Childhood Emotional Abuse Tied to Adult Opioid Addiction

[Chip (OP)]

source: https://www.medscape.com/viewarticle/877628

Childhood Emotional Abuse Tied to Adult Opioid Addiction

Childhood Maltreatment Common in Opioid Users

People who misuse opioids often report extensive histories of childhood maltreatment, which includes emotional and physical abuse, emotional and physical neglect, and sexual abuse.

Negative and positive urgency are both impulsivity-related traits involving rash action taken under conditions of negative or positive affect, respectively.

"The literature on how these impulsivity traits are related to opioid use and SRP lags behind the study of other substances," the authors write.

Childhood maltreatment and urgency are both associated with PTSD, and PTSD is associated with more severe substance-related impairment and poorer response to treatment of substance use disorder.

"People who have a tendency to lash out make bad choices when upset, which contributes to worse PTSD symptoms, leading to increased substance use," he added.

The researchers were surprised about the important role of emotional abuse.

"In physical abuse, it is easier to recognize that the perpetrator is at fault. But in emotional abuse, the perpetrator attacks the victim's character. 'You're stupid, you're an idiot.' The victim internalizes the message and feels at fault, making emotional abuse more insidious than physical abuse," said Dr Price.

This insight has important clinical implications. "Therapeutic strategies successfully used for physical or sexual abuse are less effective in those who have been emotionally abused," Dr Price added.

Need for Concurrent Treatment

Commenting on the findings for Medscape Medical News, Lynn Webster, MD, vice president of scientific affairs at PRA Health Sciences, Raleigh, North Carolina, and past president of the American Academy of Pain Medicine, said the study authors are to be "congratulated on tackling the difficult task of correlating childhood experiences with the risk of opioid disorder.

"The study is informative and should lead to a better understanding of what drives substance abuse in general," said Dr Webster.

"These findings illustrate that there are profound emotional issues that may be far more important risk factors than opioid dose or number of pills prescribed," said Dr Webster, who was not involved with the study.

Dr Price agreed that emotional problems should receive greater focus in substance abuse treatment.

"The common wisdom is to work sequentially, first addressing the substance abuse and then addressing mental health, but this approach is misguided. Our study suggests that the impulsivity and PTSD resulting from early emotional abuse can be pathways to substance abuse, so mental health problems should be addressed in concert with substance issues," he said.

This is an edited version. Technical data can be seen at the source link.