In response to Marsden et al (Reference Marsden, Gossop and Stewart2000) we were interested to note the prevalence of psychiatric symptoms in their group of clients seeking treatment for drug dependence, particularly the fact that female drug users reported higher levels across all scales, as this mirrors our experience in treating intravenous drug misusers. We would suggest that such symptoms may be sequelae of child abuse.

There is an established link between childhood trauma and psychiatric symptoms in adulthood (e.g. Reference Briere and RuntzBriere & Runtz, 1993), and recent evidence to suggest a link between such early life experiences and substance misuse. Contemporary psychoanalytic theories of addiction also emphasise the relationship between experience of early life trauma and later substance misuse (e.g. Reference WurmserWurmser, 1984), proposing that drug use is an attempt at self-medication (Reference KhantzianKhantzian, 1997), or a chemical means of inducing a dissociative state, so often apparent in victims of child abuse. McDougall (Reference McDougall1989) suggests that substance misuse offers an external means of discharging painful internal states, through immediate action.

Our work in Cornwall indicates that of 111 randomly selected patients seen by the drug team, 46% of males and 73% of females reported childhood abuse to a degree that would have placed them on the at-risk register. Child sexual abuse was reported by 1.85% of males and 43% of females. This work provides evidence that there is a high incidence of early life trauma and abuse in the drugmisusing population. The figures account for the larger proportion of women presenting with drug dependence problems reporting abuse issues, which fits with Marsden et al's report of a higher incidence of psychiatric symptomatology among their female clients.

We feel this is a very important area that needs to be evaluated further, as we find that the degree of trauma suffered by the patient can predict therapeutic needs and types of intervention required, including substitute prescribing, residential treatment and/or in-depth psychotherapeutic treatment. This is an aspect in the future that may enable drug services to tailor treatment packages to meet the individual's needs and to target appropriate interventions.