured as one construct, in sex offending versus nonsexual offending delinquent youth with effect sizes ranging from .25 to .34. High rates of traumatic exposure in this population place these youth at increased risk for the potential sequelae of such exposure, including substance use (Finkelhor, 2009; Kilpatrick et al., 2000; Widom et al., 2006), which has critical implications for assessment and treatment. Although historically much emphasis has been placed on sexual victimization history in juvenile sexual offending, these results point to the importance of considering the effects of other types of abuse and the effects of the accumulation of multiple types of abuse.

Importantly, researchers have explored whether victimization history predicts sexual offending. In a sample of 139 juvenile sex offenders using a retrospective design, Johnson and Knight (2000) found that sexual abuse statistically predicted sexual coercion, whereas physical abuse indirectly predicted sexual coercion through alcohol abuse and peer aggression. Physical and sexual abuse were related to increased sexual aggression in a sample of 117 juvenile male sex offenders (Kobayashi, Sales, Becker, Figueredo, & Kaplan, 1995). In addition, juvenile sex offenders with a sexual abuse history have been found to initiate sexual offending at a younger age, have more victims, and have more severe offenses compared with their nonsexually abused counterparts (Burton et al., 2011). Thus, having a sexual abuse history appears to be related to a more severe offending pathway. Conversely, little is known about the effects of other subtypes of traumatic victimization, or the experience of multiple types of victimization, on aggression used during sexual offending.

Substance Use and Sexual Offending

The prevalence and impact of substance use on juvenile sexual offending remains an understudied area of research; consequently, we have included relevant literature on substance use in adult sexual offenders to inform study hypotheses. As documented in a review by Kraanen and Emmelkamp (2011), several studies have found higher rates of substance use in adult sexual offenders compared with nonviolent offenders using file review (Looman, Abracen, DiFazio, & Maillet, 2004), screening instruments (Abracen, Looman, & Anderson, 2000), and semistructured interviews (Harsch, Bergk, Steinert, Keller, & Jockusch, 2006), despite some studies showing the opposite relation (Alish et al., 2007; Motiuk & Porporino, 1993).

Additional investigations have been conducted with adult samples to capture the extent of substance use prior to the commission of a sexual offense, rather than substance use/abuse history broadly. Estimates of the use of alcohol at the time of a sexual assault vary widely, ranging from approximately 30% to 70% (Peugh & Belenko, 2001; see Abbey, Zawacki, Buck, Clinton, & McAuslan, 2004; Seto & Barbaree, 1995; Testa, 2002, for reviews). In a review of correlational, event-based, and experimental investigations of the role of alcohol use in the perpetration of adult sexual offending, Testa (2002) reported that each of these modes of investigation provided support for the role of alcohol in sexual aggression. This finding is consistent with theories proposing that alcohol may provide a disinhibiting effect that operates by allowing the abuser to apply more liberal views of socially acceptable behavior, or by interfering with processing inhibitory cues related to the offense (Norris, Davis, George, Martell, & Heiman, 2002; Seto & Barbaree, 1995).

Despite demonstrating an association with substance use and sexual offending in adults, few researchers have examined the prevalence or patterns of substance use in juvenile sex offenders. Within the few samples investigated, about 50% of sex offending youth report using substances (e.g., Hsu & Starzynski, 1990; Mio, Nanjundappa, Verleur, & de Rios, 1986). These rates are consistent with unpublished data from our research that indicate 61% of juvenile sex offenders have used alcohol, 55.7% have used marijuana, and 12% have used other illicit substances (e.g., inhalants, cocaine; Caserta & Burton, 2013). However, other, much earlier studies report rates of usage around 4% (e.g., Awad & Saunders, 1989; Fagan & Wexler, 1988). Indeed, a recent meta-analysis of 59 studies comparing 3,855 male adolescent sex offenders to 13,393 male adolescent nonsex offenders indicated much variability in the prevalence of substance use problems in 20 studies comparing sex offenders to nonsexual offenders, with rates ranging from 2% to 97% depending on the methodology and definition of use/abuse (Seto & Lalumière, 2010). Taken together, the authors found greater substance use problems among nonsex offenders. Thus, even if the true prevalence is difficult to discern based on the current research, it appears as though substance use rates in this population are substantial. In turn, substance use in this population may have an impact on sexual offense patterns.

Finally, there are also inconsistent data regarding rates of substance use in the commission of adolescent sexual offending. For example, Van Ness (1984) found that 55% of adolescent rapists abused substances prior to their offense, suggesting that intoxication could have increased the risk of offense commission. Conversely, Fehrenbach and colleagues (1986) in a study of community-based youth found that only 6% of juvenile sexual offenders or their victims used any type of substances at the time of the sexual offense. Moreover, in a study described above, alcohol abuse in adolescence directly predicted sexual coercion in a sample of juvenile sex offenders (Johnson & Knight, 2000); however, the investigation assessed alcohol abuse history rather than use just prior to the commission of an offense. Indeed, theoretically, substance use has been considered as a contextual risk factor for adolescent sexual offending due to disinhibition and/or effect on judgment (Caserta & Burton, 2013; Marshall & Barbaree, 1990); however, investigations assessing substance use prior to the commission of a sexual offense are scarce.

The Current Study

We investigated the relations among childhood victimization, substance use prior to a sexual offense, and aggression during sexual offending (viz., level of force used during sexual victimization) in a sample of residentially incarcerated juvenile sex offenders in the United States. Consistent with extant data (e.g., Johnson & Knight, 2000), subtypes of traumatic victimization, as well as cumulative victimization, were hypothesized to significantly predict substance use prior to an offense. Current etiological theory suggests that juvenile sexual abusers experience vulnerability due to childhood victimization, which can result in a disposition to offend. When this disposition is paired with disinhibiting influences such as deviant sexual arousal and substance use, as well as the opportunity to offend, the juvenile may be more likely to engage in deviant sexual behavior that would otherwise be inhibited (Marshall & Marshall, 2000). Thus, substance use before the crime has a potential disinihibiting effect in the victimized youth that could increase risk for sexual offending.

Due to this potential relation, substance use prior to an offense was predicted to mediate the relation between trauma and force used in sexual offending by working through a disinhibitory mechanism (Figure 1). That is, substance use prior to the offense would account for, at least in part, the relation between trauma and force used during sexual offending. We predicted that the linkage between victimization and force used during sexual offending would be strongest for sexual abuse compared with other types of victimization. Given the high rates of physical abuse reported in sex offenders, along with sexual abuse, and limited data on other forms of victimization in juvenile sex offenders, five forms of victimization (i.e., sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) as well as the effects of cumulative victimization were assessed in the current study.

Figure 1:

Proposed Mediation Model

Method

Sample Characteristics

The data in the current study comprised assessment data collected from residentially based, sexually abusive youth (N = 573) from two U.S. states at three points in time. The first assessment (Group 1) was conducted in a Midwestern state in 2004; assessment data were subsequently collected from a second group of youth (Group 2) from the same Midwestern state in 2009; and finally, data were collected from a third sample of sexually abusive youth (Group 3) from an Eastern state in 2009. Assessment data collected from Groups 1 and 2 were confidential, and anonymous data were provided by participants in Group 3. Further description of the method can be found in previous publications on this data set (e.g., Burton et al., 2011). Those youth who denied committing a sexual crime (n = 60), who did not answer either questions regarding the number of victims (n = 51), and who were more than two standard deviations away from the mean number of victims (n = 2) were removed from the sample. As a result, the sample size was reduced to 460. Finally, removing youth for invalid responding after applying the Millon Adolescent Clinical Inventory (MACI; Millon, Millon, & Davis, 1993; Millon, Millon, Davis, & Grossman, 2006) exclusion criteria to assess social desirability (n = 54) resulted in a final sample size of 406.

The sample was comprised of adolescent males with an average age of 16.64 years (SD = 1.99 years). Thirty-four percent of youth were raised in a two-parent household, 23% were raised by a single mother, and almost 19% were raised by their mother and her partner. Nearly 55% of the sample was Caucasian, 26.8% was African American, 5.9% was Latino, 6.2% was Native American, and 6.2% was categorized as Other.

Measures

Total force

The Self-Report Sexual Aggression Scale (SERSAS), a multi-item inventory measuring sexually aggressive behaviors over the life span (Burton, 2003; Burton, Miller, & Shill, 2002), was used to measure sexual aggression. Questions about several sexual acts were all prefaced with “Have you ever conned or forced someone to . . . ?” When answering the questions, youth were asked to consider their index offense. From this scale, a score indicating the severity and complexity of the amount of force used in victimizing others was calculated. This score was computed as follows: 1 = used games to convince their victim to have sex; 2 = used threats; 3 = used games and threats; 4 = used force on their victims; 5 = used force and games; 6 = used force and threats; and 7 = used force, games, and threats. A prior investigation yielded 8-week test–retest reliability for the SERSAS, for a small sample, of .96 (Burton, 2000).

Perpetration severity

To provide descriptive information regarding the types of sexual offending behaviors committed by study participants, a parallel scale to the total force scale was created from the SERSAS to assess the severity and diversity of the perpetration committed by sexual abusive youth. In considering their instant offense, youth providing a score ranging from 1 to 15, with 1 = exposure and 15 = penetration, oral sex, exposure and fondling.

Victimization

The Childhood Trauma Questionnaire (CTQ) is a 34-item scale that provides a brief and relatively noninvasive screening of five types of traumatic experiences in childhood. The version used in the current study preceded the familiar 28-item instrument (Bernstein & Fink, 1998) and was used for the sake of comparison with other research we have conducted. Questions assessing type of traumatic victimization were prefaced with “When I was growing up . . .” and participants rated their experiences on a 5-point scale from 1 = never true to 5 = very often true. All of the subscales have acceptable to good internal consistency in this study with Cronbach’s alphas on the five CTQ subscales as follows: Sexual Abuse = .85; Physical Abuse = .90; Emotional Abuse = .89; Physical Neglect = .98; and Emotional Neglect = .80. Cronbach’s alpha for the CTQ total scale score was .95.

Substance use prior to a sexual offense

Two summed items on a detailed demographic questionnaire were used to assess substance use prior to the commission of a sexual offense. On a Likert-type scale ranging from 1 (never) to 5 (always), participants were asked to rate whether they agreed with the following statements: “I used drugs before my criminal offenses” and “I used alcohol before my criminal offenses.” These questions were asked within the context of a series of sex offense-specific questions assessing the use of pornography, substance use, and involvement in sex offender group treatment before and after participants’ criminal offenses.

Overall substance use

A composite overall substance use scale was created using six drug and alcohol use items on the Self-Reported Delinquency measure (SRD; Elliott, Huizinga, & Ageton, 1985). The SRD is a 32-item measure used to assess for nonsexual, criminal behavior committed by the youth within the following domains: drug use, alcohol use, felony assault, felony theft, general delinquency, property damage, public disorder, robbery, and selling drugs. Participants used a 7-point frequency scale ranging from 0 (never) to 7 (2-3 times per day) to rate SRD items based on the year prior to their arrest. The overall substance use scale was developed to account for average substance use history in the mediation models. Cronbach’s α = .75 in this sample.

Procedure

After appropriate board permissions, assents, and consents were obtained, data were collected in small groups (8-12 participants) within the residential facilities. Youth were provided with sufficient personal space to complete measures to ensure privacy from other participants. The surveys were read aloud to adolescents identified as having reading challenges. In all cases, youth completed measures under the supervision of trained graduate students, professional social workers or social work faculty, and/or residential facility staff.

Results

Table 1 presents means and standard deviations on all study variables. Table 2 presents correlations among main study variables. On the perpetration severity scale, the most commonly reported behaviors during a sexual offense included using penetration, oral sex, exposure, and fondling (22.5%), followed by reports of solely fondling their victims (11.4%). The next most frequently occurring offending behavior was penetration (8%) as the sole method of abuse. The average perpetration severity score was 8.90 (SD = 4.91; 9 = penetration and exhibitionism or voyeurism) out of 15. The average total force score was 2.43 (SD = 2.05), with 60.7% of the sample reporting that they only used games to convince their victims to have sex. The next most frequently endorsed response was using force, games, and threats on their victims (9.3%). The number of victims endorsed in the sample ranged from 1 to 28 victims. Forty-five percent of youth endorsed having one victim, followed by 20% who endorsed having two victims. On average, the youth admitted to 2.84 sexual abuse victims (SD = 3.30 victims). Regarding the participants’ own victimization history, 84.8% of the sample reported experiencing some type of physical neglect, 83.5% reported some type of physical abuse, 79.6% endorsed emotional abuse, 72.4% endorsed sexual abuse, and 15.9% reported emotional neglect. Sixty-three percent of the sample endorsed experiencing all five types of abuse, 16.7% endorsed experiencing four types of abuse, 11.1% endorsed three types of abuse, 6.5% endorsed two types of abuse, and 2.5% endorsed one type of abuse. In the current study, youth endorsed rates of drug and alcohol use at 56.5% and 56.6%, respectively. In addition, 40.1% reported using drugs prior to the commission of sexual offenses, 37.4% reported using alcohol prior to the commission of sexual offenses, and 32.4% used drugs and alcohol prior to the commission of sexual offenses, although not necessarily at the same time.

Table 1:

Descriptive Analysis of Key Variables

Variables	M (SD)	Observed Range
Perpetration severity	8.90 (4.91)	1-15
CTQ total score	71.51 (27.53)	24-166
Drugs and alcohol before offense	3.32 (2.88)	0-10
Overall drug and alcohol use	5.86 (6.80)	0-30
Sexual abuse	12.10 (6.81)	1-30
Emotional abuse	11.62 (6.19)	2-25
Physical abuse	11.71 (6.28)	1-25
Physical neglect	15.39 (6.13)	7-40
Emotional neglect	18.85 (8.97)	3-45
Total force	2.43 (2.05)	1-7

Note. CTQ = Childhood Trauma Questionnaire.

Table 2:

Correlations of Key Variables

	Sexual Abuse	Physical Abuse	Emotional Abuse	Physical Neglect	Emotional Neglect	CTQ Total Score	Total Force	Perpetration Score	Overall Drug and Alcohol Use	Drug and Alcohol Use Before the Crime	Age	Race^a
Sexual Abuse	1.0
Physical Abuse	.47***	1.0
Emotional Abuse	.49***	.84***	1.0
Physical Neglect	.45***	.58***	.56***	1.0
Emotional Neglect	.29***	.48***	.53***	.48***	1.0
CTQ Total Score	.67***	.84***	.86***	.77***	.78***	1.0
Total Force	.11	.14*	.17**	.25***	.14*	.20***	1.0
Perpetration Score	.15**	.15*	.21***	.14**	.17**	.19***	.21***	1.0
Overall Drug and Alcohol Use	.17**	.22**	.23***	.35***	.23***	.28***	.13*	.03	1.0
Drug & Alc. Use Before Crime	.08	.12*	.13**	.24***	.04	.13**	.17**	.01	.73***	1.0
Age	.15**	.15**	.13*	.17***	.15**	.17**	.10	.05	.22***	.19***	1.0
Race^a	.05	.10	.15**	.17***	.05	.14**	.03	.12*	.00	.01	−.07	1.0

Note. CTQ = Childhood Trauma Questionnaire.

0 = Euro American, 1 = Youth of color.

p < .05. **p < .01. ***p < .001.

Mediation analyses were conducted using a bootstrapping method developed by Preacher and Hayes (2004, 2008), using 95% confidence intervals (CIs) at k = 5,000 resamples. The bootstrapping technique directly tests whether the path between the independent and dependent variable via the mediator is significant; such a technique was designed to reduce Type I and Type II error associated with traditional mediation methods (Preacher & Hayes, 2004, 2008). Mediation is supported when the 95% CIs around the indirect effect regression coefficient do not contain zero, indicating a significant indirect effect. Separate mediation analyses were used to test each victimization model. Models were analyzed accounting for the effects of age and race. Only the model using the CTQ total score yielded support for mediation. None of the other models were significant, and results are not reported for those models. Because age and race were not significantly associated with any variables in the CTQ total abuse model, a reduced final model was created to test substance use at the time of the offense as a mediator between CTQ total abuse score and force used during a sexual offense.

Analyses showed a significant direct effect of CTQ total score on substance use prior to an offense (β = .19, p < .001), with youth who reported a higher number of victimization experiences reporting higher levels of substance use prior to an offense. A direct effect of substance use prior to an offense on force used during offenses was also found (β = .12, p < .05); the youth who reported substance use prior to an offense reported using more force while offending. Analyses also showed a direct effect of CTQ total score on force used during an offense (β = .18, p < .001), indicating that more victimization experiences predicted more force. Bootstrap analyses showed a small, yet significant indirect effect of CTQ total score on force during a sexual offense mediated by substance use prior to an offense (β = .02, 95% CI = [.01, .05]). The direct effect of the CTQ on total force remained significant (β = .19, p < .001), indicating partial mediation.

Because overall substance use history was significantly related to total force in zero-order correlation, we included overall substance use in the mediation model to address whether substance use prior to an offense remained significant after accounting for overall substance use. Results indicated that although overall substance use was correlated to use before the offense, it was not significantly associated with total trauma or use of force in the mediation model.

In addition, as noted above, to increase confidence in the validity of results, we applied MACI exclusion criteria for social desirability or invalid responding. The mediation analysis was conducted with and without those participants, yielding essentially identical results.

Discussion

The current study integrated factors predicting sexual aggression, namely, childhood victimization and substance use prior to the commission of an offense. Because the literature has traditionally focused on sexual victimization history, in the current study, we included other types of victimization, including physical abuse, emotional abuse, physical neglect, and emotional neglect, as well as cumulative exposure to childhood victimization types. In addition, we focused on self-reported substance use prior to an offense as opposed to substance use history measured broadly to investigate the potential mechanism of disinhibition when considering the relation between substance use and force used during a sexual offense. Mediation models examining the direct and indirect effects of the five trauma subtypes on sexual aggression were not significant. These findings are contrary to predictions that the relations among victimization, substance use, and severity of juvenile sexual offending would be strongest for sexual abuse. The model that included a measure of exposure to multiple types of traumatic victimization revealed that substance use prior to committing a sexual offense partially mediated the effects of cumulative childhood victimization experiences on force used during the commission of a sexual offense.

The results are consistent with a large body of research demonstrating the relation between childhood trauma and substance use (e.g., Finkelhor, 2009; Widom et al., 2006) and extend this work to a sample of juvenile sex offenders. In the current study, the experience of multiple, varied childhood victimization experiences (poly-victimization), rather than a particular subtype of trauma, was most highly related to both increased force used during a sexual offense and increased substance use prior to an offense. These findings are consistent with existing data (Johnson & Knight, 2000) as well as theory suggesting that vulnerability due to childhood victimization may contribute to sexual offending when combined with disinhibiting factors, such as substance use (Marshall & Marshall, 2000). Although disinhibition was not measured directly in this study, findings also are consistent with disinhibition models that posit substance use before a crime may further lower disinhibition against committing a sexual offense (Marshall & Marshall, 2000; Norris et al., 2002; Seto & Barbaree, 1995).

The current study adds to a small body of literature examining substance use in juvenile sex offenders and is among the first to examine substance use prior to the commission of a sexual offense. In the current study, youth endorsed rates of drug and alcohol use at 56.5% and 56.6%, respectively. In addition, 40.1% reported using drugs prior to the commission of sexual offenses, 37.4% reported using alcohol prior to the commission of sexual offenses, and 32.4% used drugs and alcohol prior to the commission of sexual offenses, although not necessarily at the same time. Results of the mediation analyses are consistent with extant data indicating that substance use prior to an offense is related to increased aggression in adult samples (Abbey, Clinton-Sherrod, McAuslan, Zawacki, & Buck, 2003; Testa, 2002). In addition, the current analyses indicated that youth who use drugs or alcohol prior to a sexual offense used more force than those who did not, and youth who used both drugs and alcohol used even more force, albeit a small effect. Overall, the findings are consistent with literature that has examined similar relationships and found that a history of alcohol abuse was a strong predictor of coercion used during a sexual offense (Johnson & Knight, 2000). Consistent with Johnson and Knight’s conclusions, the effectiveness of sex offender treatment may be maximized by identifying substance use as a part of coercive behavior patterns in juveniles who commit sex offenses.

In addition, although substance use prior to a sexual offense emerged as a mediator, the relation between childhood victimization and sexual offending remained significant in the model, indicating the presence of other mediators accounting for the direct effects (Baron & Kenny, 1986). Results suggest the need to explore other factors such as antisocial predisposition, callous-unemotional traits, impulsivity, or dissociation related to victimization that may contribute to the severity of sexual offending in youth with victimization histories (Knight & Sims-Knight, 2004; Lawing, Frick, & Cruise, 2010).

Clinical Implications

It is important for clinicians, forensic evaluators, and researchers to continue exploring the relation between substance use (just prior to an offense) and sexually abusive behavior. Given Abbey et al.’s (2003) finding that alcohol use contributed to sex offenders’ use of violence during an offense, and Johnson and Knight’s (2000) conclusion that physical abuse predicted sexual coercion through a pathway that included alcohol abuse, treating alcohol use in sex-offense-specific therapy may reduce subsequent violence. Moreover, results suggest that treatment providers as well as evaluators conducting psychosexual evaluations with juvenile sex offenders should assess multiple types of traumatic experiences (poly-victimization) and the domains of impairment resulting from complex trauma. Complex trauma is associated with chronic or multiple traumatic events resulting in impairments in attachment, cognition, affect-regulation, dissociation and other domains (Cook et al., 2005). As supported by the results, attention should be paid to multiple subtypes of victimization (not only sexual victimization), and their relation to offending behavior as potential risk factors, during evaluation and treatment.

Research-based interventions adapted to address the sequelae of complex trauma (which includes substance abuse) should be considered, which have promise for treating sexually abusive youth in the juvenile justice system (Ford, Chapman, Connor, & Cruise, 2012). For example, trauma-focused cognitive-behavioral therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006) is a culturally sensitive model designed to help youth develop coping strategies and in vivo desensitization to trauma reminders, and utilizes conjoint sessions with caregivers in addressing traumatic narratives. Though TF-CBT shows promise in addressing traumatization among children with posttraumatic stress disorder (PTSD) secondary to exposure to domestic violence (Cohen, Mannarino, & Iyengar, 2011) and among adolescents with co-occurring substance abuse problems (Cohen, Mannarino, Zhitova, & Capone, 2003), outcome studies are needed with juvenile justice involved youth. Another example of a model designed for children with complex trauma is Attachment, Self-Regulation, and Competency (ARC; Arvidson et al., 2011), which is delivered in the context of caregiver systems and addresses various targets (from attunement and affect identification to executive functioning), in the three core domains leading to trauma experience integration and competency. Finally, multimodal programs that target various psychosocial systems, and address substance use, have also been shown to be effective within juvenile offender populations. For example, multisystemic therapy (MST) has been found in a randomized control trial to reduce sexual behavior problems, substance abuse, delinquency, and out-of-home placements (Letourneau et al., 2009).

Limitations

The study’s cross-sectional design is a limitation in that it does not allow for explanatory predictions. The study was also limited in its use of self-report as the sole data collection method. The study would be strengthened if file review or collateral information could have been obtained, particularly in the measurement of childhood victimization. Furthermore, the study is limited in that substance use prior to an offense was essentially used as a proxy for disinhibition; the exact mechanism underlying the relation between childhood victimization and sexual offending was not measured. Although it is believed that substance use before an offense acts as a disinhibiting factor, it is possible that other explanations are accounting for this relation. As detailed in Marshall and Marshall (2000), other disinhibiting factors have been proposed to increase risk for sexual offending (e.g., cognitive distortions related to sexual offending, anger, loneliness).

An additional limitation involves the assessment of substance use prior to a sexual offense. Although the questions were designed to capture substance use just prior to the commission of a sexual offense, it is possible youth interpreted the question differently. For example, some youth may have considered their substance use during an unspecified time period prior to their offending behavior, rather than just before an offense. To rule out the likelihood of this bias, however, we did retest the mediational model accounting for overall substance use. Overall use was correlated with use prior to the offense but uncorrelated with the outcome. Including overall use in the model did not change the results, increasing confidence in the interpretation that it is substance use prior to the offense that affects force, rather than general substance use. Alternatively, although the intention was for youth to respond to their substance use before a sexual offense, the question asked about use prior to criminal offenses. This limitation was mitigated by the fact that the question was posed in a sex offense-specific section of the questionnaire (there was a separate section for nonsexual criminality) inquiring about sexual abuse history, sex offender treatment, and other risk-relevant behavior (e.g., pornography use) before and after criminal offending, thereby prompting youth to consider only sexual offenses.

Importantly, however, the inclusion of a measure of substance use prior to the offense is a strength of the current study because it represents a proximal risk factor for sexual offending and highlights the importance of including substance use in relapse prevention plans. This variable was considered to more closely capture the disinhibitory mechanism than a broad measure of substance use history. It is recommended that future investigations of substance use prior to an offense and characteristics of sexually offending behavior include a direct measure of disinhibition to disentangle mechanisms underlying this association. For example, the Delay Discounting Task (Bickel & Marsh, 2001), a laboratory task that assesses the ability to delay gratification to obtain a later but larger reward, may capture this mechanism. Furthermore, it is recommended that future examinations of these constructs distinguish between juveniles who offend against young children (i.e., child molesters) and juveniles who offend against similar-aged female peers (i.e., rapists), as the pattern of results may be different between these groups.

Footnotes

Victoria A. Marini, PhD, received her doctoral degree in clinical psychology at the University of Vermont (UVM). She is currently a postdoctoral fellow at the Behavior Therapy and Psychotherapy Center at UVM and at Vermont Forensic Assessment in Shelburne, Vermont. Her research interests include emotional vulnerability factors underlying substance abuse and antisocial behavior.

George S. Leibowitz, PhD, is an associate professor in the Department of Social Work at the University of Vermont. His research includes investigating the role of trauma, cumulative stress and resilience among younger and older offenders, and the antecedents to sexually abusive behavior among adolescents.

David L. Burton, PhD, is an associate professor at Smith College School for Social Work. His research is focused on childhood victimization and the etiology of child, adolescent, and adult sexual aggression, as well as the effectiveness of treatment such as cognitive-behavioral therapy (CBT).

Timothy R. Stickle, PhD, is an associate professor in the Department of Psychology at the University of Vermont. His research focuses on understanding the vulnerabilities underlying differing developmental pathways to antisocial behavior.

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