The relationship between self-reported substance use and psychiatric symptoms in low-threshold methadone maintenance treatment clients

Abstract

BackgroundOngoing psychiatric symptoms and substance use are common difficulties experienced by clients enrolled in methadone maintenance treatment (MMT). However, little research to date has evaluated if specific types of current substance use are related to specific types of current psychiatric symptoms. The present study investigated these relationships with a sample of clients enrolled in a low-threshold MMT program (i.e., clients are not expelled if they continue to use substances). Some clients enrolled in low-threshold programs may never achieve complete abstinence from all substances. Thus, understanding the possibly perpetuating relationships between concurrent substance use and psychiatric symptoms is important. Understanding such relationships may aid in developing possible target areas of treatment to reduce substance use and/or related harms in this population.MethodsSeventy-seven individuals were interviewed regarding methadone usage and current and past substance use. Current psychiatric symptoms were assessed using a modified version of the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Relationships between types of substances used in the past 30 days and the types and number of psychiatric symptoms experienced in the same timeframe were examined.ResultsThe majority of participants (87.0%) reported using alcohol, illicit substances, non-prescribed prescription opioids, or non-prescribed benzodiazepines in the past 30 days and 77.9% of participants reported currently experiencing psychiatric symptoms at levels that would likely warrant diagnosis. Current non-prescribed benzodiazepine use was a predictor for increased severity (i.e., symptom count) of almost all anxiety and mood disorders assessed. Conversely, number and presence of generalized anxiety symptoms and presence of social phobia symptoms predicted current non-prescribed benzodiazepine and alcohol use, respectively.ConclusionsIndividuals enrolled in the present low-threshold MMT program experience a wide variety of psychiatric symptoms and continue to use a variety of substances, including opioids. There was a particularly consistent pattern of associations between non-prescribed benzodiazepine use and a variety of psychiatric symptoms (particularly anxiety) suggesting that addressing concurrent illicit benzodiazepine use and anxiety symptoms in MMT clients warrants further clinical attention and research.

Affective Temperaments in Alcohol and Opiate Addictions

“…According to a large epidemiological study, prevalence of self-medication with alcohol was 18.3 % for generalized anxiety disorder, whereas self-medication with both alcohol and drugs was 14.9 % for panic disorder with agoraphobia [38]. Among patients enrolled in a methadone maintenance treatment program, screening positive for social phobia was significantly associated with alcohol use, whereas both generalized anxiety disorder and social phobia were associated with the use of non-prescribed benzodiazepines [39]. The hypothesis that associations between dual SUDs and temperaments might be, at least in part, linked to attempts to ''self-medicate'' deserves further investigation in prospective studies and large, well-characterized samples.…”

Substance use, racial/ethnic identity, and suicidal ideation during COVID-19 lockdown in an international adult sample

“…These, and similar efforts, are indicative of Saudi Arabia's efforts to mitigate the negative impact of substance use among its residents. In Spain, the approach to substance use may be different from other counties in that it takes a more intentional approach in integrating harm reduction strategies that have been shown some promise in addressing symptoms of psychological distress ( Fulton et al, 2011 ; Picchio et al, 2020 ).…”

Comorbid Psychopathology and Alcohol Use Patterns among Methadone Maintenance Treatment Patients

“…Another important issue is the prevalence of alcohol abuse and dependence which is increasingly acknowledged [ 12 , 78 – 82 ] in methadone maintenance treatment settings, adversely affecting their program compliance and physical and mental health. Among the variables associated with alcohol use by methadone patients is psychiatric symptomatology.…”

“…The high prevalence of concomitant psychiatric disorders [ 7 – 10 ] and alcohol abuse [ 11 ] among drug users far exceeds general population estimates and complicates the picture raising issues not extensively studied by prior international and Greek literature. While figures vary greatly, it has been estimated that between 28 and 76% of methadone maintained patients have at least one comorbid psychiatric disorder [ 12 – 14 ], while alcohol abuse ranges between 8 and 50% during maintenance treatment, being 10–90% before entering treatment [ 10 ].…”