Researchers at the University of Vermont (UVM) have found a correlation between emotional abuse endured during childhood with future opioid use as an adult.
Matthew Price, Ph.D., professor in the department of psychological science at UVM and lead author, explained that the study involved 84 Vermont adults who presented with substance use problems.
The researchers used the PTSD Checklist (PCL5) as an assessment tool and the UPPS Impulsive Behavior Scale to measure impulsivity. They also administered the Child Trauma Questionnaire (CTQ), which evaluates different types of maltreatment, including emotional, physical and sexual abuse and emotional neglect.
The goal was to account for impulsivity or “negative urgency,” which is the “willingness to engage in rash behavior when a person is upset and is associated to PTSD,” according to Price.
“It’s helpful to understand why emotional abuse is more salient [than sexual or physical abuse]. When a family speaks critically to an individual or they’re not supportive, it causes emotional regulation problems as adults. [These individuals] have more significant psychopathology and use maladaptive behavior. They have no appropriate coping mechanisms to negative experiences,” Price said.
“However, being maltreated is not a one-to-one correlation to using substance abuse, although there is a fair amount of overlap. It’s more of a risk factor.”
Emotional abuse is just one of many risk factors for potential opioid use later in life, Price explained. “Some [study subjects] came from low socio-economic backgrounds or had a family member who had problems with substance abuse. In some cases, there were inconsistent adults in their life as a child,” he said.
Following the study, Price and his colleagues determined that an integrated intervention strategy would provide the most effective treatment option. COPE (Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure), integrated cognitive behavioral psychotherapy, is one intervention that addresses PTSD while helping the person maintain sobriety.
“When you address mental health and substance use problems, mental health may be a stronger driver of the substance use. It’s not completely one directional,” he said. “We found that PTSD was associated with substance use problems, but when you flip it we found no support. The weaker relationship finds that substance use further contributes to mental health. When you try to reduce substance use, if there’s no addressing mental health that contributes to substance use, you will be unsuccessful.”
Price cited anecdotes that show study participants who have reached a level of abstinence might relapse when they experience negative feelings and the opportunity to reuse appears.
In an effort to prevent a relapse, he and his colleagues are currently conducting an experimental study to determine if intervention might help “reduce the likelihood of engaging in rash behavior when the person is upset.”
He said, “If we can find a way to cause better emotional control and regulation, then we’ll translate it to a mobile app. In-person regular sessions with a trained counselor is the best [therapy]. But we also know it’s challenging. When you’re feeling distressed at 2 a.m., you can’t call your therapist. We want to give patients a tool on their phones. It might be a really good way to help.”