Perspectives on trauma and the design of a technology-based trauma-informed intervention for women receiving medications for addiction treatment in community-based settings

The lived experiences and treatment needs of women with opioid use disorder and posttraumatic stress symptoms: A mixed methods study

“…Women in our sample felt strong societal pressure to follow social scripts, and when not meeting these expectations, feeling shame and low self-worth. These findings are supported by our quantitative findings which showed the highest endorsed desire in an integrated treatment for OUD/PTSD was “ways to manage guilt and shame.” These findings also align with prior work ( Saraiya et al, 2020 ; Valeri et al, 2018 ) and point to the need for more research on shame in women with OUD/PTSS as well as the need to provide compassionate care for such women who feel highly critical of themselves. One study showed that both men and women with substance use disorders endorse shame, but solely women endorse feeling greater stigma and discrimination ( Valeri et al, 2018 ).…”

“…This was one reason why patient participants and providers also expressed a need for more flexible treatment protocols. Unfortunately, flexible protocols will not completely mitigate providers’ experiences of being under resourced and overburdened, which was found in a prior study as well ( Saraiya et al, 2020 ). Systemic changes to interventions alongside public health initiatives that increase support of providers who work with women with OUD/PTSD and the women themselves must work in tandem to achieve long-term change.…”

“…Such providers may be biased to have a high level of access to evidence-based treatment trainings for OUD/PTSD, and thus this small sample of providers may also not generalize to other providers. Nevertheless, prior work has sampled community service providers (e.g., Saraiya et al, 2020 ) and shown similar outcomes. Additionally, in the design of this study, participants were paid less than providers.…”

“…The interview guide for Back et al (2014) and Saraiya et al (2020) was adapted for this study’s interview guide. An expert in co-occurring substance use disorder and PTSD research provided feedback on the initial interview guide followed by final use.…”

“…However, COPE has not been modified for individuals with OUD/PTSS or OUD/PTSD, and stakeholder feedback has not been gathered on how to best modify COPE for those with OUD/PTSS or OUD/PTSD in opioid treatment programs. Prior work has established that women with histories of trauma exposure, PTSS/PTSD, and OUD, have an interest in gender-specific, trauma-focused treatment, but community health care providers felt burdened to deliver such treatments and lacked the necessary resources ( Saraiya et al, 2020 ). This prior work was limited in its lack of assessment of patients’ and providers’ experiences with OUD/PTSS and how an existing intervention, such as COPE, could be modified to increase uptake and receipt.…”