Trauma and trauma-related disorders for women on methadone: prevalence and treatment considerations

There is a growing recognition of the strong association between psychoactive substance abuse and violence. Repeated exposure to violent trauma is particularly salient for women. Moreover, violent trauma may play a role in the etiologies of depression, substance abuse, and trauma-related disorders, such as posttraumatic stress disorder (PTSD). For the female methadone patient, an untreated trauma-related disorder can be a hidden factor that hinders treatment response and leads to treatment complications, such as depression, polysubstance abuse, or treatment drop out. This article reviews the prevalence of trauma and violence for women on methadone, comparing low-income, inner-city female drug abusers with males in methadone treatment on childhood and adulthood exposure to violent trauma and PTSD. Because women are in a minority in methadone maintenance treatment programs, standard treatment approaches have generally not focused on their particular issues and needs. Two alternative models are presented for group treatment of trauma and trauma-related disorders in female methadone patients; potential benefits of each in reducing symptomatology and improving interpersonal functioning are examined. Modification of standard approaches and the typical barriers to engagement in treatment for this special population are also addressed.