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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Nursing

Year Degree Awarded

2019

Month Degree Awarded

February

First Advisor

Lisa Chiodo

Second Advisor

Raeann Leblanc

Third Advisor

Elizabeth Evans

Subject Categories

Behavioral Disciplines and Activities | Counseling Psychology | Criminology | Medicine and Health | Mental Disorders | Other Pharmacy and Pharmaceutical Sciences | Psychiatric and Mental Health | Psychiatric and Mental Health Nursing | Public Health and Community Nursing | Substance Abuse and Addiction | Women's Health

Abstract

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4th of the sample had a history of involvement in the criminal justice system. All individuals in the sample were treated with buprenorphine and were expected to participate in both individual and group meetings related to their treatment.

Patients with a history of PTSD and trauma were more adherent with buprenorphine, but also more likely to use opioids than those without PTSD or trauma. Those with CJS involvement were more medication adherent and less likely to use opioids than those without a CJS involvement. All three risk groups were found to have significant difficulty meeting other treatment visit compliance measures such as attendance to individual and group visits, had overall higher rates of total number of encounters, and were more likely to cancel their visits. PTSD and trauma moderated the relationship between CJS history and medication adherence and CJS history and opioid use. PTSD and trauma moderated the relationship between CJS history and other compliance indicators (e.g., number of initial visits and number of induction visits). Gender also moderated some of the relationships examined with women having more no-show visits, rescheduled visits more often and had higher rates of overall number of encounters. Women in particular failed to attended scheduled individual and group treatment sessions and spent more time in care. Women also had higher rates of PTSD and trauma.

The results have implications for clinicians caring for patients with OUD and patients with a history of incarceration. Assessing for and acknowledging trauma will allow those clinicians to implement patient-centered, trauma informed treatment models to deliver focused care to these specific populations that are struggling to meet treatment compliance measures.

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