Psychiatric Severity and Resilience in Outpatients Seeking Treatment for Cocaine Use Disorder

Cocaine use disorder (CocUD) remains a significant public health concern, with elevated mortality rates. Severe psychiatric disorders frequently co-occur with CocUD, possibly associated with an increased frequency of childhood trauma and with lower resilience - the capacity to overcome traumatic life events, compared to the general population. This study aimed to investigate the relationship between psychiatric severity, resilience and childhood trauma in treatment-seeking CocUD outpatients.

We analyzed the data from a multicenter, cross-sectional study, totalizing 305 CocUD outpatients recruited at specialized addiction care centers. Psychiatric severity was quantified using a custom composite score calculated as the sum of lifetime suicide attempts, psychiatric hospitalizations, and current psychotropic medications. Resilience and childhood trauma were assessed using validated instruments: the Connor-Davidson Resilience Scale (CD-RISC) and the Childhood Trauma Questionnaire (CTQ). The characterization of sociodemographic and clinical characteristics related to CoCUD allowed us to conduct unadjusted and adjusted analyses of associations between trauma, resilience and psychiatric severity.

The sample was predominantly male (77%), aged 38 ± 8.7 years. Mean age at onset of CocUD was 28 ± 8 years, and most patients were diagnosed with a comorbid substance use disorder (62% alcohol, 61% cannabis, 43% benzodiazepines and 49% opioid use disorder). Mean psychiatric severity score was 4.2 ± 10.3. Most patients reported at least one childhood abuse type (56.5 +/- 14 for the US version). The mean CD-RISC score was 47.3 ± 13. The mean CTQ score was 47 ± 17. Poisson regression showed a significant inverse relationship between psychiatric severity and total CD-RISC score (p =. 005), with a small effect size (β = -0.01). Psychiatric severity was independently but positively associated with greater CTQ total scores (p = 1.2 x 10-8, β = 0.01), female gender (p = 9.8x10^-8, β = 0.41) and comorbid benzodiazepine use disorder (p = 8.7x10^-10, β = 0.45).

Although the psychiatric severity score was built arbitrarily, it showed complex interactions with resilience and trauma among CocUD outpatients. These findings underscore the importance of systematically assessing childhood trauma and developing resilience-focused psychotherapies for managing severe CocUD. Psychiatric severity may be measured using simple clinical variables to further tailor these interventions.