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Heroin Addiction and Related Clinical Problems: 2016, 18, 2 (pages: 5 - 12)

Relationships between addictive behaviours and dual disorders, as found in heroin use disorder patients at treatment entry

Maremmani A.G., Rovai L., Bacciardi S., Massimetti E., Gazzarrini D., Pallucchini A., Pani P.P., and Maremmani I.

Summary: Introduction: In dual diagnosis (DD) patients, a clear trend emerges towards greater chronicity and severity, and more serious somatic, social and psychological problems, than in cases of uncomplicated addiction. In Heroin Use Disorder (HUD) patients, we found some clinical aspects that were related (violence and self-injurious behaviours), and others unrelated (temperamental aspects, psychopathological subtypes) to DD. More recently, we proposed an inventory for assessing the behavioural covariates of craving in HUD showing good psychometric properties. This topic required further examination among DD-HUD patients. Methods: At univariate level, we compared 70 DD-HUD and 44 HUD patients with reference to their demographic, clinical and anamnestic data, and whether they showed addictive behaviours. At multivariate level, we used a logistic regression analysis to select the prominent behavioural characteristics of DD-HUD patients by checking the analysis for the variables that were found to be significantly different at univariate level. Results: At treatment entry, DD-HUD patients reported a higher number of addictive behaviours (p=0.024) and more frequently recognized the presence of subjective craving (p=0.013). More specifically, they tended to use other substances on top of heroin (p=0.012); they prized heroin much more than anything else they had ever enjoyed before (p=0.030); they appeared to have trouble using anti-withdrawal pills (p=0.005); they accepted heroin even if they were trying to rehab (p=0.003); and they were willing to put up with a lot of stress to get heroin (p=0.004). They accepted heroin even during rehab (OR=6.34), accepted a lot of stress in their search for heroin (OR=2.85), and refused to use other substances to compensate for the unsuitable dose of heroin, when they were feeling down (OR=0.17); in all these aspects, polyabuse (OR=2.95) proved to discriminate DD-HUD from HUD patients. Conclusions: Specific addictive behaviours of DD-HUD patients appear to be correlated with finding and taking opioids to alleviate psychopathology. By contrast, behaviours linked to obsessive and relief craving (closely correlated with the progress of addiction) did not turn out to be present in significantly different form in DD-HUD vs. HUD patients.