The Autonomy of Mood Disorders Among Cocaine-Using Methadone Patients

Abstract

This study uses an algorithm to determine whether patients dually diagnosed with a mood disorder and cocaine dependence have either (a) an autonomous mood disorder (onset of mood disorder prior to substance use disorder (SUD) or mood disorder symptoms persist during periods of abstinence or (b) a nonautonomous mood disorder (onset of SUD preceded mood disorder and mood disorder symptoms remit during periods of abstinence). The relationship among autonomy, patient characteristics, and treatment completion is examined. The sample included 67 methadone patients with a mood disorder (87% major depression, 13% bipolar) who were enrolling in a 6-month psychosocial treatment for cocaine use. Of these subjects, 27% were rated as having an autonomous mood disorder and 73% a nonautonomous mood disorder. Mean age was 37 years; 55% were female and 82% were Hispanic or African-American. All subjects had been stabilized on methadone (mean = 70 mg). During the 30 days prior to study intake, subjects with an autonomous mood disorder, compared to subjects with a nonautonomous mood disorder, reported fewer days using cocaine (12.5 versus 21.1) and fewer days drinking four or more drinks of alcohol (1.1 versus 6. 1). Treatment completion was associated with less cocaine use, autonomy, and African-American ethnicity. However, when these variables were controlled using logistic regression, only autonomous mood disorder and ethnicity predicted treatment completion. These results suggest that autonomy may be a useful construct to measure, and that subjects with nonautonomous mood disorders may need special efforts to ensure treatment retention.

Predicting attrition in long-term residential substance use disorder treatment: A modifiable risk factors perspective.

“…A systematic review found most studies showed no significant relationship between age and attrition; however, most studies reporting significant associations indicate younger age as a risk factor for attrition (Brorson et al, 2013;Stark, 1992;Wickizer et al, 1994). Regarding race/ethnicity, some studies find minorities are less likely to complete treatment than non-Hispanic Whites (Guerrero, Marsh, Duan, Perron, & Lee, 2013; U.S. Department of Health and Human Services (USDHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality, 2017b), others find the opposite (Rosenblum et al, 1999;Stack, Cortina, Samples, Zapata, & Arcand, 2000), and some find no difference in completion rates across racial/ethnic groups (Stark, 1992). In contrast, multiple studies consistently identify lower education as a risk factor for attrition (Brorson et al, 2013;Hillhouse, Marinelli-Casey, Gonzales, Ang, & Rawson, 2007…”