Background: Adults in opiate agonist treatment (OAT), often have a background of adverse childhood experiences (ACEs) and more likely to be exposed to a variety of risks that may trigger current post-traumatic stress disorder (PTSD). Summative ACEs scores are often used to identify individuals at risk of PTSD and continued drug use. What has not been addressed is whether specific ACE factors are exerting more or less influence on the individual. The study investigated whether specific ACEs predicted current PTSD, and current continued drug use among adults in OAT treatment

Methods: The study consisted of a 2-year follow-up survey of adults receiving OAT (n=111) recruited from six treatment centres in North Dublin. Of the original group interviewed 2 years earlier (n=131) 85% were included. The survey consisted of the following instruments: Adverse Childhood Questionnaire (ACQ); PTSD checklist (PCL-5); and Opiate Treatment index (OTI), included measures for general health, psychological wellbeing, social functioning, and drug use in the previous 28 days.

Results: A summated ACQ score predicted the occurrence of PTSD later in life among adults receiving OAT. Further analysis showed that four specific ACEs (verbal abuse, feeling unloved, living with a person who had a mental illness or who had a problem with alcohol or used street drugs) predicted current PTSD separately, with feeling unloved the strongest predictor.

Conclusions: The findings suggest that an overarching traumatic aspect such as feeling unloved may exacerbate the stress experienced in childhood resulting from other specific ACEs and reduce resilience to PTSD later on in life. Therefore, a summative approach to ACEs may be insufficient to understand their impact later in life. The findings of this study suggest that treatment services should be cognisant of individuals with histories of childhood abuse and neglect, specifically possible attachment problems related to having felt unloved in childhood.