Abstract
BackgroundThe idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological symptoms. In the present report we compared the effects of buprenorphine and methadone on the psychopathological symptoms of 213 patients (106 on buprenorphine and 107 on methadone) in a follow-up study lasting 12 months.MethodsDrug addiction history was collected by means of the Drug Addiction History Rating Scale (DAH-RS) and psychopathological features were collected by means of the Symptom Checklist-90 (SCL-90), using a special five-factor solution. Toxicological urinalyses were carried out for each patient during the treatment period.ResultsNo statistically significant differences were detected in psychopathological symptoms, including 'worthlessness-being trapped', 'somatization', and 'panic-anxiety'. Methadone proved to be more effective on patients characterized by 'sensitivity-psychoticism', whereas buprenorphine was more effective on patients displaying a 'violence-suicide' symptomatology.ConclusionsHeroin-dependent patients with psychiatric comorbidities may benefit from opioid agonist treatment not only because it targets their addictive problem, but also, precisely due to this, because it is effective against their mental disorder too.
Highlights
The idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological symptoms
While psychiatric comorbidity has been shown to have a negative impact on the outcome of opioid use disorders [1,2,3,4,5,6,7,8,9], studies carried out in the context of Methadone Maintenance Treatment Programs (MMTPs) to evaluate outcomes strictly linked with methadone efficacy have not demonstrated any such negative influence [10,11,12,13,14]
Dole’ Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy Full list of author information is available at the end of the article substances, to the effects of heroin and/or other substances, to neurobiological addictive processes, or to psychosocial stress associated with addictive behavior [15,16,17,18]. On these bases a unitary perspective has been proposed, foreseeing the inclusion of symptoms of anxiety, mood and impulse-control domains in the psychopathology of addiction, and taking into account symptoms and syndromes that are under the threshold for the definition of an additional mental disorder, they may have a strong effect on the everyday life of patients and may frequently require intervention [19,20]. This approach is consistent with the often-found tendency in the field of addiction to evaluate the impact of psychopathology on the outcome of a treatment in terms of the severity of the psychological/psychiatric problems involved through the use of rating scales and interviews such as the Symptom Checklist-90 (SCL-90) and Anxiety Sensitivity Index (ASI), rather than in terms of formal psychiatric diagnoses [21,22,23,24,25]
Summary
The idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological symptoms. The complex nature of psychopathology in substance abuse disorders (SUDs), is difficult to assess at the moment of admission to treatment, when the heterogeneity of the psychological/psychiatric conditions displayed impairs the attribution of symptoms to psychiatric conditions preceding the initial use of This approach is consistent with the often-found tendency in the field of addiction to evaluate the impact of psychopathology on the outcome of a treatment in terms of the severity of the psychological/psychiatric problems involved through the use of rating scales and interviews such as the Symptom Checklist-90 (SCL-90) and Anxiety Sensitivity Index (ASI), rather than in terms of formal psychiatric diagnoses [21,22,23,24,25]. We found five subgroups of patients characterized by (1) depressive symptomatology with prominent feelings of worthlessness-being trapped or caught, (2) somatization symptoms, (3) interpersonal sensitivity and psychotic symptoms, (4) panic symptomatology, and (5) violence and self-aggression These groups were not correlated with sex or duration of dependence. Older patients were more strongly represented in prominent somatization and worthlessness-being trapped symptomatology groups [26]
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