Millon Clinical Multiaxial Inventory-III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies.

Abstract

The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory-III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial-narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions. Addiction subtyping research has identified constellations of personality dimensions (Barnes, Murray, Patton, Bentler, & Anderson, 2000) and psychiatric disorders (Kranzler & Rounsaville, 1998) that are associated with the onset and severity of substance abuse and may have relevance for predicting treatment response. The presence of co-occurring psychiatric disorders seems to indicate a need for specialized or more intensive addiction treatment, and depression, antisocial personality, and general psychiatric symptom severity have been the most commonly investigated problems. Depressed cocaine abusers benefit from cognitive-behavioral coping skills and pharmacotherapy (Carroll et al., 1994), and opiate abusers with greater psychiatric severity improve with more intensive psychosocial programs (McLellan et al., 1983). Antisocial alcohol abusers seem to have better outcomes with coping skills than with interactional approaches (Kadden, Cooney, Getter, & Litt, 1989;Longabaugh et al., 1994), although Kadden, Litt, Cooney, Kabela, and Getter (2001) failed to replicate this effect. Antisocial methadone patients do as well as (Brooner, Kidorf, King, & Stoller, 1998;Silverman et al., 1998), and perhaps better than (Messina, Farabee, & Rawson, 2003), non-antisocial patients when provided with potent behavioral incentives, individual psychotherapy (Woody, McLellan, Luborsky, & O'Brien, 1985), or enhanced psychosocial services (Cacciola, Alterman, & Rutherford, 1995;Cacciola, Rutherford, Alterman, McKay, & Snider, 1996). The current study evaluated psychopathology subtypes derived from the Millon Clinical Multiaxial Inventory-III (MCMI-III;Millon, 1994), the most recent edition of a widely used instrument that measures Axis I and II diagnoses of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) and is also rooted in a biopsychosocial personality theory that may be relevant to the treatments compared in this study. MCMI Psychopathology Subtyping ProceduresThe ability to prospe...

Substance Abuse Problems, Psychiatric Symptoms, and Post-Treatment Status in MCMI Psychopathology Subgroups of Cocaine Dependent Males

“…Such efforts have often identified four clinically coherent subgroups: high psychopathology, antisocial, neurotic, and subclinical (9)(10)(11)(12)(13)(14)(15)(16)(17). A high psychopathology subgroup has been found to be associated with comorbid psychiatric diagnoses including Post Traumatic Stress Disorder, greater depression, more suicide attempts, more previous psychiatric and drug treatments, and drug treatment nonresponse (8). An antisocial cluster subgroup has been linked with high alcohol consumption rates (13,16), serious alcohol problems (13), and drug treatment nonresponse in one study involving predominantly male Caucasian opiate abusers (8) but not in another in which African-American male participants were in the majority (18).…”

“…A high psychopathology subgroup has been found to be associated with comorbid psychiatric diagnoses including Post Traumatic Stress Disorder, greater depression, more suicide attempts, more previous psychiatric and drug treatments, and drug treatment nonresponse (8). An antisocial cluster subgroup has been linked with high alcohol consumption rates (13,16), serious alcohol problems (13), and drug treatment nonresponse in one study involving predominantly male Caucasian opiate abusers (8) but not in another in which African-American male participants were in the majority (18). Neurotic cluster subgroup membership has been linked to solitary drinking among alcohol abusers (12), and longer opiate use histories, more medical and psychological problems, and less favorable treatment response among opiate addicts (8).…”

“…Several researchers have drawn upon Millon's (1) theory of personality and psycho pathology, and have used the theory-linked and Diagnostic and Statistical Manual of the American Psychiatric Association coordinated Millon Clinical Multiaxial Inventory (MCMI), as tools for understanding differences among substance abusers that may allow for more effective treatment planning (2)(3)(4)(5)(6)(7)(8). One useful approach has been to cluster analyze MCMI records in various groups of substance abusers.…”

Oral naltrexone as a treatment for relapse prevention in formerly opioid-dependent drug users: a systematic review and economic evaluation

“…However, the reviewers believe that the results of the Ball trial, 58 which reported only data-driven analyses rather than randomised comparisons, are uninterpretable for the purposes of informing the question about whether incentive vouchers enhance retention on naltrexone.…”

“…Full details are not given of the programme in the Ball study, 58 but participants could earn up to $561 worth of goods if they completed the full CT, can't tell; N, no; NA, not applicable; Y, yes.…”