"We Weren't Taught How to Cope With Tragedy": Early Childhood Trauma, Grief, and Learned Coping Mechanisms Among People Who Inject Drugs.

Background and objectives: Early traumatic exposure to factors such as household substance use, violence, and familial death increase the likelihood of substance use across a person's lifespan. Our qualitative analysis sought to explore the social and relational drivers of substance use among people who inject drugs (PWID). Design and methods: We conducted qualitative interviews with 30 PWID (n = 30) in Los Angeles, CA from July 2021 to April 2022. To be eligible for this study, participants had to report being 18 years of age or older and self-report any opioid and injection drug use within the past 30 days. We used constructivist grounded theory to analyze the contexts that contribute to lived experiences surrounding familial trauma, resource scarcity, and substance use as a coping mechanism. Results: Participants in this study described drivers of current substance use patterns as related to childhood and familial trauma. These included: (1) early exposure to chaotic and/or disordered substance use by household members, (2) traumatic experiences, such as death of a family member, which they linked to substance use initiation, and (3) relying on substance use as a coping strategy which was modeled by family members. Conclusions: Early traumatic experiences and exposure to disordered substance use (ie, household family members using substances to emotionally regulate) combined with experiencing resource deprivation (ie, lacking trauma-informed mental health support and financial and wraparound care) contributed to participants' experiences of substance use as a learned coping mechanism. Integrating social and structural support interventions, such as mental health service provision and financial stabilization services, into policy-making decisions may help to address the cyclical relationship between childhood exposure to trauma and adult substance use initiation.