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Heroin Addiction and Related Clinical Problems: 2025, 27, 15

Assessing Subjective Wellness in Heroin Use Disorder with the DM-SWS: A Behavioural Self-Report Tool for Patients with Heroin Addiction Part I – Theoretical Framework, Reliability, and Exploratory Factor Analysis

Icro Maremmani, Filippo Della Rocca, Manuel Glauco Carbone, Mario Miccoli, and Angelo Giovanni Icro Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-15

Summary: Background: Subjective wellness is a critical but under-assessed dimension in opioid use disorder treatment. This study presents a preliminary psychometric evaluation of the Deltito-Maremmani/Subjective Wellness Scale (DM/SWS) among patients receiving Opioid Agonist Opioid Treatment (OAT), aiming to assess its reliability, factor structure, and clinical relevance. Methods: A cross-sectional analysis was conducted on a sample of OAT patients. Descriptive statistics were calculated for individual items, and psychometric properties were examined through internal consistency (Cronbach’s alpha), split-half reliability, and exploratory factor analysis (EFA). Inter-item correlations and distribution patterns were assessed to evaluate item coherence and scale sensitivity. Results: The DM/SWS showed strong internal consistency (α = 0.84) and acceptable split-half reliability. Descriptive statistics demonstrated adequate item variability without floor or ceiling effects. Inter-item correlations were statistically significant, with exceptions noted for intimacy-related items, suggesting specific psychosocial challenges. Factor analysis revealed three principal components: (1) emotional resilience and functional stability; (2) behavioural activation and stress coping; and (3) introspective well-being, including intimacy and spiritual alignment. The item on relational harmony emerged as the most endorsed, reinforcing the protective role of interpersonal stability in the recovery from addiction. The psychometric profile aligns with expected heterogeneity and skewness in dual-diagnosis populations. Conclusions: The DM/SWS is a reliable and valid instrument for assessing subjective wellness in opioid-dependent individuals. Its multidimensional structure offers valuable insights for personalised treatment planning. Future research should explore its sensitivity to clinical change and predictive value regarding treatment outcomes.

Keywords: Wellness; Health Status Indicators; Patient Reported Outcome Measures; Opioid-Related Disorders; Methadone Maintenance; Buprenorphine; Statistics as Topic