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: 16 Sep 2019
Reviewer: Jerilynn Prior
Reviewer's report:
Major Comments for Authors:
This is an important study with implications for treatment of women with many kinds of substance use
problems. However, at present the following are unclear:  the recruitment, treatment plan with its
duration and the follow up and where the participant then was. That is especially important because
those with substance use problems tend to relapse in their usual social and physical environments and
we don't' know if that is true at the end of this study (the final outcome) or not. 
I have made detailed recommendations. 
Specific necessary changes:
1.The  title  includes  the  word  "impacts"  which  implies  a  causal  relationship.  This  is  not  a
controlled study and cannot show causation therefore suggest to change "impacts" to "associated with".
Please also change this word usage elsewhere in the document, e.g. line 19 of Background
2.The title could also add "less positive" before "treatment outcomes" 
3.The Results Abstract section starts with "Both groups" but these you have not yet described
them! Please start by saying that, of the 75 women enrolled, __X_# (%) reported a history of childhood
abuse and the rest did not. Now you can begin with "Both groups. . . ." 
4.Also ensure that the timeline of the study is clear in the abstract and in the methods—for
example, it is unclear in Line 56 at what time point in the treatment or follow-up, the abstinence data
were obtained.
5.Add "adult women" as a keyword
6.Line 16-17 in Intro—this phrase is unclear "treatment outcome may include a history"  Please
revise.
7.Please make it entirely clear in the introduction whether other studies have shown a relationship
of childhood abuse with addictive behaviour treatment programme outcomes.
8.In Methods, in describing the Kajsa project, please outline the usual treatment programme, how
long it lasted for each woman, how intense it was, and identify if women came there from across the
country (in other words, since it was an outpatient programme, had to find a residence in a new city).
Also identify whether the follow-up occurred when they had returned to their original environments or
not. 
9.Line 46—the rather large number of women not included in the outcomes is a concern—please
change the order your list of variables that did not differ so that the fact that there was no childhood
abuse difference comes first in the list. 
10.Under Participants, please indicate how you recruited women into the study.
11.Line 10 page 5—the indication of how long participants were in the study should come first
before discussion of drop-outs by duration in therapy. 
12.I strongly suggest that "Study Procedure" that could have "Study Design" added to it on page
six be  moved  to become  the first section in the Materials  and  Methods  section—it  answers  the
questions I had in the Participant and Treatment sections
13.Page 6 line 34—were there options in the instrument to capture surrogate parental figures—
some may have been in foster care or orphanages. How would you have handled those possibilities
related to a family history? 
14.Table 1 and elsewhere throughout the paper when referring to adult females, call them women
15.In the discussion, there needs to be some thoughtful evaluation of the programme—if, as I
suspect but is not clear, the treatment months are out of a woman's own home environment and the 12-
month follow-up is in her original environment (one in which the abuse began), it is important to
discuss this. And to perhaps consider ongoing support for women in their home communities. 
16.The other potentially important issue to at least mention is that the age range at which alcohol
substance use disorder began is in the perimenopause age-range in the population, a time when wildly
swinging and higher estradiol levels1 may increase insulin resistance, depression2 3 and anxiety3.
Please include a discussion of the hormonal environment of the woman as potentially contributing to
AUD.
17.The reader also needs to know whether, in Sweden, this programme is part of universal health
care and supported or women had to pay for it, whether their jobs were secure during the time they took
off work (if they did) and if they had dependent children if there were social support for their needs (in
the presumed absence of the women while they took the programme). 
Reference List
1. Prior JC. Perimenopause: The complex endocrinology of the menopausal transition. Endocrine
Reviews 1998;19:397-428.
2. Schmidt PJ, Ben DR, Martinez PE, et al. Effects of Estradiol Withdrawal on Mood in Women With
Past Perimenopausal Depression: A Randomized Clinical Trial. JAMA Psychiatry 2015;72(7):714-26.
3. Gracia CR, Freeman EW. Onset of the Menopause Transition: The Earliest Signs and Symptoms.
Obstet Gynecol Clin North Am 2018;45(4):585-97. doi: 10.1016/j.ogc.2018.07.002 [published Online
First: 2018/11/08]
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
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:
Needs some language corrections before being published
Declaration of competing interests
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3. Do you hold or are you currently applying for any patents relating to the content of the
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4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
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