There is considerable evidence demonstrating associations between childhood trauma, including physical, sexual and emotional abuse, with negative mental health, physical health and social outcomes (Larkin and Read, 2008; Lown et al., 2011), deficient social skills (Garbarino, 1987), antisocial behaviour (Jonson-Reid et al., 2010), substance abuse (Gonzalez and MacMillan, 2008) and, in particular, misuse of alcohol in a victim's later life (Makhija and Sher, 2007; Caballero et al., 2010; Rothman et al., 2010). It was shown that childhood maltreatment is a risk factor for adolescent binge drinking (Shin et al., 2009). Furthermore, it was reported on a direct link between the child abuse (CA) and adolescent suicide, between CA and adolescent substance and alcohol misuse, and an indirect link between CA and adolescent suicide through alcohol and substance misuse (Makhija, 2007). Childhood maltreatment has been linked to alcohol abuse and dependence in victims also after they become adults (Anda et al., 2002; Dube et al., 2002; Mirsal et al., 2004; Cheng et al., 2011); however, current evidence is considered (Shin et al., 2009) to be insufficient to prove this relationship for male adults; and some studies do not indicate a significant association between child sexual or physical abuse and alcoholism in adult men, in contrast to women (Langeland and Hartgers, 1998; Widom and Hiller-Sturmhöfel, 2001). As for causes and mechanisms, victims of abuse may resort to alcohol for improvement of their self-esteem (Neumark-Sztainer et al., 1997); besides, alcohol misuse can be a form of self-destructive behaviour, arising from self-blame or feelings of worthlessness (Makhija and Sher, 2007). Generally speaking, individuals abused during their childhood might be prone to alcohol misuse, as they search for ways to cope with their experiences (Makhija and Sher, 2007).
Abuses have been chronically under-reported because children fear the loss of support, stigmatization and retaliation (Rodriguez et al., 2001; Quiroga, 2009). CA sometimes persists in families being perpetuated from one generation to another (Lancaster and Gelles, 1987; Ney, 1989). In some populations, there is cultural acceptance to the abuse of children (Quiroga, 2009). Detection and exposure of CA often depends on the victim's will. It is easy to expose an unprotected individual, e.g. an alcoholic. Otherwise, different tools can be applied to prevent the disclosure: denial of facts and accusations of slander; intimidation and/or subornation of the victim; appeals to preservation of honour and reputation of the family, ethnicity, nation, etc. It should be commented that over 99% of publications on child maltreatment have been based on research conducted in more developed countries (Mikton and Butchart, 2009); while in less-developed societies, CA can persist without much publicity. There follows a case report from the former Soviet Union; it is factually true except for some proper names. It occurred in a middle-class family, and was not associated with alcohol abuse in the perpetrator, which made it more difficult to disclose.
In the summer 1959, Sergei (S.) was 3 years old. His parents were divorcing, and he was sent together with an elderly servant (a term ‘domrabotnitsa’—house worker was used in the Soviet Union) to a suburb village, where a room in a cottage was rented. They spent there also the summers of 1960 and 1961. They had almost no contact with other summer residents; and the child spent much time sitting on a sofa, which obviously resulted in a delay of physical development and acquisition of social skills. In 1963, his mother married Gr., who was 15 years older than S. The following risk factors of recurrent child maltreatment (Hindley et al., 2006) were present in this case: lack of social support; presence of another, younger child in the family; parental history of abuse (Gr. had been battered by his father), relatively young age of the caregiver/perpetrator. An ethnic factor probably played its role: Gr. was of Jewish descent, while S. sometimes stressed his Russian ethnicity just for spite. The abuse was administered by slapping in the face and head area as well as whipping with a belt; the first episode, complicated by a nasal bleeding, took place when S. was 7–8 years old. Episodes of violence were accompanied by intimidation and verbal abuse, which was practised also out of connection with battery. The abuse was often administered under the pretext of punishment, but sometimes without any pretext whatever. There are statements in the literature that abusive encounters are heavily laden with emotion (Herbruck, 1979). In the present case, it was probably so in the beginning, but later the scenes of abuse became more theatrical and less laden by a true emotion on the part of the perpetrator. The scenes sometimes occurred before spectators: the mother, relatives and friends. In rare cases, the mother participated in battering, which is in agreement with the data that mothers professed to abuse their own children at higher rates when their male partners were stepfathers of victims when compared with genetic fathers (Alexandre et al., 2010). A motive could have been a subconscious squaring of accounts with the disloyal partner in the person of his son, apparently on the background of dissociation, because maternal affection was obviously present and returned. Furthermore, Sergei's mother had been an orphan adopted by her aunt, who sometimes maltreated her.
As usual in such cases, S. was ashamed to tell to anybody. Once he answered affirmatively a question of a schoolteacher whether he had been physically punished; it had no consequences. Another teacher, having reasons to suspect that something was going wrong in the family, made a home visit; it was followed by discontinuance of the abuse for several months accompanied by an improvement of his progress in school studies, which is in agreement with the evidence that maltreated children are at multiple risk for poor school functioning (Cicchetti et al., 1995), and that home visiting is effective against maltreatment of children (Roberts et al., 1996). Apart from occasional participation in parties at home, where alcohol was never consumed in excess, and drinking up to a bottle of beer with a schoolmate, S. did not consume alcohol until 1969. That summer, when S. had become 13 years old, he drank a 0.75 l bottle of portwein (port imitation containing about 18% of alcohol by volume) with an older boy. During the 1969/70 school year, his alcohol consumption rapidly increased, up to 250 ml of vodka or a 0.75 l bottle of fortified wine at one sitting. In the following years, he was several times detained by the police (militia) and at least twice spent the night in a sobering-up station (vytrezvitel: http://en.wikipedia.org/wiki/Sobering-up_station). Several months after the admission to a university in 1973, a separate room was rented for S. Next year, because of drunkenness and absenteeism, he was dismissed from the university and went to the army for 2 years; his education was interrupted for 4 years. In 1979, at an urgent request of his mother, S. underwent an implantation of the disulphiram preparation Esperal, which was followed by an abstinence period of about 8 months. After that he resumed alcohol consumption; there were no symptoms of disulphiram–ethanol reactions. S. managed to discontinue alcohol misuse at the age of approximately 35 years, when it became incompatible with his professional duties.
This case illustrates an immediate, ‘mechanistic’ cause–effect relationship between domestic violence and early drinking initiation with heavy binges in an adolescent: S. just did n't want to go home, while a possibility to stay around the school was provided by a drinking company of schoolmates including some older boys. There could have been also other predisposing factors, such as the challenges by the milieu. Besides, alcohol enabled S. to overcome some communication barriers and later to attack the offender, with a variable success. Exogenous nature of the early-onset alcohol misuse is confirmed by the fact that, in spite of a considerable experience of alcohol consumption, S. did not develop physical dependence and discontinued alcohol misuse, when he found himself outside the challenging environment, and when it became necessary because of professional reasons. He has not resumed alcohol misuse also in his later life, in spite of occasional challenges. It appears probable that, although family violence can contribute to alcohol misuse during adolescence, a healthy personality can overcome the misuse during his or her later life. It can explain for a less strong (if any) association between CA and alcoholism in male victims becoming adults (Shin; Langeland and Hartgers, 1998; Widom and Hiller-Sturmhöfel, 2001), when compared with adolescents (Caballero et al., 2010; Rothman et al., 2010). One can speculate, however, that severe alcohol misuse during adolescence and early adulthood can have repercussions on the later life, thus remaining a lifelong detrimental factor, capable—in some cases—of provoking alcohol consumption. For example, all working people in Russia have ‘work-books’ (trudovye knizhki), where official employments and reasons of all dismissals are registered. An unfavourable inscription made 25 years ago can interfere with successive employment even today, providing topics for conversation for personnel managers. The same effect can have a registration with a ‘narcological dispensary’: a substance abuse prevention and treatment centre, where persons diagnosed with alcoholism are registered. A certificate from the dispensary is required, for example, for obtaining a driving licence.
There is evidence in favour of the intergenerational continuity of abuse, i.e. that abused children tend to become batterers of the next generation of children (Egeland et al., 1987; Lancaster and Gelles, 1987). At the same time, it is pointed out that this relationship is not deterministic but stochastic (Lancaster and Gelles, 1987), so that it is hardly possible to predict the outcome of an individual case. Fortunately, S. has not become a child abuser (of his own son, who is 25 years old now, and the son of a partner in the past), although impulses were sometimes sizeable. However, he abused physically his intimate partner and later his wife; the abuse being administered by slapping in the face and, rarely, pulling by the hair. It was usually done under the influence of alcohol, but sometimes also in a sober condition. Incidents of the abuse took place during his wife's pregnancy, although in some cases it could have been provoked. The last incident of violence occurred in the early 1990s. Discontinuance of the abuse coincided in time with cessation of excessive alcohol consumption. Since then, the family situation has been partly reversed: emotional abuse (provocations, dominant behaviour) on the part of the wife, sometimes with participation of their grown-up son, creating an atmosphere of mobbing, so that the question of separation is on the agenda even now, after 28 years of marriage, in spite of apparent mutual dependence, common property and other obstacles.
In some countries of the former Soviet Union, there is a backlog in the prevention of CA and neglect. Violence in families was largely a taboo theme during the Soviet times (Nikulina, 2006), and its existence was sometimes denied (Kovac, 2002). Accordingly, many cases of CA remained undisclosed (Semenova, 2000). Public organizations sometimes did not react to known cases of violence in families: for example, Sergei's maternal grandmother (the mother's aunt) wrote letters to the authorities about the abuse, which had no consequences. Today's Russian-language professional literature on CA is rather scarce and partly represented by compilations from foreign publications. It is stated that a part of the society is opposed to a broad discussion of violence in families (Nikulina, 2006). Dimensions of the problem are difficult to assess because there are no reliable statistics (Nikulina, 2006). There is no generally agreed attitude to the problem and no consequent policy (Besschetnova, 2003; Smagina, 2006), which is complicated by a shortage of adequately educated personnel (Besschetnova, 2003) and limited access to foreign professional literature. Discussion of such cases in professional literature and the media should contribute to eradication of CA and its complications such as alcohol misuse in victims.