Trauma-Related Stress and Resilience in a Multistate Sample of Methadone Treatment Staff

Abstract

Background: The quality of methadone treatment for opioid use disorder varies across the U.S., affecting patient retention and overdose. Staff stress, trauma exposure, vicarious trauma (VT), burnout, and empowerment are important yet understudied factors that influence workforce well-being and performance. Objectives: This study aimed to characterize trauma-related well-being among staff in a national sample of opioid treatment programs (OTPs) and to explore potential correlates of resilience. Design: A cross-sectional survey was conducted from June to August 2024 with OTP staff from clinics participating in a parent national study. Methods: The survey combined validated instruments and tailored questions to assess work experience, lifetime trauma exposure, trauma and stress-related symptoms, VT, burnout, and multiple dimensions of empowerment. Exploratory factor analysis was used to identify domains of staff well-being. Results: The sample (N = 86) included medical staff, counselors, and non-medical/counseling staff from OTPs across 16 states. Thirteen percent of staff met preliminary criteria for posttraumatic stress disorder, 89.2% reported VT exposure at work, and 63.8% reported moderate to severe VT symptoms. Medical staff reported the highest VT and stress scores. Overall, 19.8% of staff met criteria for burnout, with counselors reporting the highest rates (30%). VT symptoms were positively correlated with burnout among counselors, medical, and other staff (r = 0.413-0.650, P < .05). Empowerment subscales were strongly correlated. Two distinct, uncorrelated domains of staff well-being emerged: VT resilience (low VT symptoms and burnout) and empowerment (high perceived control and influence), reflecting distinct aspects of trauma-related functioning. Despite high exposure to lifetime trauma and VT, staff demonstrated moderate resilience and moderate-to-high levels of empowerment. Conclusion: Staff of OTPs experience high levels of trauma exposure and symptomatology, VT, and burnout, with notable differences by clinic role. Resilience and empowerment domains suggest opportunities to improve staff wellness.