Learning from Women with Opioid Use Disorder

Childhood traumas, such as sexual and physical abuse, an incarcerated parent or food insecurity, can lead to substance abuse disorder in adults. But what does it really mean for women who have experienced trauma as children, when they become mothers?

In order to better understand mothers with opioid use disorder, researchers partnered with women in treatment for opioid use disorder who were participating in a mindfulness meditation research study. (Read about one woman’s journey through the program.) The study aims to inform better treatment for women with opioid-use disorder.

“Mothers experiencing opioid use disorder are resilient, but have to parent under many stresses,” says Diane Abatemarco, PhD, Director of Jefferson’s Maternal Addiction Treatment Education & Research (MATER) program. “A better understanding of childhood experiences in this population is extremely important. It serves to build compassion and create space for healing.”

We spoke with one of the study’s authors, Meghan Gannon, PhD, who worked with mothers in treatment for OUD at the MATER program. We asked her about her research, what she learned, and how it can change how moms are treated.

What were you hoping to learn in this study? Why was it important to look traumas experienced by women with more granularity?

The ACE tool is used to determine the exposure to adverse events a person had experienced as a child. In a landmark study from the CDC and Kaiser Permanente, researchers showed that exposure to adverse childhood experiences (ACEs) were linked to negative health outcomes. In fact, the higher the ACE score -- meaning the more experiences of trauma a child experiences – the more likely that person would develop negative health outcomes,  later in life. But there’s other elements of that survey – those which look more closely at the household characteristics, things like divorce, having to move many times, food insecurity, parents who have been incarcerated, and others – that paint a fuller picture of childhood adversity and trauma and fuller picture of what trauma entails.  Most people think of trauma as just physical abuse or sexual abuse, but it can encompass a lot more than that.

These additional details can be incredibly useful in helping design therapy and interventions that do not re-traumatize women, as we help teach strategies to cope with their past while learning to break the cycle of intergenerational trauma. The better we can understand a life of someone who is in treatment for substance use disorder, the more we can de-stigmatize it. There’s a lot of work that needs to be done in reducing the stigma around those in treatment.

What did you find in the study that surprised you?

We were most surprised at how young the women in our study experienced trauma and the number of those who had attempted suicide. It was much younger than other studies have reported. Of the 152 women in our study sample, 32% had reported an attempt at suicide as a child. It’s just so high.  Those numbers really sat with us as a study team.

In earlier studies, the mean age at first trauma was reported at 9.46 years. In our paper women reported traumas as early as 6 years of age, with a range of 6-10 years.

The ACE burden in our sample was also very high, mean ACE was 4.3. When you compare it to a general sample of data of females in PA, their mean ACE reported is 1.4. To make this disparity even clearer, 65% of the women in our study reported 4 or more ACEs while the PA sample we used (BRFSS) it was 14%.  Articulating these disparities and disseminating these data are critical to the intervention work done in this population as well as advocacy work.

What would you like this study to accomplish?

A lot of times these women are portrayed in negative ways by the media and by others in society. I hope this research helps humanize the women in our care. We should look at a woman’s lifetime of experiences, and focus on the intervention that supports women as they deal with the stress of a raising a new child.

The study substantiates a lot of our work at MATER, which is trauma informed, mindfulness based and resilience oriented. We hope it helps disseminate this work to a wider community. Having solid data can help strengthen the argument for why this is important.

How is MATER using these findings to inform care?

We are also developing interventions that not only work with the mother, but with her support system as well. We bring in a woman’s support system so that together we can build a stronger community and safety net for the mom.  Having that support and sense of community is critical for women who have experienced profound trauma.

This work underlines the philosophy at MATER, that you need an understanding of a woman’s journey. We view the moms we serve as courageous. And seeing the trauma profile as illustrated in our findings, you can see why we view them as courageous. We need to see how lives are shaped by experience in order to help create a more positive future.