The risk for women (and to some extent men) of ongoing assault and violence needs to be addressed to ensure their physical safety, and to prevent further trauma. When the clinical profile is complicated by other substance dependence diagnoses and ongoing trauma it is likely that opioid replacement therapy alone, whilst effective in reducing many of the problems associated with heroin dependence (Cacciola, Alterman, Rutherford, McKay, & Mulvaney, 2001), is insufficient for these more complex cases (Sacks, McKendrick, & Banks, 2008). Where there is a history of childhood trauma, treatment may require a concurrent focus on substance use, mental health and trauma issues, with some evidence suggesting that such an approach is more effective than standard intervention (Cocozza, et al., 2005; Morrissey, et al., 2005). In addition, the presence of a mood disorder has been found to predict treatment dropout and poor treatment outcome across several domains more strongly than the presence of Axis II disorders amongst dependent opioid users (Kokkevi, Stefanis, Anastasopoulou, & Kostogianni, 1998; Teesson, et al., 2007). Hence, greater focus on the treatment of mood disorders may lead to better outcomes across the board.
