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Heroin Addiction and Related Clinical Problems: 2025, 27, 16

Assessing Subjective Wellness in Heroin Use Disorder. Part II. Sensitivity to Clinical Change and Temporal Responsiveness of the DM-SWS in Opioid-Dependent Patients

Icro Maremmani, Filippo Della Rocca, Manuel Glauco Carbone, Mario Miccoli, and Angelo G. I. Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-16

Summary: Introduction: The Deltito-Maremmani Subjective Wellness Scale (DM-SWS) was developed to assess subjective well-being in individuals recovering from heroin addiction. Building on previous evidence of its reliability and structural validity, this study examines the DM-SWS’s sensitivity to clinical change and temporal responsiveness in patients undergoing opioid agonist treatment (OAT). Methods: Sixty-three individuals diagnosed with Heroin Use Disorder (HUD) were recruited from outpatient addiction services in Tuscany, Italy. Participants completed the DM-SWS with reference to three time points: the current week, the worst week during treatment, and the best week outside of treatment. The ten-item scale measures emotional, social, and existential dimensions of wellness. Non-parametric tests (Friedman and Wilcoxon signed-rank) were used to analyse score variations, with Bonferroni correction applied. Results: Significant improvements were found from the worst to the current treatment week in managing daily responsibilities (p < 0.001), tolerating irritations (p < 0.001), and maintaining hope (p = 0.001). These gains were reflected in the global severity index (p = 0.033) and in two key DM-SWS domains: Resilient Stability (p < 0.001) and Proactive Social Engagement (p = 0.002). However, Existential/Intimate Fulfilment declined slightly (p = 0.020). Compared with the best week outside treatment, few differences emerged: Resilient Stability was higher in the current week (p = 0.030), while other areas showed stability or mild decline. Conclusions: The DM-SWS is sensitive to meaningful changes over time and provides a multidimensional view of recovery. Its capacity to reflect both progress and specific unmet needs, such as existential fulfilment, supports its value as a patient-centred outcome measure in addiction care. These results suggest the importance of integrating broader wellness indicators into treatment evaluation.

Keywords: Subjective wellness; heroin use disorder; patient-reported outcome measures; sensitivity to change; opioid agonist treatment.