(59) Adverse Childhood Experiences are Associated with Overdose History in Outpatient SUD Care

INTRODUCTION/BACKGROUND
Those with a history of Adverse Childhood Experiences (ACEs) have an increased risk of mental health issues and substance use. Having a substance use disorder (SUD) increases the risk of overdose (OD). There has been little investigation regarding ACEs and risk of OD. This study examined the relationship between ACE scores and a self-reported history of OD among patients engaging in an addiction and mental health outpatient setting.

METHODS
This single-center, cross-sectional design included adult patients participating in a dual-diagnosis addiction and mental health outpatient recovery and treatment program from November 2017 to March 2020. Patients (n= 115) were assessed with self-report questionnaires which included ACEs and history of OD. Bivariate and multivariable logistic regression was used to determine factors associated with self-reported OD history.

RESULTS
Of the 115 participants, 26 (22.6%) reported a past OD at their intake appointment. The mean ACE score for those participants was 4.0 (standard deviation [SD] = 2.7) vs. 2.3 (SD = 2.2) among those who did not report OD. In the multivariable regression, a higher ACE score and older age were significantly associated with history of OD (AOR = 1.23, 95% CI: 1.00-1.50, p = 0.0456; AOR = 4.10, 95% CI: 1.00-17.02, p = 0.0519).

CONCLUSION
Given the observed association between OD and higher ACE scores and older age, patients presenting for treatment in outpatient dual-diagnosis clinics should be screened for ACEs and OD history, providing the opportunity for this data to be incorporated into their clinical care and engagement in trauma-informed care.

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Diversity, Equity, and Inclusion: In the discussion of our manuscript we discuss the limits of the ACEs survey and the missed consideration of diversity, equity, and inclusion. Although the ACE survey provides us with an important assessment of childhood trauma, it could potentially be improved by an augmented ACE scoring system, developed to assess environmental stressors which can also have adverse effects on adult physical and mental health and therefore on OD risk. 33 An improved environmental ACEs survey could be developed to measure variables missing from the original ACE survey. The focus of this augmented questionnaire could take into account: environmental problems (tobacco smoke exposure, air and noise pollution), socio-economic variables (racial status, languages spoken, disability, household income), and neighborhood assessment (e.g. perceived safety, proximity to grocery stores, perceived access and quality of school systems, and proximity to religious institutions). These questions act as a sample to illustrate a more in depth look at some of the perceived environmental stressors of childhood. With the addition of these factors to ACE survey we could obtain a more comprehensive view of one’s childhood experience and trauma.