The role of adverse childhood experiences and trauma on treatment outcomes among people in opiate agonist treatment

Abstract

Background: Opiate Agonist Treatment (OAT), also referred to as Methadone Maintenance Treatment (MMT), has been the cornerstone of medically assisted treatment for people with an opiate use disorder for over five decades. OAT has been shown to retain people in treatment, and reduce the significant harms caused by harmful heroin use, in particular, the health related problems caused by drug injecting behaviour and blood borne viruses such as Human Immunodeficiency Virus (HIV). Despite the success of OAT in reducing illicit opiate use, research shows that polydrug use remains relatively high among people in OAT. Research also shows that children who grow up in dysfunctional homes are at an increased risk of childhood maltreatment and the development of substance use disorders and mental health disorders such as post-traumatic stress disorder (PTSD) in adulthood. However, the relationships between adverse childhood experiences (ACEs) and PTSD on the outcomes of substance use treatment are not fully understood. The present study aims to address this issue. Aims: The main aim of the study is to investigate the relationship between ACEs, PTSD, current drug use, HIV risk taking behaviour, physical health, psychological well-being, criminality, and social functioning, among adults attending addiction treatment services. The study also explores whether there are gender differences in the number of ACEs and the levels of PTSD between males and females attending OAT services. Methods: This study makes use of an observational cross-sectional design. Data for this research study was collected in 2019 from among the original 131 subjects who attended one of the six participating opiate addiction treatment centres for the Healthy Addiction Treatment Recovery Model (HAT) research study in 2017, a study designed to measure treatment outcomes among people in OAT. The data collected included measures for the number of ACEs, the level of PTSD and six outcomes of OAT, current drug use, HIV risk taking behaviour, physical health, psychological well-being, criminality, and social functioning. Extensive descriptive analyses were conducted and inferential analyses such as correlations, Chi sq. and multiple regression models were statistically explored. This study received ethical approval from the researcher?s university. Results: The average age of the participants was 43 years and the mean length of time spent in their current treatment was 11 years. The average age at which people left school was 15 years and the current level of unemployment at 77%, was very high among the cohort. Criminality and HIV risk taking behaviour, was very low among the participants. The mean score for PTSD was 30, with 40% of participants returning scores of ?33 indicating a diagnosis of PTSD may be appropriate. The average number of ACEs among the cohort was 4 from a maximum of 10 ACEs and a strong positive correlation was found between the number of ACEs and PTSD. Three predictor variables were identified for psychological well-being, (ACEs, general health, and PTSD) with PTSD emerging as the strongest predictor, explaining 54% of the variance in psychological well-being. PTSD was also identified as a significant predictor of social functioning, and physical health. Chi Sq. analysis between the ten ACE factors and those people scoring above and below a PTSD cut-off score of 33, found a significant association between nine of the ten ACE factors, with the strongest association found between PTSD and childhood emotional neglect. Furthermore, the regression modelling for the continuous PTSD variable showed that four of the ACE factors significantly predicted PTSD, with `emotional neglect? emerging as the strongest predictor followed by `growing up in a `household with someone who abused alcohol or used street drugs?. Conclusion: The findings of this study support OAT as an effective harm reduction treatment approach in reducing heroin use, HIV risk taking behaviour and criminality among people in OAT. However, evidence was not shown to support OAT in improving mental, physical health and social functioning outcomes among people attending the services. The results suggest that the psychological and mental health needs of this sample of people in OAT are not being fully addressed within the current treatment modality. The results also suggest that given the relationship between PTSD and historical ACEs, psychological well-being and general health, the prevalence of PTSD among this sample may explain the length of time people remain in treatment. Therefore, historical trauma needs to be addressed if service users are to fully recover from opiate addiction. Furthermore, given, that the mean age of participants was 43 years, emotional neglect may be a chronic form of ACE, which affects people?s ability to recover from PTSD and harmful substance use.