Abstract
BackgroundWith a decrease in heroin’s purity and availability in the European drug market, Hungarian opioid dependent patients started to substitute heroin with novel psychoactive substances (NPS) and especially with synthetic cathinones.GoalThis study aims to assess whether clients of opioid substitution treatment (OST) with and without a history of synthetic cathinone use during therapy differ in (1) the rate and type of experienced childhood trauma, (2) the way they cope with negative life events, (3) their motivation to change substance use behavior, (4) the rate of treatment retention.MethodsA total of 198 clients of an outpatient centers (Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest) OST were asked to provide information about their general substance use experiences, including the consumption of NPS during treatment, their childhood traumatic experiences (Childhood Trauma Questionnaire), cognitive emotion regulation strategies (Cognitive Emotion Regulation Questionnaire), their motivation to change substance use behavior (University of Rhode Island Change Assessment Scale) and current psychiatric symptoms (Brief Symptom Inventory). Baseline data was collected in the summer of 2015, while 4 years follow-up data on treatment retention was obtained in the summer of 2019.ResultsThe majority of the clients were male (N = 141, 71.2%), receiving methadone as a substitute for opioids (N = 178, 89.9%), while mean age of the full sample was 39.7 (SD = 6.8). Based on a logistic regression model, the odds for past year synthetic cathinone use was higher among clients with more severe psychiatric symptoms (B = 0.8, OR = 2.2, p < 0.01) and among clients who were in treatment for a shorter period of time (B = 0.1, OR = 0.9, p < 0.05). Synthetic cathinone use during treatment was further associated with less adaptive strategies to cope with negative life events. Synthetic cathinone use was also a risk factor for reduced treatment retention (B = −0.8, OR = 0.4, p < 0.05) and was associated with lower odds of being member of a latent class with less severe psychopathological profile (B = −0.9, OR = 0.4, p < 0.05).ConclusionSynthetic cathinone use during treatment is associated with poorer treatment outcomes and might be characterized by more severe psychiatric symptoms and amotivation to change substance use among opioid dependent clients.
Highlights
Considering the ever-changing world of contemporary drug scene, the past two decades were characterized by the emergence of novel psychoactive substances (NPS), started with the appearance of synthetic cathinone(s) (SC), as first reported in the early 2000s (Urquhart, 2004)
Of the many possible factors underlying substance use during opioid substitution treatment (OST) – e.g., shorter treatment duration (Li et al, 2012), a medium 60–100 mg/day medication dose (Baumeister et al, 2014), low treatment attendance, drug using friends, family conflicts (Sullivan et al, 2014), male gender (Vigna-Taglianti et al, 2016), younger age (Amiri et al, 2018), or the quality and supportiveness of the social network (Shen et al, 2018) – this paper focuses on the presumed impact of unresolved childhood trauma, with special emphasis placed on individual patterns of cognitive emotion regulation as related to stressful live events
Psychiatric Symptoms Current psychiatric symptoms were assessed by the Brief Symptom Inventory (BSI) (Derogatis, 1975; Urbán et al, 2014)
Summary
Considering the ever-changing world of contemporary drug scene, the past two decades were characterized by the emergence of NPS, started with the appearance of SC, as first reported in the early 2000s (Urquhart, 2004) Cathinonederivatives, such as mephedrone, 4-MEC, methylone, pentedrone or MDPV became popular alternates of formerly scheduled psychostimulants and even depressants (e.g., opioids). Certain reports denoted that long-term abstinent ex-opiate users shifted to SC injecting (e.g., Van Hout and Bingham, 2012; Péterfi et al, 2014; Rácz et al, 2015) throughout a time period of sustained heroin shortage in the drug market. As part of this shift, clients of OST started to abuse SC during their maintenance treatment. Goal: This study aims to assess whether clients of opioid substitution treatment (OST) with and without a history of synthetic cathinone use during therapy differ in (1) the rate and type of experienced childhood trauma, (2) the way they cope with negative life events, (3) their motivation to change substance use behavior, (4) the rate of treatment retention
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