Comiskey, Catherine

de Vries, Han

McDonagh, David

National Documentation Centre on Drug Use

David McDonagh BA (Hons), Grad MII, PhD Candidate Professor Catherine Comiskey BA (Mod), MA, MSc, PhDDr Jan de Vries BA, MSc, PhD Lisbon Addictions 2022The role of Adverse Childhood Experiences (ACEs) on People in Opiate Agonist Treatment: The importance of feeling unlovedAgendaIntroduction & BackgroundMethodologyPTSD and ACEsFindingsConclusions & DiscussionThe authors declare no conflict of interest related to this presentationTrinity College Dublin, The University of DublinOpiate Agonist Treatment in Ireland➢ Approximately 21,000 individuals have an opiate use disorder (Health Research Board 2019) o 10,316  in Opiate Agonist Treatment (OAT) (2017 estimate), (Delargy, Crowley & Van Hout, 2019)o 60% attend specialised treatment centres with 40% attending community GP and pharmacy services ➢ Methadone is the most common treatment for opiate use disorder in Ireland (>95%)• Number of years an individual remains in treatment is usually very long (Comiskey, et al. 2018)Trinity College Dublin, The University of DublinBackground for the current study • Baseline study in 2017 collected data on treatment outcomes and service users' experiences of their current treatment (n = 131)• The Study Aim was to explore whether the current Nursing model was meeting clients needs and provide recommendations (Comiskey at al. 2018; Comiskey at al. 2019)➢ People openly talked about they’re chaotic childhoods growing up; particularly, neglect, abuse and household dysfunction. These data not collected as part of the study.➢ A follow up study was recommended by the research team to measure trauma and adverse childhood experiences among this cohort.Trinity College Dublin, The University of DublinMethodology: Cross-sectional Follow up Study Questionnaires utilised in this study✓ Demographic questionnaire✓Opiate Treatment Index, (Drake el .al 1992)❖10 item Adverse Childhood Experiences Questionnaire, (Centers for Disease Control and Prevention, https://www.cdc.gov)❖20 item PCL-5, Self report measure of current PTSD. (National Center for PTSD, https://www.ptsd.va.gov)❖ = Added for the follow-up studyParticipants: 104 participants re-interviewed (Female, n= 38: Male, n= 66)Trinity College Dublin, The University of Dublin• Mean age 42 years (Females 39 years; Males 44 years)• Average time in current treatment: 11 years (Range: 3 months to 27 years) (62% ≥ 2nd Treatment)➢ Harm reduction➢ Low levels of heroin use➢ Low levels of HIV risk taking and injecting behaviour➢ Very low incidents of criminality➢ Daily use: Cannabis (38%); Tranquillisers (63%). ➢ Weekly use: Alcohol (31%); Crack cocaine (19%). Treatment FindingsTrinity College Dublin, The University of Dublin➢ 55% of people reported 4 or more ACEs (23% had an ACE score of  ≥ 7)➢ PTSD mean score was 30 (Female = 37; Male = 26; p= .010).❖ Scores ≥ 31 to 33, are considered appropriate for a PTSD diagnosis. (Bovin et al., 2015).❖ 45% of people had trauma scores ≥ 31❖ 40% of people had trauma scores ≥ 33➢ Psychological wellbeing almost two times poorer than the general population ❖ Sample mean GHQ-28  score  = 7 (Female = 9; Male =6)PTSD & ACE FindingsTrinity College Dublin, The University of DublinFindings: Adverse Childhood ExperiencesA C E 1 A C E  2 A C E  3 A C E  4 A C E  5 A C E  6 A C E  7 A C E  8 A C E  9 A C E  1 056.3%60.2%63.7%64.1%73.8% 59.2%64.1%40.8%55.3%54.4%43.7%39.8%36.3%35.9%26.2% 40.8%35.9%59.2%44.7%45.6%No YesVerbal AbuseFeeling UnlovedAlcohol or DrugsMental IllnessPhysical AbuseSexual AbusePhysicalNeglectLost ParentMother AbusedPrisonTrinity College Dublin, The University of DublinAdverse Childhood Experiences & PTSDTable 6.8.1: Chi square analysis for the association of PTSD and ACEs factors ACE question      d f n X2 p ACE 1. Push grab of slap or throw something at you # 1 103 18.5377 <.001*** ACE 2. Swear at you insult or put down # 1 103 25.308 <.001*** ACE 3. Touch or fondle you or have you touch them in a sexual way 1 102 6.624 .010** ACE 4. Nobody loved you/ thought you were important # 1 103 29.12247 <.001*** ACE 5. Feel that you didn’t have enough to eat, wear dirty clothes  1 103 5.176 .023* ACE 6. Lost a biological parent 1 103 10.321 .001** ACE 7. Mother ever pushed grabbed slapped of repeatedly hit # 1 103 13.874 <.001*** ACE 8. Lived with a problem drinker or used street drugs # 1 103 20.609 <.001*** ACE 9. Household member depressed or had a mental illness # 1 103 17.0669 <.001*** ACE 10. Did household member ever go to prison 1 103 .546 .460 ns Significance levels: * p <.05: ** p < .01: *** p < .001: ns = not significant # Factors chosen for regression analysis   Trinity College Dublin, The University of DublinResults: ACE Predictors of Acute Trauma ACE predictors of PTSDAnalysis showed four ACEs explained 54% of the variance in PTSD scores (R2 = .54, F (4, 98) = 30.285, p < .001***),The feeling they were unloved as a child was found to be the strongest  predictor of PTSD explaining 34% of the variance in PTSD scores A significantly higher proportion of women (54.1%) felt unloved as children than men (25.8%); (X2 = 8.25, p =.004**). Feeling Unloved, 34%Living with problem drinker, 12%Verbal Abuse, 5%Household mental illness, 3%Unexplained, 46%Trinity College Dublin, The University of DublinOAT is effective in retaining and maintaining people in OATAging cohort; mean age 42 yearsUp to 40% of people in OAT at risk of PTSDChildhood emotional neglect was found to be a significant  predicting of PTSD among the subjects of this studyScreening all service users for ACEs Trauma Informed treatment serviceConclusions & DiscussionTrinity College Dublin, The University of DublinReferencesBovin, M., Marx, B., Weathers, F., Gallagher, M., Rodriguez, P., Schnurr, P., & Keane, T. (2015). Psychometric Properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in Veterans. Psychological assessment, 28. doi:10.1037/pas0000254Centers for Disease Control and Prevention. (2016). About Adverse Childhood Experiences. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/about_ace.htmlComiskey, C., Galligan, K., & McDonagh, D. (2018). Developing an Addiction Nursing Model: An exploratory study examining the evolving role of the nurse and development of a relevant framework for practice within the addiction services. Unpublished. Trinity College Dublin. Dublin. Comiskey, C., Banka, S. P., McDonagh, D., & Galligan, M. K. (2021). Co-Design of a CityWide Pilot Anti-Stigma Training Programme.Darke, S., Hall, W., Wodak, A., Heather, N., & Ward, J. (1992). Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. British Journal of Addiction, 87(5), 733-742. doi:10.1111/j.1360-0443.1992.tb02719.xDelargy, I., Crowley, D., & Van Hout, M., C. (2019). Twenty years of the methadone treatment protocol in Ireland: reflections on the role of general practice. Harm Reduction Journal, 16(1), 5-5. doi:10.1186/s12954-018-0272-4Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study>. PEDIATRICS, 111(3). Health Research Board. (2019). National Drug‐Related Deaths Index 2004 to 2016 Data. Retrieved from Dublin: https://www.hrb.ie/fileadmin/2._Plugin_related_files/Publications/2019_Publication_files/2019_HIE/NDRDI/National_Drug-Related_Deaths_Index_2004_to_2016_data.pdfKhantzian EJ. The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard review of psychiatry. 1997;4(5):231-44.McLaughlin, K. A., Koenen, K. C., Bromet, E. J., Karam, E. G., Liu, H., Petukhova, M., . . . Kessler, R. C. (2017). Childhood Adversities and Post-traumatic Stress Disorder: Evidence of Stress Sensitisation in the World Mental Health Surveys. The British Journal of Psychiarty. doi:10.1192/bjp.bp.116.197640National Center for PTSD. (2019). PTSD Basics. Retrieved from https://www.ptsd.va.gov/understand/what/ptsd_basics.aspVink, R. M., van Dommelen, P., van der Pal, S. M., Eekhout, I., Pannebakker, F. D., Velderman, M. K., . . . Dekker, M. (2019). Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education. Child Abuse & Neglect, 95, 104051. Thank You

The role of adverse childhood experiences (ACEs) on people in opiate agonist treatment: the importance of feeling unloved.

https://www.drugsandalcohol.ie/38363/1/EMCDDA_David_McDonagh_The_role_of_Adverse_Childhood_Experiences.pdf

The role of adverse childhood experiences (ACEs) on people in opiate agonist treatment: the importance of feeling unloved.

Abstract

Similar works

Full text

Available Versions

National Documentation Centre on Drug Use