The role of personality functioning and childhood trauma in patients in opioid substitution treatment

Background Personality pathology and childhood trauma are known to be associated with substance use disorders (SUDs) in general and opioid use disorders (OUDs) in particular but the complex relationship is only partially understood. Investigating personality functioning in patients with OUD is crucial for gaining a deeper understanding of the emergence and course of illness as well as for planning appropriate treatment strategies.Aims To empirically investigate personality functioning in a sample of patients in opioid substitution treatment and to examine the associations between personality functioning, injecting drug use (IDU) and childhood trauma.Methods In a cross-sectional design, 31 patients with OUDs currently in an opioid substitution treatment program were assessed with the revised Structured Interview for Personality Organization, the Structured Clinical Interview for DSM-5, the Addiction Severity Index - Lite and the Childhood Trauma Questionnaire. The sample consisted of 80.6% male and 19.4% female patients.Results The large majority (93.5%) of participants were diagnosed with severe impairment of personality functioning. Impaired personality functioning and higher rates of reported childhood trauma were associated with a younger age of onset of IDU and a greater number of years of IDU. Level of personality functioning showed a stronger statistical association with both IDU and the number of diagnosed personality disorders than reported childhood trauma.Conclusions OUDs are associated with severely impaired personality functioning. Assessment of personality functioning can provide important information for treatment strategies in addition to categorical psychiatric diagnoses and trauma history.