Reviewer’s report
Title: History of childhood abuse is associated with less positive treatment outcomes in socially stable
women with alcohol use disorder
Version: 0 Date: 13 Sep 2019
Reviewer: Meredith Francis
Reviewer's report:
This study provides a needed exploration of how childhood experiences of trauma can complicate
recovery from substance use disorders. This is a very important topic of research, and I commend the
authors for completing this study. The use of longitudinal design with a 12-month time point for
follow-up is  a major strength, especially given that the literature on recovery indicates that it is
important to consider longer time frames when studying recovery. The use of validated measures is a
strength as well. Overall, the article is very clear and well-written, and the findings are presented well. I
am recommending this article for acceptance following minor essential revisions.
I have three essential areas for revision and clarification for this study:
1. This study used a sample of "socially well-adjusted women undergoing treatment for AUD." I
recognize that this was the population of the larger project from which your study sample was drawn,
but this type of population is by no means typical of people in treatment for AUD, and particularly for
those with trauma histories. Please include a brief discussion of why it was important to use a sample
of socially well-adjusted women in this study in your introduction, and discuss this as a limitation in
your  discussion.  It  is  currently  listed  as  a  strength,  but  it  likely  makes  the  study  results  less
generalizable to the average population with AUD. If this is representative of the general population in
AUD treatment in Sweden, please note this instead.
2. As you note, your sample size was fairly small, particularly for the 12-month time point after
attrition. Please include a power analysis to show that you have adequate sample size for your analyses,
and note any potential power issues in your discussion.
3. Your measure of AUD diagnosis was designed based on DSM-IV criteria rather than one based on
DSM 5 criteria. Given that the DSM 5 was the standard measure when the data were collected, why
was a measure based in the DSM-IV used? Please provide a rationale for your use of these diagnostic
criteria. If possible, consider examining the endorsed DSM-IV symptoms and creating a score of the
number of DSM 5 criteria that align with this so that the results can be compared with other studies that
use the newer criteria.
I also have three minor areas for revision and clarification for this study:
4. Your discussion of the research implications of your findings is thorough. I was looking for a
discussion of potential clinical implications of your findings. What are some of the things clinicians
might need to be aware of with this population? Are there any suggestions for how the group with
childhood abuse histories could be better supported during and after treatment? This does not need to
be extensive, but should be at least considered.
5. I am confused by your statement on pg. 13 lines 7-13: "However, a degree of cross-study variation in
the prevalence of the different forms of childhood abuse is evident. This may be attributable to the
nature of the respective study populations, e.g., inpatients/outpatients." I'm not clear on why abuse type
might vary by treatment modality. Is there a way you can clarify this or provide a different example that
makes more sense?
6.  Please  remove  the  parentheses  on  pg.  4  lines  7-12  so  that  the  sentence  reads:  Of  these,  70
participants were not included as they either declined study participation (n = 59), dropped out of
treatment before the commencement of data collection (n = 5) or were not invited to participate in the
study due to an administrative error (n = 6).
Finally, I am curious about examining these relationships by the type of abuse (physical, sexual,
emotional), severity of abuse, and current traumatic symptoms. I do recognize that this is beyond the
scope of this study and is likely not possible with this sample size. These are not necessarily aspects
you need to include in this article, but could be listed as other areas for research in your discussion
section.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
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