Carolyn E. Sartor, PhD

Assistant Professor of Psychiatry

Research Interests

Alcoholism; Psychiatry; Substance-Related Disorders; Healthcare Disparities

Public Health Interests

Alcoholism/Alcohol; Genetic epidemiology; Health Disparities; Psychological Trauma; Substance abuse

Research Organizations

Psychiatry: Addictions, Division of | Connecticut Mental Health Center: Division of Substance Abuse; The Consultation Center | Prevention and Community Research, Division of | Psychology Section

Research Summary

My program of research is aimed at refining etiological models of substance use disorders in adolescents and young adults by integrating a developmental psychopathology perspective with genetically-informative designs. The identification of differences by gender and race/ethnicity in the contribution of various risk and protective factors to substance use behaviors is central to this pursuit. I study the progression through stages of substance use (e.g., initiation, onset of symptoms) and the timing of stage transitions in relation to the onset of psychiatric disorders and trauma exposure, with a particular focus on the influence of childhood sexual abuse on the course of alcohol and drug use in women.

Specialized Terms: Alcoholism/alcohol; Substance abuse; Genetic epidemiology; Psychological trauma

Extensive Research Description

My program of research is aimed at characterizing the contribution of various risk and protective factors, including genetic factors, to pathways of substance use and misuse from adolescence to young adulthood, with a particular focus on alcohol use in young women. Taking a developmental psychopathology approach to the study of substance use disorders is key to capturing the dynamic processes that influence their course. I have applied this perspective by studying alcohol and other substance use disorder development with respect to stages of use (e.g., initiation, onset of substance related problems). My work in this area has included investigations of a rarely studied characteristic of the course of substance use, the rate of progression between stages of use. This phenotype reflects a distinct aspect of alcohol and drug use that is not captured by simply documenting whether a stage of use is ever reached. Studies I have conducted with colleagues have revealed, for example, that whereas early age at first drink is a strong predictor of alcohol use disorder, early drinkers take longer to transition from first drink to problem drinking than later initiators.

Health disparities A major component of the line of research I am pursuing, which to date has been largely overlooked, is the identification of distinctions by race/ethnicity in both the course of substance use and the risk and protective factors that influence it. Lower rates of use, lower prevalence of problem or habitual use, and later age at initiation of the use of alcohol and cigarettes in African Americans compared to Whites - despite higher rates of exposure to risk factors such as trauma - suggests that existing etiological models of alcohol and cigarette smoking do not fit as well for African Americans as Whites. The absence of such differences with respect to marijuana use further highlights the need for a more nuanced approach to understanding the development of substance use across racial/ethnic groups, which is essential to developing culturally tailored interventions.

Genetics/familial influences Much of my work on the development of substance use and related problems has made use of twin and other family-based study designs. Investigations conducted with my colleagues have revealed distinctions in the contribution of heritable influences at various stages of substance use. Initiation of substance use is attributable to a significant degree to environmental influences common to family members (e.g., shared peers, parenting practices). Progression to problem use, by contrast, is influenced in about equal parts by genetics and environmental factors specific to an individual (e.g., traumatic events), with little to no shared environmental contributions. These findings indicate that the course of substance use is more malleable in its early stages and that consideration of individual level variability is particularly important for interventions aimed at disrupting the progression from initiation to pathological alcohol or drug use.

Trauma A major goal of my program of research is to elucidate the mechanisms linking childhood trauma to early and problem substance use. I have focused in particular on the role of childhood sexual abuse in the manifestation of familial risk for alcohol related problems in women. Rates of childhood sexual abuse are elevated in offspring of alcoholic parents, likely due to characteristics of the alcoholic family environment such as poor parental supervision. Adolescent girls and young women with a history of sexual abuse have often been exposed to a constellation of risk factors, such as parental separation and trauma related psychopathology (e.g., PTSD, depression) in addition to genetic risk for alcohol use disorders. Disentangling this complex pathway is an important step toward reducing risk for substance use disorders in this high-risk population.

Current studies

Distinctions between Black and White young women in the course of alcohol use (NIAAA R01AA023549) This secondary data analysis project is aimed at identifying distinctions between African American and White female youth in the timing of transitions and risk factors associated with progression through drinking course, with the goal of refining models of alcohol use and misuse in African American girls and young women. Data are derived from three large scale longitudinal studies with a combined sample size of 6,828 (33% African American).

Stress, Personality, and Health Outcomes, Virginia Commonwealth University The goal of this college sample based pilot project is to explore the relationship of perceived susceptibility to negative events with problem substance use and other trauma related psychopathology, with a focus on identifying racial/ethnic and gender differences in these associations.

Selected Publications

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