“I was 15 when I started doing drugs with my dad”: Victimization, Social Determinants of Health, and Criminogenic Risk Among Women Opioid Intervention Court Participants

Abstract

The presence and severity of childhood and adult victimization increase the likelihood of substance use disorder (SUD), crimes, antisocial behaviors, arrests, convictions, and medical and psychiatric disorders among women more than men. These problems are compounded by the impact of social determinants of health (SDH) challenges, which include predisposition to the understudied, dramatic increase in opioid dependence among women. This study examined victimization, related SDH challenges, gender-based criminogenic risk factors for female participants, and public health opportunities to address these problems. We recruited women from the first national Opioid Intervention Court, a fast-track SUD treatment response to rapidly increasing overdose deaths. We present a consensual qualitative research analysis of 24 women Opioid Intervention Court participants (among 31 interviewed) who reported childhood, adolescent, and/or adult victimization experiences in the context of substance use and recovery, mental health symptoms, heath behaviors, and justice-involved trajectories. We iteratively established codes and overarching themes. Six primary themes emerged: child or adolescent abuse as triggers for drug use; impact of combined child or adolescent abuse with loss or witnessing abuse; adult abduction or assault; trajectory from lifetime abuse, substance use, and criminal and antisocial behaviors to sobriety; role of friends and family support in recovery; and role of treatment and opioid court in recovery, which we related to SDH, gender-based criminogenic factors, and public health. These experiences put participants at risk of further physical and mental health disorders, yet indicate potential strategies. Findings support future studies examining strategies where courts and health systems could collaboratively address SDH with women Opioid Intervention Court participants.

The lived experiences and treatment needs of women with opioid use disorder and posttraumatic stress symptoms: A mixed methods study

“…Namely, patient participants reported wanting a therapy with ways to manage feelings of guilt and shame, chronic pain, and anger in addition to learning how to approach things they avoid in daily life (i.e., in vivo exposures) significantly more than providers. Our findings align with the findings from prior qualitative studies ( Greenfield, Cummings, Kuper, Wigderson, & Koro-Ljungberg, 2013 ; Morse et al, 2022 ) thereby supporting the evidence base on how integrated trauma-focused treatments need to be modified for this special population.…”

“…Women reported emotional trauma and divorce as painful and distressing, often more so than their Criterion A traumas, such as sexual assault. Others have found similar findings showing that adverse childhood experiences, general stress, namely household dysfunction, divorce, and emotional abuse, have felt distressing to women using opioids and triggered future opioid misuse ( Chatterjee et al, 2018 ; Martin et al, 2023 ; Morse et al, 2022 ; Saraiya et al, 2021 ). These findings suggest that treatments for women with OUD/PTSD may need to consider women with other trauma types which would not qualify for the PTSD diagnosis and sub-threshold PTSS which may be left untreated due to lack of formal diagnosis.…”