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Heroin Addiction and Related Clinical Problems: 2025, 27, 17

Assessing Subjective Wellness in Heroin Use Disorder. Part III: Convergent and Discriminant Validity of the DM-SWS. Correlations with demographics, Symptom Scales and Behavioural Questionnaires

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

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-17

Summary: Introduction. Subjective wellness is increasingly recognised as a core component of recovery from heroin addiction, complementing traditional clinical outcomes such as abstinence and symptom remission. The Deltito-Maremmani Subjective Wellness Scale (DM-SWS) is a multidimensional patient-reported outcome measure designed to assess wellness across emotional, social, and existential domains. Following prior studies establishing its factorial structure, reliability, and sensitivity to change, this third validation study investigates its convergent and discriminant validity using standardised clinical instruments. Method. A cross-sectional study was conducted among individuals receiving treatment for heroin use disorder. Participants completed the DM-SWS alongside demographic data and four validated instruments: the Integrated Heroin Addiction Profile (IHAP), the Symptom Checklist-90 (SCL-90), the Heroin Craving Behavioural Covariate Inventory (CRAV–HERO), and the Post-Heroin/Post-Traumatic Stress Disorder Spectrum questionnaire (PH/PTSD-S). Correlational analyses (Spearman’s rho) and logistic regression (for demographic data) were used to assess the relationship between DM-SWS scores and key demographic and clinical variables. Results. Educational level was the only demographic variable significantly associated with DM-SWS scores. Strong inverse correlations were observed between the DM-SWS and psychological distress indicators, including SCL-90 symptom clusters and the H/PTSD-S. The Resilient Stability factor was negatively associated with all behavioural craving domains of the CRAV–HERO. In contrast, the Proactive Social Engagement and Existential/Intimate Fulfilment factors were unrelated to craving intensity. The scale also demonstrated discriminant validity, showing no significant correlation with heroin use typologies or somatic comorbidity profiles. Conclusions. The DM-SWS demonstrates robust convergent validity with measures of psychopathology, craving behaviour, and trauma-related stress, while maintaining discriminant specificity. Its multidimensional structure provides a nuanced assessment of wellness that is distinct from drug use severity or physical health status. These findings support the utility of the DM-SWS as a clinically sensitive and psychometrically sound tool for monitoring wellness in heroin addiction treatment contexts.

Keywords: Subjective Wellness; Heroin Addiction; Patient-Reported Outcomes; Craving Behaviour; Heroin Trauma-Related Stress