Bullying and Substance Use Part 2: Now That We Know, What Can We Do?

In Bullying and Substance Use Part I: What Do We Know? topics included a definition of bullying used by early research into the issue, categories of bullying, prevalence of bullying, and some of the effects of bullying for children who are bullied and for those who bully or observe bullying. Bullying Part 2 will focus on the consequences experienced worldwide by adults who experienced bullying as children, including substance use and mental health consequences, and some ways behavioral health providers can address this issue.

The Role of Childhood Bullying in Substance Use and Mental Health Disorders

One seminal study examined the possibility that bullying or being bullied predicts psychiatric problems and suicidality in young adulthood. The study participants were 1420 students who had experience bullying or being bullied (bullies only, victims only, bullies and victims, or bullies/victims). The participants were assessed 4-6 times from age 9-16 and again in young adulthood at ages 19, 21, and from age 24-26 years. The diagnostic interviews included depression, anxiety, antisocial personality disorder, substance use disorders, and suicidality (including suicidal thoughts, ideation, or attempts). As victims and bullies/victims had higher rates of childhood psychiatric disorders and family hardships, the researchers controlled for those conditions. The victims had higher rates of agoraphobia, generalized anxiety, and panic disorder. The bullies/victims had higher rates of young adult depression, panic disorder, agoraphobia (in females only), and suicidality (males only). Only the bullies showed increased risk for antisocial personality. The researchers concluded that “The effects of being bullied are direct, pleiotropic, and long-lasting, with the worst effects for those who are both victims and bullies” (Copeland et al., 2013). The published journal article has been cited at least 1,045 times, and following articles represent just some of the research that has occurred since its publication. The research findings upon which each article is based are summarized as follows:

• Research done in Norway looked at the bullying involvement of 14-15 year olds and subsequent self-reported health and psychosocial issues at age 26-27. Findings included:
  • Compared with groups not involved with bullying, any involvement in bullying (victim or bully) was associated with lower levels of education;
  • Aggression toward others was associated with higher rates of unemployment and need for social services;
  • Victims and bully-victims had higher rates of poor general health and higher levels of pain;
  • Those aggressive to others and bully-victims had higher rates of tobacco use and lower job functioning;
  • Victims and bully-victims were at increased risk of illegal drug use Sigurdson et al., 2014).

• A Finnish study followed children 8 years of age through age 29 looked at bullying behavior and. The collected data for associated psychiatric outcomes as reported by parents, teachers, and the children at age 8 years, and found that compared to study participants who did not engage in bullying behaviors, 11.5% of participants involved in bullying behaviors from any perspective had a had obtained a psychiatric diagnosis at follow-up (Sourander et al., 2016).
• A mixed methods study of 72 U.S. students from a major university who had identified by having experienced bullying during their K-12 educational experiences found themes of:
  • mental health issues that continued through adulthood,
  • physiologic concerns,
  • and relationship issues.

The mental health concerns included suffering from childhood through young adulthood from “depression, anxiety, low self-esteem, and eating disorders that they attributed directly to their experiences with bullying in childhood. The ability to trust others in adult friendships and intimate relationships was significantly affected” (deLara, 2019). The fallout from childhood bullying and resultant mental health concerns resulted in self-medication through substance use, food, or other behaviors such as self-harming.

• A larger study to research the pathways from bullying victimization to substance use and sexual risk taking of emerging adults (ages 18-25 years of age) assessed for childhood physical and sexual abuse through three questions about parental or caregiver abuse and sexual contact by someone at least 5 years older prior to age 13. Researchers assessed for substance use consumption, dependence, and alcohol-related problems using the 10-item Alcohol Use Disorders Identification Test (AUDIT) (Saunders et al. 1993). The 8-item Cannabis Use Disorder Identification Test-Revised (CUDIT-R), which assesses cannabis misuse , was also administered to participants (Adamson et al. 2010). Assessment instruments for sexual risk taking, depression, anxiety, self-esteem, and social desirability were also administered to participants. Findings included:
  • Victimization through bullying had statistically significant direct effects on substance use and sexual risk taking;
  • Participants who suffered bullying victimization experienced significant indirect effects of bullying through depression, anxiety, and low self-esteem (Provenzano & Boroughs, 2021).

The impact of bullying – throughout at least young adulthood – on substance use and mental health disorders is well-documented by the research base thus far. A recent meta-analysis of 215 studies of the long-term effect of childhood bullying from 28 publications with a total of 28,377 participants has further added to current knowledge of the potentially lifelong impact of bullying, particularly for those who, as children, bullied others. The study authors summarized the results of their meta-analysis: “compared with nonbullying peers, children and adolescents who bully have a higher risk of drug, alcohol, and tobacco use later in life. In addition to these specific types of substance use, bullies also had a higher risk of non-subtyped substance use (for example, general substance use dependence). Our findings suggest that early bullying predicts substance use even many years later and over and above common confounders” (Vrijen et al., 2021).

Recommendations for Behavioral Health Providers

Most people have some understanding of what bullying is and what it looks like, and to learn more about categories of bullying and how to recognize it, read Bullying and Substance Use Part I: What Do We Know? on the Catalyst blog. For behavioral health providers who may not have known about the long-term effects of bullying on children and on their behavioral health as emerging and young adults, there are a few suggestions and resources available.

1. Talk about bullying with clients. Understand that bullying can occur in both children and adults. Be they perpetrators or victims, according to the research base, bullying can cause PTSD, depression, anxiety, suicidal ideation, substance use disorder, eating disorders, self-harm, and self-medication for mental health issues at least from childhood through young adulthood, and potentially beyond. This means that existing mental health or substance use issues can be exacerbated by being a bully, victim, bully-victim, or observer. Therefore, many more people are impacted by bullying in addition to the victim. The implications of this for treatment and prevention providers mean that bringing the topic to the level of conversation can yield important information for both treatment and prevention interventions and the potential benefits reach far beyond the single person in treatment.
2. Use screening tools as a matter of course. This includes current screening and assessment tools for mental health disorders and substance use disorders. While some screening tools are used by virtually all behavioral health providers, be on the lookout for new tools that directly assess bullying as they become available. One relatively new tool is the California Bullying Victimization Scale (CBVS-R), a retrospective self-report measure for adults. This measure is a validated tool for measuring childhood bullying and the psychological distress experienced as a result in adults (Green et al., 2018).
3. Understand that identifying and treating bullying is different for children and adults. The urgency of adult response to bullying in children that is swift and appropriate for bullies, victims, and observers alike is apparent to most people. The importance of recognizing and treating the underlying experiences of bullying or being bullied that may have precipitated the development of mental health or substance use disorders is just beginning to be well understood. Both bullies and victims may experience shame, trauma, lower self-esteem, and denial or minimization that prevents them from acknowledging or healing deep wounds.
4. Access resources to learn more. While there has been great progress in the research about the impact of childhood bullying behaviors on emerging and young adults, far more research needs to be done about addressing the effects of bullying, particularly for the treatment of adults with this history. Keep abreast of the research and explore the resources offered by many credible and reliable government and non-government agencies and organizations, such as stopbullying.gov, the Association for Behavioral and Cognitive Therapies (ABCT), and the Substance Abuse and Mental Health Services (SAMHSA) KnowBullying Mobile App. There are a variety of resources on bullying on the SAMHSA website, such as the Community Conversations About Mental Health: Information Brief that explains the impact of bullying on substance use and mental health disorders and what communities can do about this important issue. Additional resources on bullying and related issues can be found on the CASAT OnDemand Resources & Downloads page.
5. Get involved. Advocate for research on bullying and bullying prevention. Make sure you have a list of additional resources on bullying for clients and share them with colleagues. Request training through your state agency or other training organizations for new approaches for the treatment of adult survivors of bullying. Advocate for addressing childhood bullying in schools and on the internet by contacting local, county, state, and national leaders. Being involved only means doing at least one small action within your sphere of influence to make a difference.

References

Copeland WE, Wolke D, Angold A, Costello EJ. Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence. JAMA Psychiatry. 2013;70(4):419–426. doi:10.1001/jamapsychiatry.2013.504

deLara, E. W. (2019). Consequences of childhood bullying on mental health and relationships for young adults. Journal of Child and Family Studies, 28(9), 2379-2389.

Green, J. G., Oblath, R., Felix, E. D., Furlong, M. J., Holt, M. K., & Sharkey, J. D. (2018). Initial evidence for the validity of the California Bullying Victimization Scale (CBVS-R) as a retrospective measure for adults. Psychological assessment, 30(11), 1444.

Provenzano, D. A., & Boroughs, M. S. (2021). Substance Use and Sexual Risk Taking in Emerging Adults with a History of Bullying Victimization. International Journal of Bullying Prevention, 1-12.

Sigurdson, J. F., Wallander, J., & Sund, A. M. (2014). Is involvement in school bullying associated with general health and psychosocial adjustment outcomes in adulthood?. Child abuse & neglect, 38(10), 1607-1617.

Sourander, A., Gyllenberg, D., Klomek, A. B., Sillanmäki, L., Ilola, A. M., & Kumpulainen, K. (2016). Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age. JAMA psychiatry, 73(2), 159-165.

Vrijen, C., Wiertsema, M., Ackermans, M. A., van der Ploeg, R., & Kretschmer, T. (2021). Childhood and adolescent bullying perpetration and later substance use: a meta-analysis. Pediatrics, 147(3).

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