(Withdrawn) Trauma and Craving Among Those Reentering from the Criminal Justice System with Opioid Use Disorder: Treatment Implications

Background and Purpose: Recent research suggests that those with a history of criminal justice system involvement report higher levels of childhood trauma which may be linked to substance dependence and which poses challenges to their adherence to substance dependence treatment. In order to address these challenges, we enrolled adults reentering the community from the criminal justice system who were receiving medication assisted treatment for opioid use disorder (OUD) in a mindfulness intervention in a community clinic. To better tailor our interventions we carried out an extensive preliminary assessment that included questions about trauma history as well as about the ongoing desire to use opioids.

Methods: Thirty-eight participants were enrolled in a baseline interview conducted via video using REDCap software. Adverse childhood experiences were assessed via the ACE questionnaire, where respondents were asked to report on their childhood physical and sexual abuse, exposure to violence, parental loss, trauma and neglect; cumulative scores range from 0 to 10, based on the total number of experiences endorsed. Opioid craving was assessed via a modified version of the Opioid Craving Scale (OCS), a visual analogue scale where respondents were asked to indicate on a scale of 0 to 100 how much they currently craved opiates. We also examined demographic background variables such as age, race ethnicity, education, and gender at birth as covariates in the analysis.

Results: Among the 38 participants enrolled in baseline interviews, most were male (66%), and Latinx (55%) with at least a high school diploma (74%). Participants ranged in age from 29 to 68 years of age and the median age was 42 years. ACE scores were extremely elevated, even relative to other criminal justice samples. The median ACE score was 7, the mode was 8 and over two thirds (68%) reported at least 8 events. Four participants reported all 10 events while only 3 participants reported no events at all. Given the negative skew of the ACE scores, we analyzed the measure as a dichotomy with scores lower than 8 contrasted with those 8 and above. OCS scores ranged from 0 to 82, with a median of 10. The modal value, endorsed by 14 respondents, was 0. Accordingly, after taking the square root of OCS scores (to normalize the variable), we regressed this on the dichotomous ACE measure, controlling for race/ethnicity, gender, education and age. The model, which generated an R² of 0.39, suggested that those endorsing 8 or more ACEs had significantly elevated OCS scores (b= 2.403; s.e.=.94; p <.02).

Conclusions and Implications: Our data suggest that adverse childhood experiences are particularly salient and extremely elevated for those reentering from the criminal justice system who also present with OUD. The links between extremely elevated trauma and reports of ongoing craving for opioids in a group that is currently receiving medication assisted treatment underscore the importance of designing programs that focus not just on treating dependence, but also on addressing the persistent sequela of trauma impacting ongoing everyday experience, possibly adversely impacting adherence and long-term treatment outcomes.