Carolyn E. Sartor Ph.D. Clinical Psychology
Assistant Professor of Psychiatry
alcoholism/alcohol; substance abuse; genetic epidemiology; psychological trauma
Web-based diary study of short-term patterns of alcohol use and the association of those patterns to trauma in young women
Examination of mediating and moderating effects of psychopathology and environmental stressors on genetic contributions to transitions in alcohol use disorder development in adolescent girls and young women
The primary focus of my research is the developmental course of alcohol and other substance use, specifically, the relative influence of genetic and environmental factors at various stages of use and dependence. I have a particular interest in studying exposure to childhood trauma as an environmental contributor to patterns of problem drinking and progression to alcohol use disorders in women.
Extensive Research Description
My program of research is aimed at characterizing genetic and environmental contributions to pathways of substance use and misuse from adolescence to young adulthood. This developmental period is marked by major role shifts and changes in interpersonal functioning and is also the period of peak problem substance use. The divergence in paths between heavy drinkers who mature out and those who go on to develop more chronic alcohol-related problems occurs in this developmental stage known as emerging adulthood. Identifying the factors that contribute to various trajectories of substance use, and in particular of alcohol use, is a major goal of my research. 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 substance use disorder development with respect to stages of use (e.g., initiation, onset of substance-related problems). Much of my work has focused on a less commonly studied characteristic of drinking course, the rate of progression between stages of use. This phenotype captures an aspect of the course of substance use that cannot be gleaned from simply studying influences on whether a given stage of use is reached. For example, early age at first drink is a strong predictor of alcohol use disorders, but early drinkers take longer to transition from first drink to dependence than later initiators. Distinctions by stage in the relative contribution of various psychiatric and psychosocial risk factors have been found in both alcohol and nicotine dependence development. Parental divorce and ADHD, for instance, play a more significant role in initiation than in the rate of progression from initiation to problem use, whereas use of other substances is more strongly associated with progression to problem use than initiation. Recognition of these differences can lead to improvements in stage-specific prevention strategies.
Genetics Much of my work on substance use disorders has made use of twin samples. Twin modeling can be applied to estimate the relative genetic and environmental contributions to a given phenotype by comparing the similarity of the phenotype of interest in monozygotic (MZ, i.e. identical) twin pairs to the similarity in dizygotic (DZ, i.e., fraternal) twin pairs, with greater similarity in MZ’s suggesting a substantial heritable influence on the phenotype. Twin studies have demonstrated a modest heritable contribution to initiation of substance use, which is shaped to a significant degree by environmental influences common to members of a twin pair (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 event), with little to no shared environmental contributions.
Trauma My research interests include the association between trauma exposure and substance use disorders, and in particular, the role of childhood sexual abuse (CSA) in the manifestation of familial risk for alcohol-related problems in women. Rates of CSA are elevated in offspring of alcoholic parents, likely due to common risk factors such as poor parental supervision. Adolescent girls and young women with histories of CSA 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.