Browsing by Subject "Adverse childhood experiences"

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    Adverse childhood experiences, insecure attachment, and appointment compliance in an outpatient addiction psychiatry treatment population
    (Wiley, 2025) Chambers, Joanna E.; Perkins, Susan M.; Mosesso, Kelly M.; Ahdoot, Azziza; Arnaudo, Camila L.; Chambers, R. Andrew; Psychiatry, School of Medicine
    Background and objectives: Suffering adverse childhood experiences (ACEs) increases the probability of developing adult mental illness, addictions, and insecure attachment. This study determined how ACEs and insecure attachment are associated with each other, and how they may predict treatment engagement in an integrated dual diagnosis treatment clinic. Methods: A sample of n = 264 patients entering a university-affiliated addiction psychiatry clinic underwent diagnostic intakes supplemented by assessments of attachment styles (Anxious/Avoidant, using the 36-item Experiences in Close Relationships-Relationship Structures (ECR-RS) scale) and childhood adversity (10-item Adverse Childhood Experiences Questionnaire (ACE-Q) scale). Compliance with psychotherapy versus medication appointments was tracked for 6 months post intake. Results: ACE-Q scores (median of 4) were significantly associated with higher anxious and avoidant attachment scores and the number of mental health diagnoses. Only one in five patients obtained 75% or higher compliance rates with psychotherapy; two in five achieved 75% or higher compliance with medication appointments. Greater anxious attachment predicted lower show rates for both psychotherapy and medication appointments, whereas greater avoidant attachment predicted lower compliance for psychotherapy only. Discussion and conclusions: This study confirms the linkage of ACEs and insecure attachment patterns in dual-diagnosis patients seeking integrated addiction psychiatry care. Insecure attachment patterns differentially predicted lower appointment compliance, particularly for psychotherapies. Scientific significance: Childhood trauma and associated adult attachment dysfunction warrant further investigation not only as causes and correlates of mental illness and addiction but also for improving treatment engagement, therapeutic attachments, and recovery outcomes.
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    Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative
    (Springer, 2023) Ahrens, Kym; Blackburn, Natalie; Aalsma, Matthew; Haggerty, Kevin; Kelleher, Kelly; Knight, Danica K.; Joseph, Elizabeth; Mulford, Carrie; Ryle, Ted; Tolou-Shams, Marina; Pediatrics, School of Medicine
    Youth involved in the legal system (YILS) experience rates of opioid and substance use disorders (OUD/SUDs) and overdose that is well above those in the general population. Despite the dire need, and the existing programs that focus on treatment of these problems in YILS, research on opioid initiation, and OUD prevention, including feasibility and sustainability, are severely limited. We present four studies testing interventions that, while not necessarily novel as SUD treatments, test novel structural and interpersonal strategies to prevent opioid initiation/OUD precursors: (1) ADAPT (Clinical Trial No. NCT04499079) provides real-time feedback using community-based treatment information system data to create a more effective mental health and SUD treatment cascade to prevent opioid use; (2) HOME (Clinical Trial No. NCT04135703) provides youth experiencing homelessness, including YILS, with direct access to shelter in independent living without prerequisites as an opioid initiation prevention strategy; (3) LeSA (Clinical Trial No. NCT04678960) uses the Trust-Based Relational Intervention® to equip YILS and their caregivers with self-regulatory and communication skills during the transition from secure confinement to reduce opioid initiation/re-initiation; and (4) POST (Clinical Trial No. NCT04901312) tests two interventions integrating interpersonal/drinking and drug refusal skills, case management, and goal setting among YILS in transitioning out of secure detention as opioid initiation prevention strategies. We discuss early implementation barriers and facilitators, including complexities of prevention research with YILS and adaptations due to COVID-19. We conclude by describing anticipated end products, including implementation of effective prevention interventions and integration of data from multiple projects to address larger, multi-site research questions.