Is exposure to childhood maltreatment associated with adult psychological distress among adult intravenous drug user?

The Cedar Project: exploring the role of colonial harms and childhood maltreatment on HIV and hepatitis C infection in a cohort study involving young Indigenous people who use drugs in two Canadian cities

OBJECTIVES

This study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs.

DESIGN

The Cedar Project is a cohort involving young Indigenous people who use drugs in British Columbia (BC), Canada. Indigenous collaborators, collectively known as the Cedar Project Partnership, govern the entire research process.

SETTING

Vancouver is a large city on the traditional territory of the Coast Salish peoples. Prince George is a mid-sized city, on the traditional territory of Lheidli T'enneh First Nation.

PARTICIPANTS

420 participants completed the Childhood Trauma Questionnaire and returned for follow-up from 2003 to 2016.

PRIMARY/SECONDARY OUTCOME MEASURES

Primary outcomes were HIV and HCV infection over the study period. Secondary outcomes included sex and substance use-related risks.

RESULTS

Prevalence of childhood maltreatment was 92.6% experienced any maltreatment; 73.4% experienced emotional abuse; 62.6% experienced physical abuse; 60.3% experienced sexual abuse; 69.5% experienced emotional neglect and 79.1% experienced physical neglect. We observed significant associations between childhood maltreatment and apprehensions into residential schools and foster care. All maltreatment types were associated with higher odds of sex/substance use-related risks; sexual abuse was associated with higher odds of HCV infection (adjusted OR: 1.67; 95% CI 1.05 to 2.66; p=0.031).

CONCLUSIONS

Findings reflect high prevalence of childhood maltreatment and their associations with HIV/HCV risk and HCV infection. Public health prevention and treatment initiatives must be trauma informed and culturally safe to support healing, health, and well-being.

Prevalence of childhood trauma measured by the short form of the Childhood Trauma Questionnaire in people with substance use disorder: A meta-analysis

BACKGROUND

Substance use disorder is known to be associated with childhood trauma, yet prevalence estimates have varied markedly due to methodological differences. The meta-analysis presented here aimed to estimate prevalence rates of childhood trauma for people with substance use disorder using the short form of the Childhood Trauma Questionnaire (CTQ-SF).

METHODS

Four major public databases (PubMed, Embase, The Cochrane Library and PsycINFO) were searched for eligible studies until April 2nd, 2018.

RESULTS

Ten studies were included with a total sample size of 1,310 across six countries. The prevalence estimates of each subtype of childhood trauma across all substance use disorder samples were: emotional abuse (38%, 95% CI: 28%-48%); physical abuse (36%, 95% CI: 27%-45%); sexual abuse (31%, 95% CI: 23%-41%); emotional neglect (31%, 95% CI: 18%-45%) and physical neglect (32%, 95% CI: 25%-40%). Subgroup analysis by continent demonstrated that the highest prevalence rates of emotional abuse were found in North America and South America (45%). Compared with other continents, the prevalence rates of North America were the highest for physical abuse, sexual abuse, emotional neglect and physical neglect (39%-44%).

CONCLUSIONS

Childhood trauma is prevalent among substance use disorder samples compared to the general population. Different continents have different levels of prevalence of childhood trauma, which may be due in part to socioeconomic, cultural and definitional variations.

History of parenting instability and lifetime suicidal behavior in people who inject drugs

Despite high rates of suicide in people who inject drugs, little is known about the risk factors for suicide related to childhood and family history in this population. We aimed to explore the relationship between the history of out-of-home care (OHC) and lifetime suicide attempts among people who inject opioids. Participants (N = 202) were current injection opioid users with at least one previous episode of opioid maintenance treatment. They were recruited into a double-blind randomized controlled trial for opioid substitution treatment. Secondary analysis of baseline data was conducted from the European Addiction Severity Index and basic demographics questionnaires. A total of 81 (40%) participants reported a history of living in OHC and 27% reported attempting suicide. Participants who reported living in OHC were more likely to report lifetime suicide attempts compared to those who did not live in OHC. History of OHC and suicidal ideation were significant risk factors for suicide attempts adjusting for depression and anxiety. Highest rates of lifetime attempts were among participants who lived in a group home, foster care, and/or psychiatric facility. Living in OHC during childhood was significantly associated with higher rates of suicide attempts in our sample. Greater efforts should be made to provide children from vulnerable families with environments where stable one-to-one relationships can be cultivated.

Utilizing resources of neuropsychopharmacology to address the opioid overdose crisis

BACKGROUND

North America is facing a severe public health crisis in the form of excessive numbers of deaths due to overdose from self-administration of opioids by individuals who are dependent on these substances.

AIMS

There are many factors that must be addressed in order to gain control over this tragedy. Of particular relevance to neuropsychopharmacology is the fact that the problem is due in part to misuse of pharmaceuticals and especially the illicit production of the powerful synthetic opioids, fentanyl, and carfentanil.

METHOD

The development and adoption of appropriate pharmacotherapies are of critical importance. We discuss specific options to deal effectively with both withdrawal from opioid dependence and substitution of clinically approved drugs in place of illicit substances.

CONCLUSION

Hopefully, this crisis will reinvigorate both basic and clinical neuropsychopharmacological research leading to the develop new and more effective options for dealing with the many and varied elements of the current opioid crisis as described in the present commentary.