Improving Detoxification Outcomes from Methadone Maintenance Treatment: The Interrelationship of Affective States and Protracted Withdrawal

Latowsky, Mark

doi:10.1080/02791072.1996.10472486

Cited by 23 publications

(21 citation statements)

References 72 publications

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“…Future prospective studies of personality pathology following detoxification from methadone would test this hypothesis. Moreover, the fact that elevated schizophrenia-spectrum traits are found in subjects 6-18 months after discontinuation from MMT suggests that methadone discontinuation may result in a protracted opiate withdrawal syndrome (42,43). Protracted withdrawal syndromes were also found in studies of phencyclidine (PCP) (44) and alcohol (45) addiction and may influence vulnerability to relapse.…”

Section: Discussionmentioning

confidence: 94%

Personality measures in former heroin users receiving methadone or in protracted abstinence from opiates

Cohen

Gertmenian-King

Kunik

et al. 2005

Acta Psychiatr Scand

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Objective-Methadone Maintenance Therapy (MMT) and detoxification to abstinence are among the most common treatment options for opiate-dependent patients. This paper compares personality traits in detoxified former heroin users and those on MMT in order to assess their relevance to treatment selection.Methods-Twenty-six formerly heroin-dependent subjects receiving MMT (MM), 33 formerly heroin-dependent subjects withdrawn from MMT (MW), and 43 healthy controls were compared on the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Temperament and Character Inventory (TCI).Results-On the TCI, MM patients had higher Novelty Seeking and lower Self Directedness scores than controls. Both MM and MW subjects scored higher than controls on multiple MCMI-II scales. MW but not MM subjects scored higher than controls on 2 Cluster A scales and the Delusional Disorder scale.Conclusions-Schizophrenia-spectrum pathology in former opiate users may be greater than previously recognized and could potentially be relevant to treatment selection.

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Section: Discussionmentioning

confidence: 94%

Personality measures in former heroin users receiving methadone or in protracted abstinence from opiates

Cohen

Gertmenian-King

Kunik

et al. 2005

Acta Psychiatr Scand

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“…Clients who receive MMT and remain in treatment show significant improvement in depressive symptoms (Rounsaville et al, 1982;Musselman and Kell, 1995;Dean et al, 2004). In contrast, during protracted abstinence from opiates, former heroin users are particularly prone to depressive states (Mason et al, 1998;Nunes et al, 2004), which may persist (Latowsky, 1996;Satel et al, 1993) and contribute to relapse (Gossop et al, 2002;Rao et al, 2004). Prior studies have not examined neural function related to depression in long-term opiate-abstinent and methadone-maintained, former heroin users.…”

Section: Introductionmentioning

confidence: 99%

Cerebral metabolism and mood in remitted opiate dependence

Galynker

Eisenberg

Matochik

et al. 2007

Drug and Alcohol Dependence

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Background-Opiate-dependent individuals are prone to dysphoria that may contribute to treatment failure. Methadone-maintenance therapy (MMT) may mitigate this vulnerability, but controversy surrounds its long-term use. Little is known about the neurobiology of mood dysregulation in individuals receiving or removed from MMT.Methods-Fifteen opiate-abstinent and 12 methadone-maintained, opiate-dependent subjects, who lacked other Axis I pathology, and 13 control subjects were compared on the Cornell Dysthymia Rating Scale (CDRS) and regional cerebral glucose metabolism (rCMRglc) using [ 18 F] fluorodeoxyglucose positron emission tomography.Results-CDRS scores showed no group differences. Opiate-abstinent subjects had lower rCMRglc than control subjects in the bilateral perigenual anterior cingulate cortex (ACC), left midcingulate cortex, left insula and right superior frontal cortex. Methadone-maintained subjects exhibited lower rCMRglc than control subjects in the left insula and thalamus. In opiate-abstinent subjects, rCMRglc in the left perigenual ACC and mid-cingulate cortex correlated positively with CDRS scores.Conclusions-In remitted heroin dependence, opiate-abstinence is associated with more widespread patterns of abnormal cortical activity than MMT. Aberrant mood processing in the left perigenual ACC and mid-cingulate cortex, seen in opiate-abstinent individuals, is absent in those receiving MMT, suggesting that methadone may improve mood regulation in this population.

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“…Active addicts may be hindered by poor impulse control, planning, and decision-making (Grant et al, 2000;Lee and Pau, 2002;Bolla et al, 2003;Hill et al, 1979;Gritz et al, 1975;Chastain et al, 1986;Strang and Gurling, 1989;Guerra et al, 1987;Tapert, 1999;Franken et al, 2000), suggesting that opiate-induced cognitive impairment may contribute to the relapsing nature of addiction (Gossop et al, 2002;Latowsky, 1996;Rogers and Robbins, 2001;Teichner et al, 2002;Aharonovic et al, 2003). Little is known about the course of opiate-associated cognitive deficits after cessation of opiate use.…”

Section: Introductionmentioning

confidence: 99%

Neuropsychological functioning in opiate-dependent subjects receiving and following methadone maintenance treatment

Prosser

Cohen

Steinfeld

et al. 2006

Drug and Alcohol Dependence

126

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Objective-An accumulating body of research suggests that former heroin abusers in methadone maintenance therapy (MMT) exhibit deficits in cognitive function. Whether these deficits are present in former methadone maintained patients following discontinuation of MMT is unknown. This study tests the hypothesis that former heroin users who have detoxified from methadone maintenance therapy and are drug-free have less pronounced cognitive impairment than patients continuing longterm MMT.Method-A series of neuropsychological tests were administered to three groups of subjects: 29 former heroin addicts receiving methadone maintenance treatment, 27 former heroin addicts withdrawn from all opiates, and 29 healthy controls without a history of drug dependence. Testing included Wechsler Adult Intelligence Scale-Revised Vocabulary Test, the Stroop Color-Word Test, the Controlled Oral Word Association Test, the Benton Visual Retention Test, and a Substance Use Inventory.Findings-Both methadone-maintained and abstinent subject groups performed worse than controls on tasks that measured verbal function, visual-spatial analysis and memory, and resistance to distractibility. Abstinent subjects performed worse than their methadone maintained counterparts on tests measuring visual memory and construct formation. Cognitive impairment did not correlate with any index of drug use.Conclusions-We confirmed previous findings of neuropsychological impairment in long-term MMT recipients. Both patients receiving MMT and former heroin users in prolonged abstinence exhibited a similar degree of cognitive impairment. Cognitive dysfunction in patients receiving methadone maintenance may not resolve following methadone detoxification.

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Improving Detoxification Outcomes from Methadone Maintenance Treatment: The Interrelationship of Affective States and Protracted Withdrawal

Cited by 23 publications

References 72 publications

Personality measures in former heroin users receiving methadone or in protracted abstinence from opiates

Personality measures in former heroin users receiving methadone or in protracted abstinence from opiates

Cerebral metabolism and mood in remitted opiate dependence

Neuropsychological functioning in opiate-dependent subjects receiving and following methadone maintenance treatment

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