Understanding the impact of trauma among people who use drugs
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Researchers from Monash Addiction Research Centre and Turning Point have identified high rates of complex trauma that may create barriers to treatment among people who use supervised injecting facilities.
Supervised injecting facilities save lives in more ways than you’d expect.
Not only do these services provide vital care in the event of an overdose, they also support people who use opioids to manage chronic pain or trauma, and act as a gateway to further help. Medical care, housing assistance, mental health support and essential opioid pharmacotherapy treatment are all examples of the vital services they provide.
Accessing these lifesaving services, however, can be a challenge for the people who need them most.
New research from Monash Addiction Research Centre and Turning Point has examined why people struggle to access the services that could help them.
Conducted as part of the Review of the Medically Supervised Injecting Room Trial, this study identified high rates of complex trauma that can create barriers to treatment among people who use supervised injecting facilities.
“We already know that high rates of post-traumatic stress disorder (PTSD) among people who inject drugs can adversely affect health outcomes and create barriers to engaging with services,” explains the study’s lead author, Research Fellow Dr Ali Cheetham.
“People who use drugs often have nowhere else to turn. They face stigma, discrimination, and exclusion from traditional healthcare settings,” she adds.
Supervised injection facilities are one of the few accessible and non-judgmental points of contact with the health system for people who inject drugs.
To better understand how to improve access to care among people who often fall through the cracks, the researchers examined the prevalence of PTSD and complex PTSD (C-PTSD) among people who attend the Melbourne Supervised Injecting Room, and the ways that symptom severity might relate to perceived barriers to alcohol and drug treatment.
What did the study find?
“Our research identified high rates of both lifetime trauma exposure and symptoms of current PTSD among people attending the facility,” Dr Cheetham says.
Ninety per cent of all respondents had experienced at least one traumatic life event.
“C-PTSD is a condition marked by difficulties in emotional regulation, self-worth and interpersonal relationships and was found to significantly impact how people engage with services,” Dr Cheetham says.
Concerns about privacy, time constraints and perceived limits on service availability were all examples of the barriers that prevent people from accessing the facilities that could help them.
“Many survey respondents had also experienced negative interactions with healthcare providers or the criminal justice system, which may make them wary of disclosing personal information,” Dr Cheetham says.
Women, in particular, were more likely to report multiple traumatic experiences and perceived additional challenges accessing care, including heightened stigma, housing instability and financial hardship.
For such a highly marginalised population with significant exposure to trauma, Dr Cheetham suggests that building a sense of trust and meeting basic needs such as food and shelter may better position people who need care to feel able to engage in treatment.
Next steps
According to Dr Cheetham, further research to better understand the relationships between trauma and barriers to treatment could inform the development of tailored interventions and staff training programs that better support their service users’ unique needs.
“Rather than simply recognising trauma exposure as a singular concept, distinguishing between PTSD and C-PTSD and understanding their impact on relationships could guide practical decisions about service intensity, referral pathways, and the most effective types of wrap-around supports,” Dr Cheetham says.
In doing so, services could improve engagement with both addiction treatment and trauma recovery services among the people who need them most.
“Providing staff with ongoing training informed by principles of trauma-informed care is also vital,” Dr Cheetham says. “As is fostering a supportive environment that prioritises staff wellbeing, in the face of vicarious trauma and burnout risks.”
“These findings highlight the importance of understanding the prevalence and impact of trauma among people who turn to substances to help them cope, not just to treat the substance use disorder, but also to heal the deep wounds that often lie beneath it,” she says.
Read the paper: Complex trauma and perceived barriers to treatment among people accessing a supervised injecting facility
About Monash University
Monash University is Australia’s largest university with more than 80,000 students. In the 60 years since its foundation, it has developed a reputation for world-leading high-impact research, quality teaching, and inspiring innovation.
With four campuses in Australia and a presence in Malaysia, China, India, Indonesia and Italy, it is one of the most internationalised Australian universities.
As a leading international medical research university with the largest medical faculty in Australia and integration with leading Australian teaching hospitals, we consistently rank in the top 50 universities worldwide for clinical, pre-clinical and health sciences.
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