Reducing Drug Intake During Treatment for Drug Use Disorder More Challenging Among Young Adults With a History of Trauma

While those with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders, knowledge on the effect of the number of trauma experiences is scarce. In this study the researchers assessed the impact of having experienced multiple potentially traumatic experiences on drug use disorder treatment efficacy.

Despite attending drug use disorder (DUD) treatment, successfully helping young adults who are traumatized actually reduce their substance intake remains uniquely challenging. These findings were published in BMC Psychiatry.

This study analyzed pooled data from 2 clinical trials conducted at the same 9 DUD treatment centers located in Denmark between 2014-2017. Participants (N=775) aged 15-25 years who had contacted a treatment center with intention to receive treatment for a non-opioid use disorders were recruited for these studies. The DUD treatment comprised 12 sessions of manual-based counselling with motivational interviewing and cognitive behavioral therapy. The participants were assessed for cannabis use, psychological well-being, and session attendance.

Participants were 22.7% girls or women, aged mean 20.3 (standard deviation [SD], 2.65) years, and 34.7% had a self-reported psychiatric diagnosis. During the previous month, the participants reported using cannabis 17.6 (SD, 11.34) days, cocaine 1.15 (SD, 3.2) times, ecstasy or MDMA 0.42 (SD, 1.9) times, and engaged in illegal behavior for profit 2.44 (SD, 6.37) days.

Few participants (8.3%) reported having experienced no potentially traumatic events. The disclosed events included threats (63.3%), neglect (58.7%), physical assault (52.1%), bullying (41.3%), severe disease (33.4%), an accident (31.5%), sexual assault (15.9%), and death of a parent or sibling (14.7%).

During treatment, weekly cannabis use decreased significantly (c2[13], 268.1; P <.001) from 4.04 (SD, 2.77) to 2.16 (SD, 2.88) days.

Compared with individuals who had never experienced a traumatic event, those who reported 1-4 types of events (P =.045) or ³5 types of trauma (P =.010) had a higher degree of cannabis use. Although cannabis use declined significantly over the course of treatment, traumatized individuals had a slower decline in use than non-traumatized individuals (1-4: coefficient, 0.19; 95% CI, 0.04-0.33; P =.010; ³5: coefficient, 0.25; 95% CI, 0.09-0.40; P =.002).

Elevated cannabis use was also associated with female gender (coefficient, 1.13; 95% CI, 0.09-0.40; P =.033) and not attending school or having employment (coefficient, 1.32; 95% CI, 0.40-2.24; P =.005).

Individuals who had the most trauma (³5 types) attended more sessions (mean, 7.0; SD, 4.3) than those with no trauma (mean, 6.5; SD, 4.7) or 1-4 types (mean, 6.5; SD, 4.3). However, there was a pattern of attendance over time, in which individuals with no trauma attended more early sessions than other groups and attended fewer later sessions than other groups.

Session attendance associated with individuals with 5-8 types of trauma (adjusted odds ratio [aOR], 0.52; 95% CI, 0.47-0.58; P =0.000), increased age (aOR, 1.18; 95% CI, 1.07-1.29; P =.001), and among girls or women (aOR, 1.82; 95% CI, 1.03-3.19; P =.038).

Well-being increased over the course of treatment and no time by trauma interaction was observed.

This study may have been limited by relying on self-reported traumatic events and use of substances.

These findings indicated young adults who are traumatized were harder to treat for DUD than those who had no history of trauma.


Karsberg S, Hesse M, Pedersen MM, Charak R, Pedersen MU. The impact of poly-traumatization on treatment outcomes in young people with substance use disorders. BMC Psychiatry. 2021;21(1):140. doi:10.1186/s12888-021-03129-x.