Abstract
Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).
Highlights
Interventions targeting opiate abstinence pose challenges to patients arising from withdrawal symptoms,1 followed by longer‐term challenges around establishing an opiate‐free life
The post hoc comparisons show that the prison group (PG) had committed more drug offenses than the inpatient group (IG)
The present findings show that self‐efficacy measured at Time 1 (T1) by the DTCQ‐830 was an effective predictor of subsequent self‐reported heroin use or not at a 6‐month follow‐up
Summary
Interventions targeting opiate abstinence pose challenges to patients arising from withdrawal symptoms, followed by longer‐term challenges around establishing an opiate‐free life The latter may include craving to use opiates again, pressure to relapse from opiate misusing acquaintances, and the need to replace opiate misuse as a coping mechanism for problems in living.. Opiate abstinence treatments occur in a variety of settings including hospital wards, outpatient clinics, and prisons. These may differ regarding the extent of psychosocial support available, with potential consequences for patients’ affective states and commitment to treatment objectives. Treatment guidelines emphasize patients’ readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Discussion and Conclusions: Self‐efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Demographic details, family situations, histories of illegal drug consumption, treatment for drug‐related problems, and engagement in criminal behavior
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