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August 2014

The Double-Hit Effect of Childhood Maltreatment on Drug Relapse

Author Affiliations
  • 1Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
  • 2Department of Psychiatry, University of Montréal, Montréal, Quebec, Canada
JAMA Psychiatry. 2014;71(8):871-872. doi:10.1001/jamapsychiatry.2014.924

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.