Examining Childhood Trauma, Perceived Stress and Treatment Adherence among Drug Addicts
Keywords:
Childhood Trauma, Perceived Stress, Treatment Adherence, Drug AddictionAbstract
Drug addiction remains a prevalent psychological disorder, with its incidence steadily rising, particularly in our society. It is associated with significant morbidity and mortality rates. Both genetic predispositions and environmental factors contribute to the onset of drug addiction. This study investigates key factors such as childhood trauma, perceived stress, and treatment adherence among drug addicts in Pakistan. A comprehensive literature review suggests that stress and traumatic life experiences may significantly increase the likelihood of future drug addiction. This research explores the interplay between these factors, assessing their impact on drug addiction and determining their roles as contributing factors. The study was conducted with a sample of 50 male drug addicts aged 20 to 40 years, selected from rehabilitation centers in Lahore through purposive sampling. The Childhood Trauma Questionnaire – Short Form (CTQ-SF), Perceived Stress Scale (PSS), and Medication Adherence Rating Scale (MARSA) were employed to assess the variables. Statistical analysis was performed using Correlation Analysis via SPSS version 21. The findings indicate that childhood trauma and perceived stress are critical factors influencing treatment adherence among drug addicts. A positive correlation was observed between childhood trauma and perceived stress. Additionally, the results suggest that lower socioeconomic status, unemployment, and relapse are positively associated with perceived stress. However, perceived stress did not emerge as a significant predictor of treatment adherence, and childhood trauma was not a significant predictor of perceived stress.
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Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45(6), 814-822.
https://doi.org/10.1016/j.jpsychires.2010.11.008
Antunes, B., Harding, R., & Higginson, I. J. (2012). Implementing patient-reported outcome
measures in palliative care clinical practice: A systematic review of facilitators and
barriers. Palliative Medicine, 26(3), 216-229. https://doi.org/10.1177/0269216311412982
Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K., ... & Ruggiero, J.
(1994). Initial reliability and validity of a new retrospective measure of child abuse and
neglect. American Journal of Psychiatry, 151(8), 1132-1136.
https://doi.org/10.1176/ajp.151.8.1132
Betz, L. T., Penzel, N., Schrimpf, M., Kroemer, N. B., & Endrass, T. (2021). Childhood trauma
and its relevance for psychopathology and treatment. European Archives of Psychiatry and
Clinical Neuroscience, 271 (5), 743-759. https://doi.org/10.1007/s00406-020-01208-1
Briere, J. (1992). Child abuse trauma: Theory and treatment of the lasting effects. Sage
Publications.
Buka, S. L., Stichick, T. L., Birdthistle, I., & Earls, F. J. (2001). Youth exposure to violence:
Prevalence, risks, and consequences. American Journal of Orthopsychiatry, 71(3), 298–
https://doi.org/10.1037/0002-9432.71.3.298
Carpenter, L. L., Carvalho, J. P., Tyrka, A. R., Wier, L. M., Mello, A. F., Mello, M. F., ... & Price,
L. H. (2009). Decreased ACTH and cortisol responses to stress in healthy adults reporting
significant childhood maltreatment. Biological Psychiatry, 66(7), 678-683.
https://doi.org/10.1016/j.biopsych.2009.05.017
Cohen, L. R., Field, C., Campbell, A. N., & Hien, D. A. (2011). Intimate partner violence outcomes
in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials
Network "Women and Trauma" Multi-site Study. Addictive Behaviors, 36(8), 886-892.
https://doi.org/10.1016/j.addbeh.2011.03.007
Cohen, M., & Densen-Gerber, J. (1982). A study of the relationship between child abuse and drug
addiction in 178 patients: Preliminary results. Child Abuse & Neglect, 6(2), 383–387.
https://doi.org/10.1016/0145-2134(82)90044-X
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal
of Health and Social Behavior, 24(4), 385-396. https://doi.org/10.2307/2136404
Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P., Lenzen, T., Grotegerd, D., ... &
Kugel, H. (2012). Limbic scars: Long-term consequences of childhood maltreatment
revealed by functional and structural magnetic resonance imaging. Biological Psychiatry,
(4), 286-293. https://doi.org/10.1016/j.biopsych.2011.10.021
Diderichsen, F., Andersen, I., & Manuel, C. (2018). Socioeconomic position and variations in
exposure to risks as determinants of health inequalities. Scandinavian Journal of Public
Health, 46(20_suppl), 6-12. https://doi.org/10.1177/1403494817743895
Fink, G., & Bernstein, D. (1994). Stress research at the molecular, cellular, and behavioral level.
Advances in Experimental Medicine and Biology, 364, 1–398. https://doi.org/10.1007/978-
-4615-2455-2
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of
adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect,
(1), 19–28. https://doi.org/10.1016/0145-2134(90)90077-7
Goeders, N. E. (2003). The impact of stress on addiction. European Neuropsychopharmacology,
(6), 435–441. https://doi.org/10.1016/j.euroneuro.2003.08.004
Gordillo, V., del Amo, J., Soriano, V., & González-Lahoz, J. (1999). Sociodemographic and
psychological variables influencing adherence to antiretroviral therapy. AIDS, 13(13),
-1769. https://doi.org/10.1097/00002030-199909100-00021
Hunter, B. A., & Harvey, J. (2021). Associations between socioeconomic status, perceived stress,
and chronic health conditions: A cross-sectional analysis of the Canadian Community
Health Survey. Journal of Community Health, 46(1), 1-11. https://doi.org/10.1007/s10900-
-00874-3
Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000).
Childhood sexual abuse and adult psychiatric and substance use disorders in women: An
epidemiological and co-twin control analysis. Archives of General Psychiatry, 57(10),
–959. https://doi.org/10.1001/archpsyc.57.10.953
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric
disorder in the US National Comorbidity Survey. Psychological Medicine, 27(5), 1101-
https://doi.org/10.1017/s0033291797005588
Kronish, I. M., Edmondson, D., Li, Y., & Cohen, B. E. (2012). Posttraumatic stress disorder and
medication adherence: Results from the Mind Your Heart study. Journal of Psychosomatic
Research, 72(1), 48-53. https://doi.org/10.1016/j.jpsychores.2011.09.004
Lakowski, B., Kessler, R. C., Neighbors, H., & Hobson, S. (2011). Medication adherence and the
role of trauma in people with mental health disorders. Social Psychiatry and Psychiatric
Epidemiology, 46(4), 315-323. https://doi.org/10.1007/s00127-010-0189-4
Lincoln, A. K., Liebschutz, J. M., Chernoff, M., Nguyen, D., Amaro, H., & Earls, F. (2006). The
impact of intimate partner violence on the health of college women. Journal of American
College Health, 55(1), 39–45. https://doi.org/10.3200/JACH.55.1.39-44
McLaughlin, K. A., Sheridan, M. A., Tibu, F., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2014).
Causal effects of the early caregiving environment on development of stress response systems in children. Proceedings of the National Academy of Sciences, 111(9), 5787-5792.
https://doi.org/10.1073/pnas.1312860111
Miranda, R., Meyerson, L. A., Long, P. J., Marx, B. P., & Simpson, S. M. (2002). Sexual assault
and alcohol use: Exploring the self-medication hypothesis. Violence and Victims, 17(2),
–217. https://doi.org/10.1891/vivi.17.2.205.33649
Neilson, E., McDonnell, L., & Carver, C. (2019). Socioeconomic status, stress, and substance use
among young adults: A focus on health disparities. Social Science & Medicine, 230, 1-9.
https://doi.org/10.1016/j.socscimed.2019.03.031
Nelson, E. C., Heath, A. C., Madden, P. A., Cooper, M. L., Dinwiddie, S. H., Bucholz, K. K., ...
& Martin, N. G. (2006). Childhood sexual abuse and risks for licit and illicit drug-related
outcomes: A twin study. Psychological Medicine, 36(10), 1473–1483.
https://doi.org/10.1017/S0033291706008397
Rohsenow, D. J., Corbett, R., & Devine, D. (1988). Molested as children: A hidden contribution
to substance abuse? Journal of Substance Abuse Treatment, 5(1), 13–18.
https://doi.org/10.1016/0740-5472(88)90029-3
Shuring, M., & Robroek, S. J. (2013). Unemployment, stressful life events, and depressive
symptoms: A propensity score matching analysis. European Journal of Public Health,
(6), 956-961. https://doi.org/10.1093/eurpub/ckt042
Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York
Academy of Sciences, 1141(1), 105–130. https://doi.org/10.1196/annals.1441.030
Steptoe, A. (2011). Stress, social support, and the socioeconomic status gradient. Annals of the
New York Academy of Sciences, 1231(1), 37-52. https://doi.org/10.1111/j.1749-
2011.06096.x
Stringhini, S., & Lynch, J. (2010). Socioeconomic status and health: Overcoming the limitations
of traditional indices. Social Science & Medicine, 71(5), 873-880.
https://doi.org/10.1016/j.socscimed.2010.05.024
Thompson, K., Kulkarni, J., & Sergejew, A. A. (2000). Reliability and validity of a new
Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research,
(3), 241-247. https://doi.org/10.1016/S0920-9964(99)00130-9
Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of
cumulative adversity. Journal of Health and Social Behavior, 36(4), 360-376.
https://doi.org/10.2307/2137325
UN Report. (2023). World drug report 2023. United Nations Office on Drugs and Crime.
https://www.unodc.org/unodc/en/data-and-analysis/wdr2023.html
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., ... & Bentall, R.
P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patientcontrol, prospective-and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661-
https://doi.org/10.1093/schbul/sbs050
Zullig, K. J., Valois, R. F., Huebner, E. S., & Drane, J. W. (2013). Socioeconomic status and
perceptions of life satisfaction in adolescents. American Journal of Health Education,
(3), 164-171. https://doi.org/10.1080/19325037.2013.764246
Zweig, J. M., Yahner, J., & Rossman, S. B. (2012). Violence and victimization in lives of female
trauma survivors: A comparison of women who have and have not used substances.
Journal of Interpersonal Violence, 27(13), 2621–2641.
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