Reducing barriers to trauma inquiry in substance use disorder treatment – A cluster-randomized controlled trial

Background: Despite of the high rate of trauma in clients with substance use disorders, trauma often remains undetected in a majority of treatment-seeking clients. Improving professionals’ knowledge and competences in the inquiry of traumatic events is therefore of utmost importance to appropriately address the specific trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to inquiring about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings to improve the systemtic inquiry of traumatic events in clients. Methods: In this cluster-randomized trial, we examined whether a one-day training in trauma inquiry (‘Learning How to Ask’) would reduce professionals’ perceived barriers to trauma inquiry. 148 professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals of the intervention group received a one-day training plus a refresher session 3 months later, the professionals of the control group received no training. Professionals rated their level of six common barriers to trauma inquiry on four-point Likert scales at baseline, at 3-month and 6-month follow-up, namely ‘Feeling uncomfortable when asking about traumatic events’, ‘Fear of offending the client’, ‘Fear of retraumatizing the client’, ‘Fear that client may terminate treatment’, ‘Unsure whether authorities have to be informed when perpetrator is known’, and ‘No trauma-specific treatment available’. Results: Five of the six perceived barriers to inquiring about traumatic events significantly decreased from baseline to 6-month follow-up to a greater extent in the trained group than in the control group (‘Feeling uncomfortable’: b = -0.32, 95% CI [-0.52, -0.12]; ‘Fear of offending the client’: b = -0.33, 95% CI [-0.56, -0.09]); ‘Fear of retraumatizing the client’: b = -0.45, 95% CI [-0.69, -0.22]; ‘Fear that client may terminate treatment’: b = -0.28, 95% CI [-0.49, 0.07]; ‘No trauma-specific treatment available’: b = -0.25, 95% CI [-0.51, -0.01]). Conclusions: Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may improve detection of traumatic events.