Anxiety sensitivity and grit as mediators between childhood abuse and relapse risk for substance use

Background: Childhood abuse is prevalent in those with substance use disorders (SUDs), and can lead to adverse consequences, including relapse to substance use following treatment. Objective: To determine whether anxiety sensitivity (AS) and grit mediate associations between childhood abuse and substance use relapse risk. Participants and setting: Patients on an inpatient detoxification and stabilization unit seeking treatment for SUDs (N = 702). Methods: Participants were administered self-report measures assessing childhood physical and sexual abuse (CPA/CSA), AS, grit, and relapse risk. A parallel mediation model was used to investigate the association between childhood abuse and relapse risk as mediated by AS and grit. Results: Anxiety sensitivity was associated with greater relapse risk (beta = 0.29, t = 8.24, p < 0.001). Indirect effects of CPA and CSA on relapse risk through AS were statistically significant (CPA: beta = 0.05, 95 % C.I. = 0.02-0.08; CSA: beta = 0.04, 95 % C.I. = 0.01-0.07), indicating AS significantly mediated effects of both CPA and CSA on relapse risk. Grit was not a mediator, however, higher grit score was significantly associated with decreased relapse risk (beta = -0.17, t =-4.90, p < 0.001). Conclusions: Anxiety sensitivity may be an important construct linking child abuse to relapse risk. Although grit may not mediate the effect of child abuse on relapse risk, it may be clinically relevant to relapse risk. As this sample consisted of treatment-seeking adults, the generalizability of results to other populations is uncertain. Future studies should investigate interventions targeting these constructs in this population.