ArticlePDF Available

Childhood trauma as a correlate of lifetime opiate use in psychiatric patients

Authors:

Abstract

Associations have been reported between childhood sexual and/or physical abuse and adult substance abuse in general. This study investigated the relationship between childhood abuse and opiate use in particular among 763 consecutively admitted psychiatric inpatients. Patients were interviewed about demographic information, alcohol and drug use, and history of interpersonal violence. Opiate users were 2.7 times more likely to have a history of childhood sexual and/or physical abuse than nonopiate users, after controlling for diagnostic and sociodemographic variables. Opiate use was higher among those reporting physical abuse alone (24.1%) or both physical and sexual abuse (27%) than among those reporting sexual abuse alone (8.8%). Implications of these findings are discussed.
NOTICE
This material may be protected by
Copyright Law (Title 17 U.S. code)
... Substantial evidence has linked abuse to opioid misuse (Heffernan et al. 2000;Spatz Widom et al. 2006;Conroy et al. 2009;Moselhy et al. 2010;Huang et al. 2011;Afifi et al. 2012;Quinn et al. 2016;Austin and Shanahan 2018). Physical abuse has been linked to an increased risk of prescription opioid misuse in young adults (Austin and Shanahan 2018) and injection drug use among high-risk youth (Kerr et al. 2009). ...
... However, substantial empirical evidence corroborates the cumulative effects of trauma on opioid misuse among adults and youth in the general population. Opioid misuse tends to be more prevalent among patients who report experiencing both types of abuse compared to those who experienced one of them (Heffernan et al. 2000). Moselhy et al. (2010) found that individuals with opioid use disorder have a higher incidence of traumatic life events, including physical and sexual abuse than individuals without opioid use disorder. ...
Article
Aim Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. Methods A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. Results Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. Conclusion Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.
... Childhood trauma and ACEs have been reported to be very common in the histories of those with substance use disorders and opioid use disorder (OUD), specifically. Rates of childhood psychological trauma were disproportionately high among those living with substance use disorders (SUDs; Heffernan et al., 2000;Naqavi et al., 2011), including individuals living with OUD Gannon et al., 2021), and may potentiate the development of SUDs and decrease quality of physical and mental health for those living with OUD. For example, opioiddependent individuals with histories of sexual abuse had poorer mental and physical health and have been found to be heavier users of opioids as compared to opioid-dependent individuals with no history of sexual abuse (Heffernan et al., 2000;Bartholomew et al., 2005;Charney et al., 2007). ...
... Rates of childhood psychological trauma were disproportionately high among those living with substance use disorders (SUDs; Heffernan et al., 2000;Naqavi et al., 2011), including individuals living with OUD Gannon et al., 2021), and may potentiate the development of SUDs and decrease quality of physical and mental health for those living with OUD. For example, opioiddependent individuals with histories of sexual abuse had poorer mental and physical health and have been found to be heavier users of opioids as compared to opioid-dependent individuals with no history of sexual abuse (Heffernan et al., 2000;Bartholomew et al., 2005;Charney et al., 2007). ...
Article
Background: Opioid-related deaths continue to rise. Psychological trauma is commonly comorbid with Opioid Use Disorder (OUD). Adverse childhood experiences can disrupt the development of emotion regulation, increasing risk of substance use. Self-compassion may reduce OUD risk and outcomes by facilitating emotion regulation, decreasing the toxicity of shame, and reducing internalized stigma that can hinder recovery. Mindfulness practice enhances self-compassion. Methods: This study is part of a pilot (N = 18) of the Mindful Recovery OUD Care Continuum (M-ROCC) during buprenorphine office-based opioid treatment (OBOT). The present study was conducted to gain a deeper understanding of the intervention's effects on self-compassion development, and to explore differential changes in self-compassion during the intervention among participants with varying intensity of trauma exposure measured by high levels of childhood adversity (defined by 4+ adverse childhood experiences (ACEs) at baseline). We conducted secondary analyses of a subset of qualitative interview data (N = 11 unique participants) collected for the pilot study (weeks 4 and 24, 14 total interviews) to elaborate upon changes in Self-Compassion Scale (SCS-SF) scores. Results: In the primary pilot study, participants' mean SCS-SF scores shifted significantly from baseline to week 24, β = 0.22, p = 0.028. This change is elaborated upon through interviews. Despite pervasive challenges to becoming more self-compassionate (e.g., trauma histories and substance use), participants reported increased compassionate self-responding and decreased uncompassionate self-responding. Mindfulness training was identified as the primary mechanism underlying the shift. Kindness to self and others and-to a lesser extent an increased sense of common humanity-were also identified as key to overall self-compassion. Compared to those in the lower ACEs group, participants in the higher ACEs group tended to have lower baseline self-compassion scores (d = 1.09, p = 0.055). Conclusion: M-ROCC may increase self-compassion among patients with OUD during OBOT by increasing compassionate, and decreasing uncompassionate, self-responding. Patients with OUD with greater childhood adversity tended to have lower levels of self-compassion, which improved with M-ROCC. Future trials with larger samples are needed to confirm these potential outcomes, mechanisms, and differential impacts between ACEs subgroups.
... The consequences of adverse childhood experiences (ACEs) and toxic stress in adolescents and adults are public health crises in the United States. As studies validate the effects of ACEs on adult mental and physical health outcomes [1,2] it is discouraging to know that in 2016, 34 million -nearly half of U.S. children (ages 0 to 17) -reported one ACE [3]. Further, one in ten children Open Access *Correspondence: wendy.wolfersteig@asu.edu ...
Article
Full-text available
Background The impact of adverse childhood experiences on substance use has been well reported, however, less well documented is looking at the comparison of youth and adult substance use and their respective adverse childhood experiences. This study leveraged local data sources to support prevention efforts inside a state-level working group and examined research questions that explored the relationship between reported adverse childhood experiences and substance use for youth and adult samples at the state level. Methods This study conducted a series of logistic regression models (95% CI) between substance use outcomes with different age group populations to investigate the relationship between adverse childhood experiences and substance use for each group. Adverse childhood experiences scores and substance use were examined using two Arizona datasets: 1) Arizona Youth Survey (n = 42,009) and 2) the Behavioral Risk Factor Surveillance System (n = 5328). Results The results of youth and adult datasets were consistent: users with adverse childhood experiences scores of 4 to 6 had a positive association with more substance use. When the variables were examined, showing the entire sample of youth and adult groups compared to those subgroups with a score of zero, a score of 1 to 3, and a score of 4 to 6, the overall pattern was the same; the more frequent use of substances was directly associated to the group with higher scores. Additionally, findings support increased attention on prevention and intervention efforts with higher reports of adverse childhood experiences as well as substance use. Conclusions These findings demonstrate how local research can help prioritize prevention resources and increase the value of data-based decision-making. Policy-makers and providers can examine youth and adult data to compare priorities and assess for planning purposes. Specifically, it is possible to replicate known research findings, identify the most impacted subpopulations, and forecast the community’s future needs.
Article
The purpose of this study was to identify a potential relationship between childhood sexual abuse and opioid misuse in pregnancy and to illustrate the need for better integration and collaboration between the medical and psychological disciplines to combat the opioid crisis. We sampled 93 pregnant women at a high-risk pregnancy clinic within a university medical center who were in their second trimester or beyond. Fifty-five women were considered high-risk due to opioid misuse and 38 women were considered high-risk due to medical reasons other than drug use. Our findings reveal both presence of and severity of sexual abuse were significantly associated with opioid misuse in pregnancy, while physical abuse, emotional abuse, and neglect were not. While childhood sexual abuse is a significant risk factor for opioid misuse in pregnancy, most doctors do not feel comfortable asking about trauma history. A public health approach to opioid misuse in pregnancy must consider how "diseases of despair" disproportionately impact women with limited access to adequate psychological and medical care. A preventative model of care, which targets screenings for ACEs in primary care and gynecological visits may help decrease the impact of sexual abuse.
Article
Background Children who are exposed to parental substance use disorder (SUD) have a higher risk of SUD themselves. This study examines the extent to which the association between parental and own SUD is conditional upon childhood trauma, socioeconomic status, and gender. Methods This study uses data from the Nashville Stress and Health Study with 1,234 respondents ages 25-65 collected from 2011-2014, weighted be representative of the general population. The association between parental SUD and own SUD was estimated using Cox Proportional Hazard Models, controlling for covariates, and testing for interactions. Results Other things being equal, the risk of own SUD is more strongly associated with parental SUD in households with childhood traumas among men, but not women. Childhood trauma is not associated with own SUD in the absence of parental SUD among men. For men with parental SUD exposure, just one traumatic event is associated with a 38% increased risk of own SUD (HR=1.382, SE=.201, p<0.05). For men, living with grandparents is associated with added SUD risk (HR=1.476, SE=.228, p<0.05). For women, childhood trauma is not associated with own SUD, but parental SUD (HR=1.556, SE=.238, p<0.01), and early onset mood or anxiety disorder (HR=1.682, SE=.316, p<0.01) are. For both genders, those who are African American have lower risk of SUD than those who are White (HR=0.774, SE=.109, p<0.05 for women; HR=0.672, SE=.079, p<0.01 for men). Conclusions Parental SUD is associated with a substantial increase in risk for own SUD, and this association differs by gender and early trauma.
Chapter
Childhood trauma is as American as apple pie. The statistics are sobering. In 2018, more than 673,000 children were victims of abuse or neglect. This chapter will explore adverse childhood experiences (ACEs) in detail, relating how these past experiences could affect current student behavior. A case study will be used to illustrate the issues that teachers face in their classrooms. Research shows that trauma affects the brain and subsequently how people act and/or react. Emotional regulation, behavioral control, and cognitive processes that are affected by trauma will be explored. Further, this chapter will raise the issues of racial disproportionality in identification and labeling of behavioral disorders and recommendations for special education among students who may have been exposed to trauma. Lastly, recommendations for best practice will be outlined to support educators in the field.
Article
This study sought to understand how PTSD predicts opioid use onset rates and how subsequent exposures to violence also influence this risk following adjudication. Survival analysis was used to examine the moderating role that baseline PTSD status plays for predicting rates of opioid use onset risk following adjudication. Hazard models used to examine the role of time-varying covariates for predicting opioid onset risk following adjudication. PTSD was found to predict significantly greater odds of opioid use initiation. Hazard of introducing opioid use was greater during observation periods in which participants witnessed violence. This effect was greater for PTSD sufferers.
Article
The opioid epidemic remains a public health priority in the United States. There is evidence that women are experiencing disparities within the epidemic, including an earlier onset of prescription opioid misuse and a higher prevalence of child maltreatment, interpersonal violence, and mental health disorders. The purpose of the current study was to explore the social context of opioid misuse initiation among women using a syndemics framework. In-depth interviews were conducted between July 2019 and February 2021 with 56 women who had a past-year history of opioid misuse. Interview transcripts were transcribed verbatim and analyzed with MAXQDA software. Thematic content analysis was used to develop a detailed explanation for the social process of opioid misuse initiation among women through the lens of syndemics. Women's shared experiences provide evidence of the co-occurring and synergistic factors that increase their risk for initiating opioid misuse and constitute syndemic conditions. Findings revealed the centrality of traumatic events in women's lives; child maltreatment, particularly sexual violence and parental substance misuse, were prevalent and influential to women developing patterns of substance misuse as a way to cope with emotional pain. The presence of pain conditions that conferred access to prescribed opioids further compounded women's vulnerability for opioid misuse initiation. The syndemic conditions that women experience represent a critical call to action to prioritize women's health and social needs within the opioid epidemic. Prevention strategies should address violence against women and girls, as well as pain management practices that attend to trauma and psychological distress.
Article
For parenting women with substance use disorders, enrolling in medication-assisted treatment often means being involved with child protective services. This study examines the impact of biopsychosocial factors on treatment outcomes for opioid-dependent pregnant women in methadone treatment, linking these outcomes with removal of a child by child protective services. This study evaluates factors associated with a client’s success in treatment, using adherence to treatment as a predictor to assess which factors led to any removal of the child from out-of-home care. Results indicated that biopsychosocial factors were correlated with treatment outcomes, particularly if the mother had a prior removal of a child due to a substantiated child abuse case. This research adds to our understanding of factors related to treatment outcomes for pregnant women and informs treatment delivery models that effectively address the complex needs of this vulnerable population.
Article
The opioid epidemic is a public health problem associated with a host of negative outcomes. Although clinicians recognize covariation between opioid misuse with anxiety and depressive symptoms and disorders, research on this topic has only recently accumulated. Progress in this domain is impeded by the lack of systematic and integrative research to better understand and treat these co-occurring problems. This paper represents the first attempt to systematically review the empirical literature examining relations between opioid use and misuse, and anxiety and depression. In the first section, we define key terms and describe the article selection strategy. In the second section, we review the prevalence of anxiety and depressive symptoms among individuals who use and misuse prescription and illicit opioids. In the third section, we review the magnitude of associations between anxiety and depressive symptoms and disorders with opioid misuse, as well as highlight studies examining the longitudinal and temporal sequence of the relations between these variables. In the fourth section, we focus on experimental therapeutics, reviewing what is known about individual difference and transdiagnostic vulnerability factors for anxiety and depression that might contribute to opioid misuse and its symptoms. Finally, we discuss current knowledge gaps and present a heuristic model to guide future research.
Chapter
Full-text available
Society is increasingly affected by all types of human violence, including rape, robberies, assault, natural disaster, and accidents. This can leave the individual with intense terror, fear, and paralyzing helplessness. About 60% of men and 50% of women have experienced psychological trauma (defined as threat to life of self or significant other) at some time in their lives. As many as 39% of these individuals exposed to a traumatic event will develop post-traumatic stress disorder (PTSD). The lifetime prevalence of PTSD in the United States is estimated at 7.8% and is twice as common in women as in men. This is more than twice the prevalence of bipolar disorder or schizophrenia. PTSD is strongly comorbid with other lifetime psychiatric disorders. More than one third of people with an index episode of PTSD fail to recover even after many years (Kessler et al. 1995).
Article
Posttraumatic stress disorder (PTSD) is an illness of considerable prevalence, often characterized by high morbidity, treatment resistance, and a chronic course. The core symptoms of PTSD include persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and autonomic hyperarousal. We propose several neurobiologic mechanisms that may account for these primary symptoms of PTSD. Preclinical investigations of the effects of stress on learning and memory processes suggest that fear conditioning, behavioral sensitization, and a failure of extinction may be important in the persistence and reexperiencing of traumatic memories and stressor sensitivity. The pathophysiology of PTSD may involve dysfunction of several brain structures, particularly the amygdala, locus coeruleus, and hippocampus, as well as noradrenergic, dopamine, opiate, and corticotropinreleasing factor neurochemical systems. Acutely, severe psychological trauma results in the parallel activation of these systems, producing an array of adaptive behavioral and physiologic responses necessary for survival. In PTSD, however
Article
In this paper, we first examine and recast the research literature on opiate addiction in the light of a hierarchical model of self-organization. The hierarchical model consists of five modes of psychological and psychobiological functioning defined epigenetically. Research and theories of opiate addiction are classified as to their primary modal emphases. We then describe failures of self-regulation as particular vulnerabilities along the first three modes of the hierarchy. A measure of this construct, the Scale for Failures in Self-Regulation (SFSR), a projective measure that utilizes Thematic Apperception Test responses, is introduced for the study of opiate addicts. The SFSR was administered to normal and opiateaddicted subjects in order to examine the predictive and explanatory power of the hierarchical model. A multivariate analysis of variance showed the addicts to have greater difficulties in self-regulatory functioning than normal subjects. In terms of the hierarchical model, the implications of these findings for the questions of severity of illness, psychotherapy technique, and future research are discussed.
Article
• A national sample of men who were of military age during the Vietnam War (n =1,342) was interviewed six to 15 years after veterans in the sample had left the service. Our findings showed that violent experiences in war were associated with a variety of behavioral and emotional problems. When preservice background factors were statistically controlled, combat exposure showed an association with arrests and convictions (generally for nonviolent offenses), with drinking, and with symptoms of traumatic stress. Participants in atrocities reported more stress symptoms and greater use of heroin and marijuana than did other veterans. Veterans who experienced no combat and did not take part in atrocities, however, did not differ appreciably from nonveterans. Not all men who experienced combat or took part in atrocities reported personal difficulties; almost three fourths of heavy-combat veterans were not arrested after the service. Tape recorded responses of the ten blacks and 18 whites who took part in atrocities suggested that soldiers' emotional responses may have been determined by their ability or inability to dehumanize the victims. Future research would benefit from a closer coordination of clinical and epidemiologic approaches.
Article
There is a growing recognition of the strong association between psychoactive substan ceabuse and violence. Repeated exposure to violent trauma is particularly salient for women. Moreover, violent trauma may play a role in the etiologies of depression, substance abuse, and trauma-related disorders, such as posttraumatic stress disorder (PTSD). For the female methadone patient, an untreated trauma-related disorder can be a hidden factor that hinders treatment response and leads to treatment complications, such as depression, polysubstance abuse, or treatment drop out. This article reviews the prevalence of trauma and violence for women on methadone, comparing low-income, inner-city female drug abusers with males in methadone treatment on childhood and adulthood exposure to violent trauma and PTSD. Because women are in a minority in methadone maintenance treatment programs, standard treatment approaches have generally not focused on their particular issues and needs. Two alternative models are presented for group treatment of trauma and trauma-related disorders in female methadone patients; potential benefits of each in reducing symptomatology and improving interpersonal functioning are examined. Modification of standard approaches and the typical barriers to engagement in treatment for this special population are also addressed.
Previous research has shown a high incidence of sexual abuse histories among chemically dependent women. This paper reports on the associations among sexual abuse, past traumatic experiences, and current drug-associated behaviors in a study of chemically dependent pregnant and parenting women in New York City in order to examine the implications for drug treatment. Interviews were conducted with 146 indigent New York City women. Subjects were eligible for the study if they met the following criteria: were current users of crack/cocaine or had used crack/cocaine within the past 3 years, were currently pregnant, and/or were the mother of a preschool-age child. Subjects were recruited and interviewed from drug treatment programs (n = 72) and nontreatment sites (n = 74). One hundred thirty-three (91%) of the 146 women interviewed were African American or Latina. Study participants had a mean age of 29.4 years, with an average of 11.5 years of education. Seventy-four (51%) of the women interviewed reported having been victims of at least one forced sexual encounter. Sexual abuse was associated with both past experiences and current drug-associated behaviors. The age of abuse had a significant impact on outcome. Given the frequency with which sexual abuse has been found in the histories of chemically dependent women, and the linkages of sexual abuse to indicators of drug problem severity, it appears important to integrate therapy for sexual abuse into treatment for chemically dependent women. Previous research has shown a high incidence of sexual abuse histories among chemically dependent women. This paper reports on the associations among sexual abuse, past traumatic experiences, and current drug-associated behaviors in a study of chemically dependent pregnant and parenting women in New York City in order to examine the implications for drug treatment. Interviews were conducted with 146 indigent New York City women. Subjects were eligible for the study if they met the following criteria: were current users of crack/cocaine or had used crack/cocaine within the past 3 years, were currently pregnant, and/or were the mother of a preschool-age child. Subjects were recruited and interviewed from drug treatment programs (n = 72) and nontreatment sites (n = 74). One hundred thirty-three (91%) of the 146 women interviewed were African American or Latina. Study participants had a mean age of 29.4 years, with an average of 11.5 years of education. Seventy-four (51%) of the women interviewed reported having been victims of at least one forced sexual encounter. Sexual abuse was associated with both past experiences and current drug-associated behaviors. The age of abuse had a significant impact on outcome. Given the frequency with which sexual abuse has been found in the histories of chemically dependent women, and the linkages of sexual abuse to indicators of drug problem severity, it appears important to integrate therapy for sexual abuse into treatment for chemically dependent women.
Article
The relationships between experiences of parental violence during childhood and the development of victimization by severe violence from partner or alcohol-related problems in adulthood were examined by comparing women with partner victimization only ( N = 69), alcohol-related problems only ( N = 59), both partner victimization and alcohol-related problems ( N = 83), and neither problem ( N = 80). Face-to-face interviews were administered to all respondents. The Conflict Tactics Scale was used to assess father-to-daughter, mother-to-daughter, and partner-to-woman relationships. Associations between parental violence and adulthood problems were examined in a multivariate model. Control variables included childhood socioeconomic status, presence of a parent with alcohol-related problems, number of changes in childhood family structure, race of respondent, and the Global Severity Index. The mother-to-daughter relationship appeared a moderately better predictor of partner violence than the father-to-daughter relationship. Conversely, the father-to-daughter relationship was a better predictor of alcohol problems than the mother-to-daughter relationship. Father-to-daughter verbal aggression was found an especially important predictor of alcohol problems for women.
Article
Investigated the relationship between childhood experience of incest and dysfunction of women in adult life, using 117 female participants in Alcoholics Anonymous. Ss completed self-administered questionnaires assessing history of alcoholism and sobriety patterns and Institute for Personality and Ability Testing anxiety and depression scales. 82 Ss did not report a childhood incest experience, 29 did (14 cases were with father figures), and 6 could not remember. Results indicate that posttraumatic stress disorder (PTSD) occurred in almost 40% of the Ss who experienced incest. There were no significant differences in the frequency of the occurrence of PTSD when father-figure incest victims were compared with other incest victims. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
general background: the interrelated systems of the brain / the psychobiological symptomology of PTSD [physiological arousal, loss of emotions as signals] / psychophysiological effects of trauma [conditioned responses to specific stimuli, hyperarousal to intense but neutral stimuli] / neurohormonal effects of trauma [background: neurohormones and their roles in the stress response, specific neuroendocrine abnormalities in PTSD] / developmental level affects the psychobiological effects of trauma [trauma, neurohormones, and memory consolidation] / trauma and the central nervous system [background: structures and functions of the limbic system, "emotional memory may be forever," specific limbic system abnormalities in PTSD, lateralization] (PsycINFO Database Record (c) 2012 APA, all rights reserved)