Bad news-good news: Each additional ACE increases opioid relapse rate by 17%; each ACE-informed treatment visit reduces it by 2%

Aopioids2Photo by Ian Sheddan via Flickr Creative Commons
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It’s no surprise that serious childhood trauma can lead people to use opioids. In the absence of healthy alternatives and an understanding of how experiences — such as living with a parent who’s alcoholic or depressed, divorce, and being constantly yelled at when you’re a kid — can make your adult life miserable, opioids help many people cope with chronic depression, extreme anxiety and hopelessness.

But a new study has shown the significance of ACEs and ACEs-science-informed treatment: Each additional type of adverse childhood experience increases a person’s risk of relapse during medication-assisted opioid treatment by a whopping 17 percent. And each visit to a clinic that integrates trauma-informed practices based on ACEs science reduced the relapse rate by two percent, which can carry a person perhaps not to zero, but to a minimal risk of relapse.

“This research clearly shows the lasting impact that ACEs (adverse childhood experiences) can have,” says Dr. Karen Derefinko, lead author and assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, and director of the National Center for Research of the Addiction Medicine Foundation. “I think it’s the first research to connect ACEs to relapse.”

Researchers from the University of Tennessee Health Science Center and the University of Memphis also found that more than half (54%) of people in a rural Tennessee opioid clinic relapsed, and the highest relapse rate was on the first visit. Almost half of the 87 people who participated in the study had an ACE score of four or higher — the average was 3.5, which is remarkably high. The study, “Adverse childhood experiences predict opioid relapse during treatment among rural adults”, appears in the September 2019 issue of the journal, Addictive Behaviors, and was published online last week.

Derefinko
Dr. Karen Derefinko

“This study will help practitioners understand the importance of providing trauma-informed treatment,” says Derefinko. “Because of the stigma associated with drug use, it’s hindered health care workers’ understanding of why people use drugs and has led to an assumption that they’re bad people. This shows that trauma-informed care and providing resources does impact how well people can do. It’s also validating for patients and gives them a lot of hope.”

 

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CA announces robust perinatal depression prevention for Medi-Cal recipients

Melinda Coates experienced a tumultuous pregnancy. “I was really mentally upset literally from day one (of the pregnancy),” she says. (Melinda Coates is a pseudonym. To protect her and her children’s privacy and safety, we are not using her real name.)

Coates had hoped to get counseling last October, when she was seven months pregnant. That’s when she enrolled in the state’s Medi-Cal program, shortly after she and her abusive husband moved to California, “but nobody was able to get me in that quickly,” she says. “If I had gotten the help that I needed with my mental state, I may not have stayed in my abusive marriage as long,” she says.

Six weeks after her son’s birth she had one session with a counselor who prescribed an antidepressant. “I was supposed to go back, and I needed to reschedule, but I never heard from her again,” says Coates, who has been living in a domestic violence shelter since the end of June with her eight-month-old son and three-year-old daughter. She is currently separated and filing for a divorce from her husband.

A new policy in California that went into effect in July now makes it possible for pregnant women like Coates to get the counseling they need, according to a recently-released MediCal bulletin.

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