Three individuals with a substance use disorder enter an inpatient 12-step program in a community mental health center and for the first month of the program, all 3 individuals are abstinent. They are then discharged from inpatient treatment and return for face-to-face follow-up interviews at 14, 30, and 90 days postdischarge. At the latest postdischarge measure, it is observed that 1 individual did not relapse, while the other 2 relapsed at day 35. The first relapsing individual took drug of choice from day 35 to day 42 (7-day relapse), while the second individual took drug of choice from day 35 to day 90 (55-day relapse), thus showing greater severity of drug relapse than the first individual. In this issue of JAMA Psychiatry, Van Dam and colleagues1 showed that what predicted relapse in the 2 individuals was exposure to childhood maltreatment, while what predicted the severity of drug relapse in these individuals were childhood maltreatment–related reductions in specific limbic regions of the brain.
Lupien SJ. The Double-Hit Effect of Childhood Maltreatment on Drug Relapse. JAMA Psychiatry. 2014;71(8):871-872. doi:10.1001/jamapsychiatry.2014.924