A study of psychological pain in substance use disorder and its relationship to treatment outcome

Abstract

Substance Use Disorder (SUD) is a major public health concern affecting an estimated 22.5 million individuals in the United States. The primary aim of this study was to characterize psychological pain in a cohort of patients participating in outpatient treatment for SUD. A secondary aim was to determine the relationships between pre-treatment assessments of psychological pain, depression, anxiety and hopelessness with treatment retention time and completion rates. Data was analyzed from 289 patients enrolled in an outpatient community drug treatment clinic in Southern California, U.S. A previously determined threshold score on the Mee-Bunney Psychological Pain Assessment Scale (MBP) was utilized to group patients into high and low-moderate scoring subgroups. The higher pain group scored higher on measures of anxiety, hopelessness and depression compared to those in the low-moderate pain group. Additionally, patients scoring in the higher psychological pain group exhibited reduced retention times in treatment and more than two-fold increased odds of dropout relative to patients with lower pre-treatment levels of psychological pain. Among all assessments, the correlation between psychological pain and treatment retention time was strongest. To our knowledge, this is the first study to demonstrate that psychological pain is an important construct which correlates with relevant clinical outcomes in SUD. Furthermore, pre-treatment screening for psychological pain may help target higher-risk patients for clinical interventions aimed at improving treatment retention and completion rates.

Mental pain intensity and tolerance as predictors of psychotherapy process and outcome

“…The results of the current study suggest that high baseline MP intensity is associated with significant improvement in distress. These results are in contrast to the findings of Mee et al (2019), which reported that high baseline MP intensity predicted higher rates of dropout and missed sessions. Nonetheless, although therapy dropout can be linked to reduced therapeutic gains, research assessing the association between dropout and therapy outcomes has not produced conclusive results (Reich & Berman, 2020).…”

“…Nonetheless, although therapy dropout can be linked to reduced therapeutic gains, research assessing the association between dropout and therapy outcomes has not produced conclusive results (Reich & Berman, 2020). Therefore, it is possible that high MP intensity is associated with dropout but not with therapeutic outcomes, as suggested by Mee et al (2019). On the contrary, the significant therapeutic gains among patients with high MP intensity correspond with the pattern of findings reported in studies assessing the predictive effect of baseline symptomatic levels, which indicate that patients with higher symptom severity profit more from psychotherapy (Falkenström et al, 2014).…”

“…Although several scholars have pointed to the potential role of MP intensity and tolerance in therapeutic processes (Fava et al, 2019), to the best of our knowledge only one study has thus far examined the predictive effect of MP on therapeutic outcomes. Mee et al (2019) examined the associations between pretreatment MP and treatment retention among patients treated in an outpatient unit for substance use disorders. They found that patients with high baseline MP were 1.21 times more likely to dropout or miss sessions compared with patients with low baseline MP scores.…”

“…In this study, we aimed to assess the effect of baseline levels of MP intensity and tolerance on the psychotherapy process and outcome, above and beyond the effect of baseline symptom distress. Based on previous studies (Mee et al, 2019), we hypothesized that high MP intensity would be associated with fewer therapeutic gains, as well as smaller gains in session comfort compared with low MP. Similarly, we hypothesized that low tolerance for MP would predict fewer gains in outcomes and would also affect patients' session evaluation.…”

Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

“…Patients may also experience movement decreasing, deformity, swelling, and crepitus. When pain persists, patients develop pain-related psychological distress [ 7 ] and are exposed to addictive behaviors and poor evolution of their comorbidities [ 8 , 9 , 10 , 11 ]. The OA symptoms are caused by a complex pathology of whole joint, generated by inflammation; oxidative stress; and metabolic, endocrine, and genetic factors.…”