Iatrogenic Phobic Disorders in Methadone Maintenance Treated Patients

Milby, Jesse B.; Garrett, Charles; Meredith, R. L.

doi:10.3109/10826088009040051

Cited by 18 publications

(10 citation statements)

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“…High anxiety and fear about the withdrawal experience often lead to treatment drop-out and relapse. Thus, in this first iteration of the ACT treatment for methadone detoxification we chose to target detoxification fear (Milby et al, 1980; Milby et al, 1994), as well as the ACT-based mechanisms of avoidance and inflexibility in responding in the presence of negative private events. Results suggested that our ACT treatment differentially impacted detoxification fear relative to DC.…”

Section: Discussionmentioning

confidence: 99%

“…In 1980, Milby and his colleagues (1980) identified among methadone maintenance clients an “iatrogenic detoxification phobia,” which can be reliably detected and was present in almost 30% of the sample examined. Prevalence rates in the general methadone maintenance (MM) population may be even higher as severely phobic clients are less likely to enter detoxification programs.…”

Section: Introductionmentioning

confidence: 99%

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A Stage I pilot study of acceptance and commitment therapy for methadone detoxification

Stotts¹,

Green²,

Masuda³

et al. 2012

Drug and Alcohol Dependence

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BACKGROUND-While agonist replacement therapies are effective for managing opioid dependence, community treatment programs are increasingly choosing detoxification. Unfortunately, success rates for opioid detoxification are very low, in part, due to physical and psychological symptoms associated with opioid withdrawal. Few behavior therapies specifically address the distressing experiences specific to opioid withdrawal. A novel behavioral treatment, Acceptance and Commitment Therapy (ACT), works from the premise that the avoidance of unpleasant private experiences (thoughts, feelings, bodily sensations) is ubiquitous yet may be pathogenic, resulting in treatment drop-out and further drug use. METHODS-ThisStage I pilot study developed and tested an ACT-based opioid detoxification behavioral therapy. Opioid dependent patients (N = 56) who were attending a licensed methadone clinic were randomized to receive either 24 individual therapy sessions of ACT or Drug Counseling (DC) in the context of a 6-month methadone dose reduction program.RESULTS-While no difference was found on opioid use during treatment, 37% of participants in the ACT condition were successfully detoxified at the end of treatment compared to 19% of those who received DC. Fear of detoxification was also reduced across time in the ACT condition relative to DC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Stage I pilot study of acceptance and commitment therapy for methadone detoxification

Stotts¹,

Green²,

Masuda³

et al. 2012

Drug and Alcohol Dependence

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“…Apparently the abstinence fear was activated when the patients were reminded of its existence by being forced to make a more concrete decision in the questionnaire. Several studies have shown that an exaggerated fear of abstinence is common among methadone patients [23][24][25][26][27]. Table 1 shows that nearly no differences existed with respect to social background conditions or the drug use of the patients.…”

Section: Discussionmentioning

confidence: 99%

Withdrawal from Methadone Maintenance Treatment

Hiltunen¹,

Eklund²

2002

Eur Addict Res

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Although factors associated with successful termination of methadone maintenance treatment (MMT) have been well studied, the question of why certain methadone patients try to taper off methadone while others do not is still unanswered. Those patients who wish to continue MMT should of course be allowed to stay in treatment. However, even if only a small portion of the MMT patients wish to quit maintenance treatment, they should be offered all possible support by the treatment staff to maximize the possibility of a successful outcome. In the present study, we compared two groups of well-functioning MMT patients with respect to background factors, methadone-related factors, drug-related factors and psychological characteristics: one group consisted of patients who were trying to terminate their MMT (group 1) and the other group consisted of patients who were not trying (group 2). Each of the groups contained 25 well-rehabilitated subjects matched by age, gender and the number of years in MMT. The results show that the patients who were not trying to terminate MMT (in comparison to group 1) were not influenced by others to try to quit methadone, had a long history of opiate use as well as mixed drug use prior to MMT, had a higher methadone dose and reported a lower degree of anticipated abstinence symptoms. According to the statements of the subjects in group 2, the most important reason for not quitting treatment was the belief that they needed the methadone. The fact that they knew others who had failed to quit MMT and low confidence in succeeding were other common answers. Further, our results suggest that patients who were satisfied with their overall drug situation were less inclined to make a withdrawal attempt.

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“…ification (Cushman & Dole, 1973). A detoxification phobia that met DSM-I1 diagnostic criteria prevented rehabilitated patients from initiating detoxification (Milby, Garrett, & Meredith, 1980). Several other studies have documented the presence or effects of detoxification fear (Hall, 1979;Hall, Loeb, & Kushner, 1984;Hirt & Greenfield, 1979;Milby, Rice, & Garrett, 1979).…”

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confidence: 99%

“…On the pathological side are preoccupation with intense or bizarre physical symptoms and certain failure to withdraw with fear of consequent arrest and/or other dire consequences. Most pathological is a phobia of detoxification found among clients who become intensely anxious at the suggestion of detoxification and avoid it in spite of the fact that they meet rehabilitation criteria (Milby et al, 1980).…”

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confidence: 99%

Assessing pathological Detoxification Fear among methadone maintenance patients: The DFSS

Milby¹,

Gurwitch²,

Hohmann³

et al. 1987

J. Clin. Psychol.

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This study assessed the reliability, validity, discriminative accuracy, and factor structure of the Detoxification Fear Survey Schedule (DFSS). Prevalence of detoxification fear and its correlates also were assessed. Random samples from three geographically, culturally, and racially disparate populations (N = 271) of treated opioid addicts were used. The DFSS had a test-retest r = .935 and demonstrated several indicants of validity. A briefer version (DFSS-14) showed superior psychometric properties and could identify correctly 81% of detox fear subjects while it excluded 55% of nonfear subjects. The DFSS-14 had a replicated three-factor structure that accounted for 62.1 Yo of total item variance in the validation sample. Factor two, probably best named dose reduction fear, was replicated in all populations. A cut-off score set at the nonfear mean is recommended for clinical use. A brief clinical interview of positive scorers quickly should eliminate false positives and, thus, efficiently identify most of those with detoxification fear.Detoxification from methadone is difficult, and successful outcome is the exception. Only 35.7% completed detoxification in Kleber's (1977) review, and Simpson, Joe, and Bracey (1982) reported a 19% completion rate. Successful detoxification from illicit opiates, without a period of methadone maintenance, has been even lower. Wilson, Elms, and Thompson's (1975) review found a total of 19.6% successfully detoxified. Why is detoxification, especially from methadone maintenance, so difficult and success rates so low? One part of the answer lies in the effect of negative emotional reactions to detoxification discovered in recent research.Anxiety about detoxification seemed to exacerbate withdrawal symptoms and caused more patients to abort detoxification (Senay, Dorus, Goldberg, & Thornton, 1977). Anxiety over dose reduction in the absence of withdrawal symptoms during a slow detoxification was one of the main reasons 25% of rehabilitated patients discontinued detox-The authors wish to acknowledge the assistance of Gary Cutter, Ph.D., UAB Department of Biostatistics, who provided valuable consultation for data analysis strategies and methods. We also wish to acknowledge the staff at each of the three clinics: UAB, Sepulveda, and Philadelphia. Nurses, receptionists, and counselors were extremely helpful in introducing interviewers to subjects and enlisting support and cooperation, for which we are extremely grateful.

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Iatrogenic Phobic Disorders in Methadone Maintenance Treated Patients

Cited by 18 publications

References 2 publications

A Stage I pilot study of acceptance and commitment therapy for methadone detoxification

A Stage I pilot study of acceptance and commitment therapy for methadone detoxification

Withdrawal from Methadone Maintenance Treatment

Assessing pathological Detoxification Fear among methadone maintenance patients: The DFSS

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