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 | 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

  • Agrawal, A.., Grant, J.D., Lynskey, M.T., Madden, P.A.F., Heath, A.C., Bucholz, K.K., Sartor, C.E. The genetic relationship between cannabis and tobacco cigarette initiation in European- and African-American female twins. Drug and Alcohol Dependence in press.
  • Foster, D.W., Dukes, K., Sartor, C.E. The road to drink is paved with high intentions: Expectancies, refusal self-efficacy, and intentions among heavy drinking college students. Alcohol 2016, 50:65-71.
  • Jackson, K.M., Rogers, M..L, and Sartor, C.E. Parental divorce and initiation of alcohol use in early adolescence. Psychology of Addictive Behaviors 2016; 30:450-461.
  • Sartor, C.E, Jackson, K.M., McCutcheon, V.V., Duncan, A.E., Grant, J.D., Werner, K.B., Bucholz, K.K. Progression from first drink, first intoxication, and regular drinking to alcohol use disorder: comparison of African American and European American youth. Alcoholism: Clinical and Experimental Research 2016; 40:1515-1523.
  • Sartor, C.E. Grant, J.D., Duncan, A.E., McCutcheon, V.V., Nelson, E.C., Calvert, W., Madden, P. A. F., Heath, A. C., and Bucholz, K.K. Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women. Addictive Behaviors 2016; 60:131-136.
  • Sartor, C.E., and O’Malley, S.S. A web-based pilot study of childhood sexual abuse, recent stressful events, and alcohol use in women. American Journal on Addictions 2016; 25:184-187.
  • Werner, K.B., Grant, J.D., McCutcheon, V.V., Madden, P.A.F., Heath, A.C., Bucholz, K.K., and Sartor, C.E. Differences in childhood physical abuse reporting and the association between CPA and alcohol use disorder in European American and African American women. Psychology of Addictive Behaviors 2016; 30:423-433.
  • Werner, K.B., McCutcheon, V.V., Agrawal, A., Sartor, C.E., Nelson, E.C., Heath, A.C., and Bucholz, K.K. The association of specific traumatic experiences with cannabis initiation and transition to problem use: differences between African-American and European-American women. Drug and Alcohol Dependence 2016; 162:162-169.
  • Blustein, E.C., Munn-Chernoff, M.A., Grant, J.D., Sartor, C.E., Bucholz, K.K., Madden, P.A.F., Heath, A.C. The association of low parental monitoring with early substance use in European-American and African-American adolescent girls. Journal of Studies on Alcohol and Drugs 2015, 76:852-861.
  • Few, L.R., Werner, K.B., Sartor, C.E., Trull, T., Nock, M., Bucholz, K.K., Glowinski, A.L., Martin, N.G., Nelson, E.C., Statham, D.J., Heath, A.C., Lynskey, M.T., Agrawal, A. Early onset of alcohol use and self-harm: A discordant twin analysis. Alcoholism: Clinical and Experimental Research 2015, 39:2134-2142.
  • Grant, J.D., Waldron, M., Sartor. C.E,, Scherrer, J.F., Duncan, A.E., McCutcheon, V.V., Haber, J.R., Jacob, T., Heath, A.C., Bucholz, K.K. Parental separation and offspring alcohol involvement: Findings from offspring of alcoholic and drug dependent twin fathers. Alcoholism: Clinical and Experimental Research 2015, 39:1166-1173.
  • Munn-Chernoff, M.A., Grant, J.D., Agrawal, A., Sartor, C.E., Werner, K.B., Bucholz, K.K., Madden, P.A.F., Heath, A.C., Duncan, A.E. Genetic overlap between alcohol use disorder and bulimic behaviors in European American and African American women. Drug and Alcohol Dependence 2015, 153:335-340.
  • Sartor, C.E., Agrawal, A., Grant, J.D., Duncan, A.E., Madden, P.A.F., Lynskey, M.T., Heath, A.C., Bucholz, K.K. Differences between African-American and European-American women in the association of childhood sexual abuse with initiation of marijuana use and progression to problem use. Journal of Studies on Alcohol and Drugs 2015, 76:569-577.
  • Sartor, C.E., Grant, J.D., Agrawal, A., Sadler, B., Madden, P.A.F., Heath, A.C., Bucholz, K.K. Genetic and environmental contributions to initiation of cigarette smoking in young African-American and European-American women. Drug and Alcohol Dependence 2015, 157:54-59.
  • Waldron, M., Doran, K.A., Bucholz, K.K., Duncan, A.E., Lynskey, M.T., Madden, P.A.F., Sartor, C.E., Heath, A.C. Parental separation, parental alcoholism, and timing of first sexual intercourse. Journal of Adolescent Health 2015, 56:550-556.
  • Xu, K., Kranzler, H.R., Sherva, R., Sartor, C.E., Almasy, L., Koesterer, R., Zhao, H., Farrer, L.A., Gelernter, J. Genome-wide association study of maximum number of alcoholic drinks in European Americans and African Americans. Alcoholism: Clinical and Experimental Research 2015, 39:1137-1147.
  • Duncan, A.E., Munn-Chernoff M., Hudson, D.L., Eschenbacher, M.A., Agrawal, A., Grant, J.D., Nelson, E.C., Waldron, M., Glowinski, A.L., Sartor, C.E., Bucholz, K.K., Madden, P.A.F., and Heath, A.C. Genetic and environmental risk factors for major depression in African-American and European-American women. Twin Research and Human Genetics 2014, 17:244-253.
  • Duncan, A.E., Sartor, C.E., Jonson-Reid, M., Munn-Chernoff, M.A., Eschenbacher, M.A., Diemer, E.W., Nelson, E.C., Waldron, M., Bucholz, K.K., Madden, P.A.F., Heath, A.C. Associations between BMI, PTSD, and child abuse among young women. Child Abuse & Neglect 2015, 45:154-162.
  • Sartor, C.E., Kranzler, H.R., Gelernter, J. Course of dependence in cocaine dependent individuals who never used alcohol or marijuana or used cocaine first. Journal of Studies on Alcohol and Drugs 2014, 75:423-427.
  • Sartor, C.E., Kranzler, H.R., Gelernter, J. Rate of progression from first use to dependence on cocaine and opioids: a cross-substance examination of associated demographic, psychiatric, and childhood risk factors. Addictive Behaviors 2014, 39:473-479.
  • Sartor CE, Wang Z, Xu K, Kranzler HR, Gelernter J. The joint effects of ADH1B variants and childhood adversity on alcohol-related phenotypes in African-American and European-American women and men. Alcoholism: Clinical and Experimental Research 2014, 38:2907-2914.
  • Waldron, M., Bucholz, K.K., Madden, P.A.F., Duncan, A.E., Sartor, C.E., Heath, A.C. Alcohol dependence and reproductive timing in African and European ancestry twins: findings in a Midwestern birth cohort. Journal of Studies on Alcohol and Drugs 2014, 75:235-240.
  • Waldron, M., Vaughn, E.L., Bucholz, K.K., Lynskey, M.T., Sartor, C.E., Duncan, A.E., Madden, P.A.F., and Heath, A.C. Risks for early substance involvement associated with parental alcoholism and parental separation in an adolescent female cohort. Drug and Alcohol Dependence 2014, 138:130-136.
  • Haber JR, Grant JD, Sartor CE, Koenig LB, Heath A, Jacob T. Religion/spirituality, risk, and the development of alcohol dependence in female twins. Psychology of Addictive Behaviors 2013; 27:562-572.
  • Sartor CE, Agrawal A, Lynskey MT, Duncan AE, Grant JD, Nelson EC, Madden PAF, Heath AC, Bucholz KK. Cannabis or alcohol first? Differences by ethnicity and in risk for rapid progression to cannabis-related problems in women. Psychological Medicine 2013; 43: 813-823.
  • Sartor, C.E., Nelson, E.C., Lynskey, M.T., Madden, P.A.F., Heath, A.C., Bucholz, K.K. Are there differences between young African-American and European-American women in the relative influences of genetics vs. environment on age at first drink and problem alcohol use? Alcoholism: Clinical and Experimental Research 2013, 37:1939-1946.
  • Sartor, C.E., Waldron, M., Duncan, A.E., Grant, J.D., McCutcheon, V.V., Nelson, E.C., Madden, P.A.F., Bucholz, K.K., Heath, A.C. Childhood sexual abuse and early substance use in adolescent girls: the role of familial influences. Addiction 2013, 108:993-1000.
  • Duncan, A.E., Lessov-Schlaggar, C.N., Sartor, C.E., Bucholz, K.K. Differences in time to smoking initiation and onset of nicotine dependence by race/ethnicity in a Midwestern sample of adolescents and young adults. Drug and Alcohol Dependence 2012, 125:140-145.
  • McCutcheon, V.V., Grant, J.D., Heath, A.C., Bucholz, K.K., Sartor, C.E., Nelson, E.C., Madden, P.A.F., Martin, N.G. Environmental influences predominate in remission from alcohol use disorder in young adult twins. Psychological Medicine 2012, 11:2421-2431.
  • Sartor, C.E., Grant, J.D., McCutcheon, V.V., Lynskey, M.L., Waldron, M., Statham, D., Madden, P.A.F., Bucholz, K.K., Heath, A.C., Martin, N.G., Nelson, E.C. Common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and depression. Archives of General Psychiatry 2012, 69:293-299.
  • Sartor, C.E., McCutcheon, V.V., Callahan O’Leary, C., VanBuren, D., Allsworth, J., Jeffe, D.B., Cottler, L.B. Lifetime trauma exposure and posttraumatic stress disorder in women sentenced to drug court. Psychiatry Research 2012, 200:602-608.
  • Sartor, C.E., McCutcheon, V.V., Nelson, E.C., Duncan, A.E., Bucholz, K.K., Heath, A.C. Investigating the association between childhood sexual abuse and alcohol use disorders in women: Does is matter how we ask about sexual abuse? Journal of Studies on Alcohol and Drugs 2012, 73:740-748.
  • Scherrer, J.F., Xian, H., Pan, H., Pergadia, M.L., Madden, P.A.F., Grant, J.D., Sartor, C.E., Haber, J.R., Jacob, T., Bucholz, K.K. Parent, sibling and peer influences on smoking initiation, regular smoking and nicotine dependence. Results from a genetically informative design. Addictive Behaviors 2012, 37:240-247.
  • Agrawal, A., Scherrer, J.F., Lynskey, M.T., Sartor, C.E., Grant, J.D., Haber, J.R., Madden, P.A.F., Jacob, T., Bucholz, K.K., Xian, H. Patterns of use, sequence of onsets and correlates of tobacco and cannabis. Addictive Behaviors 2011, 36:1141-1147.
  • Agrawal, A., Scherrer, J.F., Pergadia, M.L., Lynskey, M.T., Madden, P.A.F., Sartor, C.E., Grant, J.D., Duncan, A.E., Haber, J.R., Jacob, T., Bucholz, K.K., Xian, H. A latent class analysis of DSM-IV and Fagerstrom (FTND) criteria for nicotine dependence. Nicotine & Tobacco Research 2011, 13:972-981.
  • Duncan, A.E., Agrawal, A., Bucholz, K.K., Sartor, C.E., Madden, P.A., Heath, A.C. Deconstructing the architecture of alcohol use disorder symptoms in a community sample of late adolescent and emerging adult women: an item response approach. Drug and Alcohol Dependence 2011, 116:222-227.
  • Kristjansson SD, Agrawal A, Littlefield A, Pergadia M, Lessov-Schlaggar C, Sartor C, Bucholz KK, Madden P, Cooper ML, Sher KJ, Heath AC. Drinking motives in female smokers: factor structure, alcohol dependence, and genetic influences. Alcoholism: Clinical and Experimental Research 2011, 35:345-354.
  • Sartor, C.E., Bucholz, K.K., Nelson, E.C., Madden, P.A.F., Lynskey, M.T., Heath, A.C. Reporting bias in the association between age at first alcohol use and heavy episodic drinking. Alcoholism: Clinical and Experimental Research 2011, 35:1418-1425.
  • Sartor, C.E., McCutcheon, V.V., Pommer, N.E., Nelson, E.C., Grant, J.D., Duncan, A.E., Waldron, M., Bucholz, K.K., Madden, P.A.F., Heath, A.C. Common genetic and environmental contributions to post-traumatic stress disorder and alcohol dependence in young women. Psychological Medicine 2011, 41:1497-1505.
  • Agrawal, A., Scherrer, J., Grant, J.D., Duncan, A.E., Sartor, C., Madden, P.A.F., Pergadia, M., Haber, J.R., Jacob, T., Bucholz, K.K., Xian, H. The effects of maternal smoking during pregnancy on offspring outcomes. Preventive Medicine 2010, 50:13-18.
  • Haber, J.R., Bucholz, K.K., Jacob, T., Grant, J.D., Scherrer, J.F., Sartor, C.E., Duncan, A.E., Heath, A. Effect of paternal alcohol and drug dependence on offspring conduct disorder: gene-environment interplay. Journal of Studies on Alcohol and Drugs 2010, 71:652-663.
  • McCutcheon, V.V., Sartor, C.E., Pommer, N.E., Bucholz, K.K., Nelson, E.C., Madden, P.A.F., Heath, A.C. Lifetime trauma exposure and PTSD risk in a young female sample. Journal of Traumatic Stress 2010, 23:811-814.
  • Xian, H., Scherrer, J.F., Pergadia, M.L., Madden, P.A.F., Grant, J.D., Sartor, C.E., Haber, J.R., Jacob, T., Bucholz, K.K. Contribution of parental psychopathology to offspring smoking and nicotine dependence in a genetically informative design. Journal of Studies on Alcohol and Drugs 2010, 71:664-673.
  • Sartor, C.E., Grant, J.D., Bucholz, K.K., Madden, P.A.F., Heath, A.C., Agrawal, A., Whitfield, J.B., Statham, D.J., Martin, N.G., Lynskey, M.T. Common genetic influences on alcohol and cannabis use and dependence symptomatology. Alcoholism: Clinical and Experimental Research 2010, 34:545-554.
  • Sartor, C.E., Lessov-Schlaggar, C.N., Scherrer, J.F., Bucholz, K.K., Madden, P.A.F., Pergadia, M.L., Grant JD, Jacob T, Xian H. Initial response to cigarettes predicts rate of progression to regular smoking: Findings from an offspring-of-twins design. Addictive Behaviors 2010, 35:771-778.
  • Sartor, C.E., McCutcheon, V.V., Pommer, N.E., Nelson, E.C., Duncan, A.E., Waldron, M., Bucholz, K.K., Madden, P.A.F., Heath, A.C. Post-traumatic stress disorder and alcohol dependence in young women. Journal of Studies on Alcohol and Drugs 2010, 71:810-818.
  • Agrawal, A., Sartor, C.E., Lynskey, M.T., Grant, J.D., Pergadia, M.L., Grucza, R., Bucholz, K.K., Nelson, E.C., Madden, P.A.F., Martin, N.G., Heath, A.C. Evidence for an interaction between age at 1st drink and genetic influences on DSM-IV alcohol dependence. Alcoholism: Clinical and Experimental Research 2009, 33:1-10.
  • Sartor, C.E., Agrawal, A., Lynskey, M.T., Bucholz, K.K., Madden, P.A.F., Heath, A.C. Common genetic influences on the timing of first use for alcohol, cigarettes, and cannabis in young African-American women. Drug and Alcohol Dependence 2009, 101:49-55.
  • Sartor, C.E., Lynskey, M.T., Bucholz, K.K., Madden, P.A.F., Martin, N.G., Heath, A.C. Timing of first alcohol use and alcohol dependence: Evidence of common genetic influences. Addiction 2009, 104:1512-1518.
  • Scherrer, J.F., Grant, J.D., Duncan, A.E., Sartor, C.E., Haber, J.R., Jacob, T., Bucholz, K.K. Subjective effects to cannabis are associated with use, abuse and dependence after adjusting for genetic and environmental influence. Drug and Alcohol Dependence 2009, 105:76-82.
  • Agrawal, A., Sartor, C., Pergadia, M.L., Huizink, A.C., Lynskey, M.T. Correlates of smoking cessation in a nationally representative sample of U.S. adults. Addictive Behaviors 2008, 33:1223-1226.
  • Duncan, A.E., Sartor, C.E., Scherrer, J.F., Grant, J.D., Nelson, E.C., Bucholz, K.K. The association between cannabis abuse and dependence and childhood physical and sexual abuse in offspring of drug dependent fathers: Evidence from an offspring of twins design. Addiction 2008, 103:990-997.
  • Sartor, C.E., Agrawal, A., Lynskey, M.T., Bucholz, K.K., Heath, A.C. Genetic and environmental influences on the rate of progression to alcohol dependence in young women. Alcoholism: Clinical and Experimental Research 2008, 32:632-638.
  • Sartor, C.E., Agrawal, A., McCutcheon, V.V., Duncan, A.E., Lynskey, M.T. Disentangling the complex association between childhood sexual abuse and alcohol-related problems: a review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs 2008, 69:718-727.
  • Sartor, C.E., Xian, H., Scherrer, J.F., Lynskey, M., Duncan, A.E., Haber, J.R., Grant, J.D., Bucholz, K.K., Jacob, T. Psychiatric and familial predictors of transition times between smoking stages: Results from an offspring-of-twins study. Addictive Behaviors 2008, 53:235-251.
  • Sartor, C.E., Lynskey, M.T., Bucholz, K.K., McCutcheon, V.V., Nelson, E.C., Waldron, M., Heath, A.C. Childhood sexual abuse and the course of alcohol dependence development: Findings from a female twin sample. Drug and Alcohol Dependence 2007, 89:139-144.
  • Sartor, C.E., Lynskey, M., Heath, A.C., Jacob, T., True, W. The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction 2007, 102:216-225.
  • Sartor, C.E., Scherrer, J.F., Shah, K.R., Xian, H., Volberg, R., Eisen, S.A. Course of pathological gambling symptoms and reliability of the Lifetime Gambling History measure. Psychiatry Research 2007, 152:55-61.
  • Jacob, T., Bucholz, K.K., Sartor, C.E., Howell, D.N., Wood, P.K. Drinking trajectories from adolescence to the mid-forties among alcohol dependent males. Journal of Studies on Alcohol 2005, 66:745-755.
  • Sartor, C.E., Jacob, T., Bucholz, K.K. Drinking course in alcohol-dependent men from adolescence to mid-life. Journal of Studies on Alcohol 2003, 79:712-719.
  • Sartor, C.E., Youniss, J. The relationship between positive parental involvement and identity achievement during adolescence. Adolescence 2002, 37:221-234.

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