Female survivors of childhood abuse have increased risk for substance misuse. Childhood abuse survivors describe current mental health and substance misuse services as not addressing central problems, the “heart of the matter.” Negative core issues related to abuse events, contexts, substance use, and current problems were explored in open-ended interviews with 20 female abuse survivors. Most were marginalized because of cocaine use, poverty, and ethnic status. Narrative analysis involved within- and between-account comparisons through adequate paraphrasing of in vivo descriptions. Results include in-depth description of basic core beliefs, developmental core influences, and current core experiences. Implications for practice and policy include appreciation of the influence of negative core experiences on mental health, substance misuse recovery, and preparedness for adulthood demands.
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