This study examined the relationship between quality of life (QOL) and dual diagnosis among patients in treatment for opioid dependence. The study sample includes 57 patients with opioid dependence alone (OD) and 41 with opioid dependence and a psychiatric axis-I disorder (DD), recruited in 2001 and 2004 at the Drug Addiction Services (SerT) of Bolzano and Pontedera (Italy). Participants were 73.5% males, with a mean age of 35.1 years (SD = 8.0). A comparison group of 45 healthy controls was also included. Assessments included a structured psychiatric interview (SCID) and a self-report quality of life assessment (WHOQOL-BREF). Patients with DD reported significantly (p < 0.05) poorer QOL in the physical and psychological domains as compared with patients with OD. Both groups of patients with and without DD showed significantly (p < 0.001) poorer QOL in the physical, psychological, and social domains with respect to healthy participants. The scores on the "relationship with environment" domain did not differ among OD, DD, and controls. The present study provides preliminary evidence that dual diagnosis is associated with poorer QOL and emphasizes the need to target treatment for the mental disorder concomitantly with the dependence problem in patients in treatment for opioid dependence.

BackgroundAddiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions.MethodsUsing the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence.ResultsA total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology.ConclusionsThis study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.

Recourse to substances is associated with increased mood and anxiety symptoms, substance sensitivity, and sensation seeking among patients with BPD + SUD and SUD. Substance sensitivity and sensation seeking traits should be investigated in all patients with BPD as possible factors associated with a development of SUD, in order to warn patients of the specific risks related to improper use of medications and substances.

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