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Peer-reviewedCC BY 4.0PLOS One

The moderating role of impulsivity in the association between sexual abuse and substance use frequency across countries, gender identities, and sexual orientations

  • Damla E. Aksen1
  • Marc N. Potenza2
  • Sarah D. Lichenstein3
  • Léna Nagy4
  • Shane W. Kraus5
  • Joël Billieux6
  • Loïs Fournier7
  • Zsolt Demetrovics8
  • Mónika Koós9
  • International Sex Survey Consortium10
  • Beáta Bőthe11
11 affiliations
  1. 1Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
  2. 2Yale University School of Medicine, New Haven, Connecticut, United States of America
  3. 3Connecticut Council on Problem Gambling, Wethersfield, Connecticut, United States of America
  4. 4Connecticut Mental Health Center, New Haven, Connecticut, United States of America
  5. 5Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
  6. 6Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
  7. 7Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
  8. 8Department of Psychology, University of Nevada, Las Vegas, Nevada, United States of America
  9. 9Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  10. 10Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
  11. 11Flinders University Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
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Abstract

This study examined how impulsivity moderates the relationship between sexual abuse and substance use frequency in a large international sample. Participants (N = 64,472) completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST-11), the UPPS-P Impulsive Behavior Scale, and sexual abuse measures through the International Sex Survey. Structural equation models tested associations between childhood sexual abuse (CSA), adolescent/adult sexual abuse (AASA), and combined exposure with substance use frequency, and explored moderation by impulsivity across gender identity, sexual orientation, and country. AASA and CSA+AASA were consistently associated with higher substance use frequency, while CSA alone showed weaker or inconsistent associations across groups. Urgency and premeditation facets of impulsivity moderated these associations, particularly among sexual and gender minority individuals. Country-level differences indicated cultural and contextual variation in how impulsivity interacts with trauma to influence substance use. Findings underscore the need for targeted, culturally responsive interventions addressing impulsivity in the aftermath of sexual trauma.

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Cite

BibTeXRIS
BibTeX
@article{aksen2026moderating,
  title = {{The moderating role of impulsivity in the association between sexual abuse and substance use frequency across countries, gender identities, and sexual orientations}},
  author = {Damla E. Aksen and Marc N. Potenza and Sarah D. Lichenstein and Léna Nagy and Shane W. Kraus and Joël Billieux and Loïs Fournier and Zsolt Demetrovics and Mónika Koós and International Sex Survey Consortium and Beáta Bőthe},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0355986},
  url = {https://doi.org/10.1371/journal.pone.0355986},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The moderating role of impulsivity in the association between sexual abuse and substance use frequency across countries, gender identities, and sexual orientations
AU  - Damla E. Aksen
AU  - Marc N. Potenza
AU  - Sarah D. Lichenstein
AU  - Léna Nagy
AU  - Shane W. Kraus
AU  - Joël Billieux
AU  - Loïs Fournier
AU  - Zsolt Demetrovics
AU  - Mónika Koós
AU  - International Sex Survey Consortium
AU  - Beáta Bőthe
PY  - 2026
DA  - 2026/09/30
JO  - PLOS One
DO  - 10.1371/journal.pone.0355986
UR  - https://doi.org/10.1371/journal.pone.0355986
AB  - This study examined how impulsivity moderates the relationship between sexual abuse and substance use frequency in a large international sample. Participants (N = 64,472) completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST-11), the UPPS-P Impulsive Behavior Scale, and sexual abuse measures through the International Sex Survey. Structural equation models tested associations between childhood sexual abuse (CSA), adolescent/adult sexual abuse (AASA), and combined exposure with substance use frequency, and explored moderation by impulsivity across gender identity, sexual orientation, and country. AASA and CSA+AASA were consistently associated with higher substance use frequency, while CSA alone showed weaker or inconsistent associations across groups. Urgency and premeditation facets of impulsivity moderated these associations, particularly among sexual and gender minority individuals. Country-level differences indicated cultural and contextual variation in how impulsivity interacts with trauma to influence substance use. Findings underscore the need for targeted, culturally responsive interventions addressing impulsivity in the aftermath of sexual trauma.
SN  - 1932-6203
ER  -