Charnaud & Griffiths (Reference Charnaud and Griffiths2000) in response to the finding of increased psychiatric symptoms in female drug users by Marsden et al (Reference Marsden, Gossop and Stewart2000) postulate that this finding may be a sequela of earlier child abuse. It is interesting to note the high incidence of childhood sexual abuse found in their study population based in Cornwall. In a Dublin sample, the level of sexual abuse for both males and females was considerably lower (21%). However, the effects of abuse appeared to have a significant influence in subsequent clinical progression of substance misuse. Those patients with a history of sexual abuse in the past had a significantly younger mean age of first opiate use (16.7 years v. 19.1 years for those without a history of sexual abuse) (Reference Browne, Keating and O'ConnorBrowne et al, 1998). The duration of drug misuse was also considerably longer (mean 10.8 v. 8.4 years).

We would support the suggestion of Charnaud & Griffiths (Reference Charnaud and Griffiths2000) that the evaluation of previous history of sexual abuse can predict the best plan of treatment for these patients. We would suggest that the long-term clinical progression of sexually abused drug misusers is that of more rapid progression to intravenous drug misuse with all the prognostic features that this implies.