Examining the association between psychological resilience and chronic versus discrete stressors among individuals who use opioids in Baltimore, Maryland.

Introduction: Psychological resilience has emerged as a key construct of interest in the study of substance use. However, very few studies have examined resilience among individuals who are actively using drugs. Furthermore, many studies of psychological resilience have focused on individual-level factors. This study addresses the call for a more 'ecological' approach to the study of resilience by exploring how socio-structural vulnerabilities may shape individuals' assessment of their own ability to cope.

Methods: The Peer Harm Reduction of Maryland Outreach Tiered Evaluation study conducted a cross-sectional survey of people who used opioids in Baltimore, Maryland, USA (n = 565). Resilience was measured using the 10-item Connor-Davidson Resilience Scale. We used linear regression to examine the association between resilience and stressors commonly encountered by individuals who use drugs, including both chronic, enduring stressors (e.g., homelessness, food insecurity) and discrete, event-based stressors (e.g., overdose, arrest).

Results: We observed a negative relationship between self-reported resilience and chronic stressors. Specifically, individuals who reported experiencing three (β = -4.08; p = 0.002) or four (β = -4.67; p = 0.008) types of chronic stress had significantly lower resilience scores. Additionally, we found that an unmet need for mental health treatment was associated with reduced resilience (β = -1.74; p = 0.040) and greater educational attainment was associated with increased resilience (β = 2.13; p = 0.005).

Discussion and conclusions: Overlapping experiences of socio-structural vulnerability, as well as access to mental health care, may influence how individuals who use drugs evaluate their own resilience. Interventions that seek to promote the resilience of this population should focus on addressing structural drivers of marginalisation and barriers to mental health treatment.