Female Methadone Patients Research Articles

Desire to avoid pregnancy and contraceptive use among female methadone patients in Los Angeles

ObjectiveOpioid use disorder (OUD) is increasing among U.S. women. Research indicates higher levels of unintended pregnancy among women with OUD as compared to the general population. Following formative in-depth research documenting the complexity of considerations around pregnancy in this population, we collected information on pregnancy preferences and contraceptive use among women attending methadone treatment. Study designWe surveyed women attending methadone clinics in Los Angeles in 2018. We used the Desire to Avoid Pregnancy (DAP) Scale, a 14-item instrument (0–4; 4 = highest desire to avoid pregnancy) to capture pregnancy preferences across 3 domains: cognitive desires, affective feelings, and anticipated consequences. We conducted factor analysis, descriptive analyses, and linear and logistic regressions to assess the DAP scale and to examine relationships between pregnancy preferences, sociodemographic characteristics, and contraceptive use. ResultsWomen (n = 46) expressed the full range of pregnancy preferences (DAP score range: 0.4–4.0; mean: 2.24, standard deviation: 1.02; Cronbach's α = 0.92). Overall, 40% used contraception at last sex. Women who reported a greater preference to avoid pregnancy were marginally more likely to use contraception at last sex as compared to women who were more open to pregnancy (odds ratio = 1.73; p = 0.09). ConclusionsSimilar to findings from other populations, responses to the Desire to Avoid Pregnancy scale among a sample of women with OUD revealed a broad range of pregnancy preferences. Pregnancy preferences were marginally associated with contraceptive use in this sample suggesting that the DAP may provide useful insights on pregnancy preferences that may facilitate contraceptive and preconception counseling in this population. ImplicationsGiven the complexity of considerations around pregnancy for women with opioid use disorder, the DAP scale may be a valuable tool to identify women's pregnancy and childbearing preferences and to facilitate alignment of women's sexual and reproductive health desires with appropriate services.

Characteristics of an Online HIV Education Program for Iranian Female Methadone Patients: The First Study

Characteristics of an Online HIV Education Program for Iranian Female Methadone Patients: The First Study

Iranian Female Methadone Patients and the Perceived Educational Needs Related to Human Immunodeficiency Virus.

BackgroundIranian female methadone patients are at risk of human immunodeficiency virus (HIV) due to involvement in high-risk sexual behaviours and/or needle sharing. The present study aimed to explore the perceived educational needs related to HIV among a group of Iranian female methadone patients.MethodsThe research design was qualitative and the participants were sampled purposively. Semi-structured interviews were conducted with 34 women and 19 clinicians in Sari, Mashhad, and Tehran, Iran. Then, qualitative content analysis was implemented.FindingsThe emergence of three major themes and six minor themes was revealed. Women expressed a need to increase their knowledge including women-specific pathophysiology and disease progression and the modes of the virus transmission and prevention. Women also expressed a need to enhance their knowledge and skills related to the physical management of the virus including self-care and reproductive health. Other themes included perceived psychosocial needs including removing stigma and access to resources in the community.ConclusionWomen reported a wide range of educational needs from basic knowledge to advanced skills. The findings can be used in designing women-specific educational programs related to HIV in Iran. Larger studies are suggested with gender-mixed samples in the Persian context.

Cognitive-Behavioral Therapy for Methamphetamine Dependence among Methadone-Maintained Patients

Background: Cognitive-behavioral therapy has been suggested as a treatment program for methamphetamine dependence. Objectives: The current brief report aimed to assess the effectiveness of 16 sessions of this treatment for abstinence from methamphetamine and improvement of psychological well-being among methadone-maintained patients. Methods: Overall, 200 male and female methadone patients who were on stable methadone doses were assigned to either an intervention group (n = 100) or a control group (n = 100). The study was part of a randomized controlled trial conducted in five methadone services in Shiraz, near the Persian Gulf of Iran. All methamphetamine-dependent participants were assessed using two questionnaires at baseline, post-test (the end of the 16th cognitive-behavioral therapy or control session), and a three-month follow-up that was conducted 90 days after the end of the 16th session. Urinalyses were also conducted to detect methamphetamine use at the same assessment points. The control group was in a wait-list control condition. There was no participant attrition during the assessment procedures. Results: Overall, 30 participants in the treatment group became abstinent at post-test and remained abstinent at follow-up. 16 sessions of cognitive-behavioral therapy led to a significant reduction in methamphetamine use (P < 0.001) and improved psychological well-being (P < 0.001) in the treatment group while there was no significant change in the control group. Conclusions: Cognitive-behavioral therapy can be an efficacious option for methamphetamine problem in methadone treatment although further studies are suggested on long-term abstinence.

Methamphetamine Dependence Among Iranian Female Methadone Patients: A Cross-Sectional Survey of Three Cities of Iran

Background: Methamphetamine (MA) dependence is a health concern in Iran (Persia). One main impacted group is female methadone patients. Objectives: The aim of this paper was to briefly report the prevalence of MA dependence among female methadone patients in 3 large cities of Iran. The other aim was to report the status of psychological well-being and social functioning among MA-dependent and non-MA dependent participants. Methods: In the first survey of Iran, 570 females were recruited from 38 main methadone clinics in Mashhad, Karaj, and Isfahan. A researcher-designed questionnaire was used to collect baseline demographics, details of MA use, and treatment history. Results: Of them, 266 females were MA-dependent. In other words, the prevalence of MA dependence among females was 46.6%. The length of MA dependence was 5 years. The adverse health impacts of high doses of methadone use were the main self-reported reasons for MA dependence. These adverse health impacts included depression (n = 118, 44.36%), oversleeping (n = 88, 33.08%), and low physical energy to do the housework (n = 60, 22.55%). However, lifetime MA treatment was only 25%. The prevalence of MA dependence was significantly associated with poor psychological well-being (P < 0.01) and social dysfunction (P < 0.01) among MA dependent females compared with non-MA dependent females. Conclusions: Methamphetamine dependence was common and associated with serious health problems. Special treatment services should be provided for these females.

Motivational Interviewing Can Facilitate Entry to Matrix Treatment for Methamphetamine Dependence

Background: Methamphetamine dependence on a stable methadone dose is a health problem in Iran (i.e. the most populated Persian Gulf country). However, many Iranian patients are not motivated to enter treatment. Objectives: The study aimed to assess the efficacy of motivational interviewing for entry to matrix treatment for methamphetamine dependence. Methods: A study was conducted on 275 Persian male and female methadone patients who were methamphetamine-dependent, however they reported unwillingness to receive the matrix model. The study was conducted in 20 methadone services in Karaj, Iran during 2014. Addiction severity index was used to collect data on demographics and illicit drug use. Psychological well-being and social functioning were assessed using the Persian versions of the general health questionnaire-28 and the social functioning subscale of the opiate treatment index. Results: The study indicated that 5 sessions of motivational interviewing were significantly efficacious in increasing attendance in the Matrix Model in the treatment group (P < 0.001). Attendance in motivational interviewing was significantly accompanied with increased psychological well-being (P < 0.001) and social functioning (P < 0.001). Conclusions: Motivational interviewing should be provided for those participants who are methamphetamine dependent but are not motivated for change. Conducting randomized controlled trials is suggested.

Methamphetamine dependence in methadone treatment services in Iran: the first literature review of a new health concern.

Methamphetamine dependence is a serious health problem among Iranian methadone patients. The current study is the first research that reviewed the prevalence of methamphetamine dependence and the associated harms among Iranian methadone patients. The other aims were to review the history of receiving methamphetamine treatment among methadone patients and the evaluated psychosocial treatments for methamphetamine dependence and/or associated harms. Searching included both peer-reviewed literature and grey literature in English and Persian. Reference lists of the relevant papers and reports were searched manually for more information. The time period between 1 January 2005 and 28 October 2017 was set for searching. Available evidence indicated that methamphetamine dependence increased from 3.9% among the two genders in 2007 to 60.3% among men in 2014 and 89.5% among women in 2015-2016. The prevalence of methamphetamine dependence was higher among female methadone patients than their male counterparts. Methamphetamine dependence was associated with multiple health problems in the social and health contexts of the two genders especially women. However, receiving methamphetamine treatment was negligible. The review indicated that cognitive-behavioural therapy improved psychological well-being. The Matrix Model led to abstinence from methamphetamine and improved psychological well-being. Motivational interviewing increased attendance in treatment. Family therapy improved the quality of life and social support. However, more similar studies were needed. Despite a serious increase in methamphetamine dependence, there were a few evaluated psychosocial treatments. There is an immediate need to evaluate efficacious psychosocial treatments especially for women. Methamphetamine treatment should be provided in methadone treatment services.

Characteristics of Iranian female methadone patients with regular methamphetamine use

Characteristics of Iranian female methadone patients with regular methamphetamine use

Matrix Model for Methamphetamine Dependence Among Iranian Female Methadone Patients: The First Report From the Most Populated Persian Gulf Country

Matrix Model for Methamphetamine Dependence Among Iranian Female Methadone Patients: The First Report From the Most Populated Persian Gulf Country

Methamphetamine Use Disorder Untreated among Women in Methadone Treatment in Iran

Background: Methamphetamine (MA) use disorder is a new health problem among female methadone patients in Iran. Some characteristics of women are likely to be associated with poor methadone treatment outcomes. However, there are few studies about the characteristics of this group. Objectives: The current study is the first research that aimed to investigate the demographic, drug use and treatment characteristics of a group of regular MA-using women in methadone treatment. Methods: Methadone-maintained women who reported at least weekly MA use were recruited from four methadone treatment centres in Tehran. Participants’ drug use, severity of MA dependence, psychiatric distress, social functioning, criminality and high risk sexual behaviours were measured among the participants. Urinalysis was done to confirm MA use. Results: Between 28 July 2014 and 15 May 2015, 120 participants completed an interview. Mean duration of MA use was 5.4 (SD 2.1) years. Only 9.2% of the participants reported prior MA treatment. Psychiatric distress was high among all participants. Overall, 61 participants (50.8%) reported long duration of MA use (i.e. five years or more) while 59 participants (49.2%) reported less than five years of MA use. Severity of MA dependence (P = 0.38), psychiatric distress (P = 0.36), social functioning (P = 0.12) and criminality (P = 0.82) were not significantly associated with duration of MA use. However, participants who reported long duration of MA use were more likely to be engaged in high risk sexual behaviours (P = 0.01) compared with those reporting short duration of MA use. Conclusions: The study results indicated that participants had multiple health problems. High risk sexual behaviours were considerable among participants with long duration of MA use despite being in methadone treatment. Participants had little or no previous treatment for MA use disorder. Treatment services should be expanded to address MA use disorder and its harms among this group.

Prolonged Exposure for Treating PTSD Among Female Methadone Patients Who Were Survivors of Sexual Abuse in Israel

The aims of this pilot study were: (a) to test the feasibility of prolonged exposure (PE) therapy conducted by a social worker staff on female patients in methadone program clinics who were survivors of child sexual abuse or rape and (b) to examine preliminary outcomes of PE on posttraumatic stress disorder (PTSD), depression, and illicit drug use at pre- and posttreatment, and up to 12-month follow-ups. Twelve female methadone patients who were survivors of child sexual abuse or rape diagnosed with PTSD were enrolled in 13–19 weekly individual PE sessions. Assessments were conducted at pre-, mid-, and posttreatment, as well as at 3, 6, and 12-month follow-ups. The treatment outcomes measures included PTSD symptoms, depressive symptoms, and illicit drug use. Ten of the 12 study patients completed treatment. PTSD and depressive symptoms showed significant reduction. No relapse to illicit drug use was detected. These preliminary results suggest that PE may be delivered by methadone social workers with successful outcomes. Further research should test the efficacy of PE among methadone patients in a randomized control trial with standard care as the control condition.

Correlates of Therapeutic Alliance and Treatment Outcomes Among Israeli Female Methadone Patients

Objectives: This study examines potential predictors (e.g., attachment style, frequency of therapeutic treatment sessions) of client-rated therapeutic alliance between the social worker and client. The relationship between therapeutic alliance and client’s psychological outcomes (hope and posttraumatic stress symptoms [PTS’s]) was also assessed. Methods: The study sample included 95 of 193 female clients (average age = 39.35, SD = 8.66) at four methadone clinics in Israel. Results: Clients reported a strong therapeutic alliance with their social workers. Stepwise hierarchical multiple regression analyses revealed that only the frequency of treatment sessions, the avoidance dimension of attachment, and less frequent opiate use were significant predictors of therapeutic alliance. Therapeutic alliance significantly predicted hope but did not predict reduced PTS. Conclusions: Implications for social work practice and future research are discussed.

Problem drinking in relation to treatment outcome among opiate addicts in methadone maintenance treatment

This study analyzed indicators of alcohol-related problems in opiate addicts before, during, and after leaving methadone maintenance treatment (MMT), in relation to illicit drug use and retention in treatment. The study was based on 204 patients, admitted to MMT for the first time between 1 January 1995 and 31 July 2000, and followed until 31 December 2000. Three measures were used to indicate alcohol use and alcohol-related problems; records of hospital care with an alcohol-related diagnosis, any treatment with alcohol-sensitizing drugs (disulfiram or calcium carbimide) during MMT, and results of the 5-hydroxytryptophol to 5-hydroxyindoleacetic acid ratio (5HTOL/5HIAA) in urine, a sensitive biomarker for recent drinking. Use of illicit drugs was determined by routine urine drug testing. About one third of the patients (n = 69) had a lifetime prevalence of hospital treatment for an alcohol-related diagnosis, 45 of whom had been hospitalized (mean 4.2 stays) prior to the start of MMT. There was a significant association (p<0.05) between the number of alcohol-related diagnoses prior to treatment and a positive 5HTOL/5HIAA test during MMT. The alcohol indicators first became positive on average 1.6 years after admission to treatment, compared with after about 4 months for illicit drugs. Use of cannabis or benzodiazepines was significantly associated with alcohol use. Female methadone patients with indications of alcohol-related problems relapsed more often into illicit drug use than did women without such indications (3.9 vs. 2.5 relapse periods/year; p<0.005), whereas no significant association was found for men. The results of the present study indicate that drinking problems among patients undergoing MMT is associated with an increased risk of relapse into illicit drug use and with discharge from treatment. Concurrent treatment of alcohol-related problems, including systematic monitoring of alcohol use, therefore should be recommended to reduce the risk for relapse into illicit drug use and improve overall treatment outcome in MMT.

Leaving Methadone Maintenance Treatment: The Role of Personality Traits and Psychic Status

This study investigates personality traits and psychiatric status among 174 methadone patients (121 men and 53 women) and 387 untreated controls (191 men and 196 women) in Sweden in 1993 and 1994. The methadone patients were followed up to 1998 with respect to being expelled from treatment. Pretreatment factors, like home background and behavioral factors, were studied in relation to treatment outcome. The methadone patients were interviewed using a structured questionnaire about alcohol and drug use and psychological, social, and behavioral factors. To obtain data about personality traits, the patients were asked to fill in a questionnaire, the Karolinska Scales of Personality (KSP) questionnaire. The male methadone patients had significantly (p < 0.0001) higher scores on somatic anxiety, muscular tension, impulsiveness, and psychasthenia, and significantly lower scores with regard to socialization, social desirability, and inhibited aggression compared with the controls. Compared with the female controls, the female methadone patients differed most significantly (p < 0.0001) in respect of socialization. Low socialization, social desirability, detachment, feelings of guilt, and suspicion were most predictive for later expulsion from treatment. Nearly half of the methadone patients who suff ered from human immunodeficiency virus (HIV) infection had difficulties with compliance with the treatment and were later expelled. The results suggest that awareness of personality traits and psychiatric status may be crucial for a better methadone treatment outcome.

Neuropsychological correlates of opioid dependence and withdrawal

Severity of opioid dependence, and performance on two successive runs of the Wisconsin Card Sorting Test (WCST), were assessed in 39 right-handed male and female methadone patients who had been randomly assigned to either a recently dosed ( n=21) or 24 hr abstinent ( n=18) condition. Results indicated that severity of opioid dependence was positively correlated with perseverative responses and errors on the second run of the WCST, p<.05. Further, controlling for the effect of dependence severity, patients in early methadone withdrawal made selectively more perseverative responses and errors than did recently dosed patients, p<.05, with no difference on nonperseverative errors. Findings were consistent with the hypothesis that opioid dependence, like alcoholism and cocaine addiction, is associated with disruption of executive cognitive functions mediated by the prefrontal cortex.

Object Relations and Reality Testing in Psychopathic and Antisocial Methadone Patients

The Bell Object Relations and Reality Testing Inventory (BOR-RTI) was used to evaluate differences in object relations and reality testing in a sample of 215 male and 25 female methadone patients based on their degree of psychopathy, measured by the Psychopathy Checklist-Revised (PCL-R), and their degree of antisociality, measured by the Personality Disorder Examination (PDE). As hypothesized, results showed that compared to non psychopaths, psychopaths demonstrated significantly greater impairment in object relations and, also, unexpectedly in reality testing. No significant differences in object relations or reality testing between antisocial and non-antisocial individuals were revealed. Additionally, it was hypothesized that differences in object relations would be found in antisocial subjects who were and were not considered to be psychopathic. No significant differences in object relations were revealed, however, but differences in reality testing were revealed between antisocial individuals based on...

Loss and regeneration: Influences on the reproductive decisions of HIV positive, drug‐using women

Current approaches to the reduction of perinatal transmission of HIV infection among drug-using women focus on the content of counseling sessions which may include suggestions to abstain from sexual intercourse, to use barrier contraceptives, or to terminate pregnancy. The broader social and cultural issues which may influence some HIV positive women's decisions to have children (such as prolonged, unwanted separation from existing children; the need for appropriate drug treatment; empowerment through educational and vocational opportunities; and the meanings associated with motherhood, children, and HIV/AIDS) are not addressed in these efforts. This study of the reproductive decisions and meanings associated with children and motherhood among drug-using, female methadone patients describes some of the social and cultural influences on reproductive decisions. The findings suggest that discontinuous mother-child coresidence; locally produced theories of perinatal transmission; and the culturally constructed meanings associated with motherhood and children influence decisions to bear children among HIV infected, drug-using women. Relevant policy issues are discussed.

Trauma and trauma-related disorders for women on methadone: prevalence and treatment considerations.

There is a growing recognition of the strong association between psychoactive substance abuse and violence. Repeated exposure to violent trauma is particularly salient for women. Moreover, violent trauma may play a role in the etiologies of depression, substance abuse, and trauma-related disorders, such as posttraumatic stress disorder (PTSD). For the female methadone patient, an untreated trauma-related disorder can be a hidden factor that hinders treatment response and leads to treatment complications, such as depression, polysubstance abuse, or treatment drop out. This article reviews the prevalence of trauma and violence for women on methadone, comparing low-income, inner-city female drug abusers with males in methadone treatment on childhood and adulthood exposure to violent trauma and PTSD. Because women are in a minority in methadone maintenance treatment programs, standard treatment approaches have generally not focused on their particular issues and needs. Two alternative models are presented for group treatment of trauma and trauma-related disorders in female methadone patients; potential benefits of each in reducing symptomatology and improving interpersonal functioning are examined. Modification of standard approaches and the typical barriers to engagement in treatment for this special population are also addressed.

Affective changes in male and female methadone patients

The Eysenck Personality Inventory and Profile of Mood States were administered to 107 men and 43 women before starting methadone maintenance and again after four months of treatment. Both men and women reported decreases in levels of neuroticism, anxiety, and fatigue after four months of treatment. The women described themselves as less depressed, whereas the men indicated that they felt more vigorous. However, the posttest levels of affect for both sexes were still comparable to those reported for outpatient psychoneurotics. The relationships of certain background characteristics and treatment experiences associated with both sexes' changes in affect were also described.