Complex trauma and perceived barriers to treatment among people accessing a supervised injecting facility

Introduction: People who inject drugs (PWID) have an elevated risk of trauma exposure, which can adversely affect health outcomes and create barriers to engaging with services. While high rates of post-traumatic stress disorder (PTSD) among PWID have been well-documented, less is known about the prevalence of complex PTSD (C-PTSD) in this cohort, or how symptom severity might relate to perceived barriers to alcohol and drug treatment.Methods: Participants (n = 102; 74.5% male) were recruited from the Melbourne Supervised Injecting Room (MSIR) in Victoria, Australia, as part of a larger study examining the health needs of MSIR attendees. Participants completed a survey that included assessment of potentially traumatic life events (Life Events Checklist; LEC), past 30-day symptoms of PTSD/C-PTSD (International Trauma Questionnaire; ITQ), and perceived barriers to drug and alcohol treatment (Barriers to Treatment Inventory; BTI).Results: Ninety-one participants (89.2%) had directly experienced at least one potentially traumatic event, with 24 participants (23.5%) endorsing events in 10 or more categories. Thirty participants (29.4%) met criteria for past 30-day PTSD; of these, 25 (83.3%) also met criteria for C-PTSD. C-PTSD symptom severity was associated with greater perceived barriers due to privacy concerns, lack of treatment availability, and time constraints, but lower barriers relating to perceived absence of a drug problem. PTSD symptom severity was associated with greater perceived barriers due to negative social support and lack of treatment availability. Females reported significantly greater trauma exposure and were more likely to meet PTSD/C-PTSD criteria than males.Discussion: Cumulative trauma exposure and current C-PTSD symptoms were common among people attending a supervised injecting facility. Potentially, these PWID may recognise their need for drug treatment or services despite greater perceived structural and interpersonal barriers to treatment. Further research is needed to identify and address the unique barriers to accessing support services in these settings.