Traumatology, Vol 32(3), Sep 2026, 369-380; doi:10.1037/trm0000566
Opioid treatment programs (OTPs) are an important part of the U.S. strategy to address the opioid epidemic and reduce overdose deaths. OTP providers face a heightened risk for secondary trauma exposure and vicarious trauma (VT) reactions. This study is the first to characterize trauma, VT, and substance use histories among OTP staff and assess how these factors impact provider well-being. Staff across three OTP clinics (N = 40, 37.5% Hispanic/Latina) completed validated assessments of lifetime trauma, VT, posttraumatic stress, depression, anxiety, burnout, compassion satisfaction, and perception of workplace safety. Staff reported high rates of traumatic stress (62.5% with clinical symptoms) and VT (72.5% with moderate to high symptoms). Lifetime trauma exposure was associated with increased compassion satisfaction (β = .31, p = .04) and perceived workplace safety (β = .37, p = .04), while VT symptoms predicted higher burnout (β = .52, p p = .04). Staff with lived substance use disorder experience showed greater vulnerability to VT, including higher depression (β = .55, p = .02) and lower perception of workplace safety (β = −.51, p = .01). Results highlight the complexity of provider lived trauma and substance use disorder as both resilience and risk factors. To enhance provider well-being and quality of patient care, OTPs should implement strategies to reduce VT exposure and provide opportunities for staff to address trauma symptoms and participate in reflective trauma-informed supervision. (PsycInfo Database Record (c) 2026 APA, all rights reserved)